Publications by authors named "João Carlos Silva"

81 Publications

Percutaneous patent ductus arteriosus closure: Twelve years of experience.

Rev Port Cardiol (Engl Ed) 2021 May 11. Epub 2021 May 11.

Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal.

Introduction: Patent ductus arteriosus, a persistent communication between the descending thoracic aorta and the pulmonary artery, is one of the most common congenital heart defects. Transcatheter occlusion is an effective alternative to surgery and is currently standard of care for most patients. The authors present the results from a single center after twelve years of experience using this technique.

Methods: Retrospective analysis of medical records from all patients referred to a tertiary center for percutaneous ductus closure between January 2006 and September 2018.

Results: A total of 221 patients were referred, with a mean age of 5.5 years-old (16 patients were infants, with the youngest aged four months). A Nit-Occlud® coil was used 139 times (62.9%), an Amplatzer™ duct occluder 79 times (35.7%), and vascular plugs were used three times. Percutaneous closure was achieved in every treated patient, with 1.4% maintaining residual shunting. Although higher overall coil device implantation was noted, duct occluder usage has been greater since 2011. Of all the coils, 55% were either 4x4 or 5x4 mm, and 73% of all Amplatzer duct occluders were either 6x4 or 8x6 mm, which correlates to the majority of patients having a small to moderately sized ductus. No complications were noted during the procedure, with a 1.8% post-procedure complication rate (one device embolization after 48 hours and three cases of loss of arterial pulse).

Conclusions: Percutaneous patent ductus arteriosus closure was safe and effective in this setting, with a low global complication rate and similar outcomes to most equivalent centers.
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http://dx.doi.org/10.1016/j.repc.2020.09.008DOI Listing
May 2021

A rare cause of ascites in a young patient.

Eur J Gastroenterol Hepatol 2021 Jun;33(6):941

Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.

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http://dx.doi.org/10.1097/MEG.0000000000001926DOI Listing
June 2021

Role of ATP-binding Cassette Transporters in Sorafenib Therapy for Hepatocellular Carcinoma: an overview.

Curr Drug Targets 2021 Apr 12. Epub 2021 Apr 12.

Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal. b Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto. Portugal.

Background: Molecular therapy with sorafenib remains the mainstay for advanced-stage hepatocellular carcinoma. Notwithstanding, treatment efficacy is low, with few patients obtaining long-lasting benefits due to the high chemoresistance rate.

Objective: To perform, for the first time, an overview of the literature concerning the role of adenosine triphosphate-binding cassette (ABC) transporters in sorafenib therapy for hepatocellular carcinoma.

Methods: Three online databases (PubMed, Web of Science and Scopus) were searched, from inception to October 2020. Studies selection, analysis and data collection was independently performed by two authors.

Results: The search yielded 224 results; 29 were selected for inclusion. Most studies were pre-clinical, using HCC cell lines; three used human samples. Studies highlight the effect of sorafenib in decreasing ABC transporters expression. Conversely, it is described the role of ABC transporters, particularly multidrug resistance protein 1 (MDR-1), multidrug resistance-associated proteins 1 and 2 (MRP-1 and MRP-2) and ABC subfamily G member 2 (ABCG2) in sorafenib pharmacokinetics and pharmacodynamics, being key resistance factors. Combination therapy with naturally available or synthetic compounds that modulate ABC transporters may revert sorafenib resistance, by increasing absorption and intracellular concentration.

Conclusion: A deeper understanding of ABC transporters' mechanisms may provide guidance for developing innovative approaches for hepatocellular carcinoma. Further studies are warranted to translate the current knowledge into practice and paving the way to individualized therapy.
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http://dx.doi.org/10.2174/1389450122666210412125018DOI Listing
April 2021

Management of Anastomotic Leak after Colorectal Surgery with Vacuum-Assisted Therapy (Endo-SPONGE®) Complemented with Fibrin Glue Sealing.

GE Port J Gastroenterol 2021 Feb 6;28(2):144-146. Epub 2020 Oct 6.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

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http://dx.doi.org/10.1159/000510577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991279PMC
February 2021

Comparison of levosimendan, NO, and inhaled iloprost for pulmonary hypertension reversibility assessment in heart transplant candidates.

ESC Heart Fail 2021 04 23;8(2):908-917. Epub 2021 Feb 23.

Department of Surgery and Physiology, Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal.

Aims: Assessing reversibility of pulmonary vascular changes through vasoreactivity testing (VRT) optimizes end-stage heart failure patient selection for heart transplant. All efforts should be made to unload the left ventricle and reduce pulmonary vascular resistance to effectively exclude irreversible pulmonary hypertension.

Methods And Results: We reviewed our centre's cardiac transplant registry database (2009-2017) for VRT and compared haemodynamic responses with 40 ppm inhaled NO (n = 14), 14-17 μg inhaled iloprost (n = 7), and 24 h 0.1 μg/kg/min intravenous levosimendan (n = 14). Response to levosimendan was assessed by repeat right heart catheterization within 72 h. Baseline clinical and haemodynamic features were similar between groups. VRT was well tolerated in all patients. All drugs effectively reduced pulmonary artery pressures and transpulmonary gradient while increasing cardiac index, although levosimendan had a greater impact on cardiac index increase (P = 0.036). Levosimendan was the only drug that reduced pulmonary artery wedge pressure (P = 0.004) and central venous pressures (P < 0.001) and increased both left and right ventricular stroke work indexes (P = 0.020 and P = 0.042, respectively) and cardiac power index (P < 0.001) compared with NO and iloprost. Right ventricular end-diastolic pressures and central venous pressure were only decreased by levosimendan. The rate of positive responses (≥10 mmHg decrease or final mean pulmonary artery pressure ≤40 mmHg with increased/unaltered cardiac index) was lower with inhaled iloprost (14%) than with either levosimendan or NO (71% and 64%, respectively; P < 0.05).

Conclusions: Levosimendan may be a safe and effective alternative for pulmonary hypertension reversibility assessment or a valuable pre-test medical optimization tool in end-stage heart failure patient assessment for heart transplantation offering extended haemodynamic benefits. Whether it increases the rate of positive responses or allows a better selection of candidates to heart transplantation remains to be established.
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http://dx.doi.org/10.1002/ehf2.13168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006659PMC
April 2021

Embolization of a left atrial appendage closure device.

Rev Port Cardiol (Engl Ed) 2021 Mar 20;40(3):247-248. Epub 2021 Jan 20.

Serviço de Cardiologia, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.12.010DOI Listing
March 2021

Short and long-term clinical impact of transcatheter aortic valve implantation in Portugal according to different access routes: Data from the Portuguese National Registry of TAVI.

Rev Port Cardiol (Engl Ed) 2020 Dec 28;39(12):705-717. Epub 2020 Nov 28.

Department of Cardiology, Hospital de Santo António, Centro Hospitalar do Porto, Portugal.

Introduction: The Portuguese National Registry of Transcatheter Aortic Valve Implantation records prospectively the characteristics and outcomes of transcatheter aortic valve implantation (TAVI) procedures in Portugal.

Objectives: To assess the 30-day and one-year outcomes of TAVI procedures in Portugal.

Methods: We compared TAVI results according to the principal access used (transfemoral (TF) vs. non-transfemoral (non-TF)). Cumulative survival curves according to access route, other procedural and clinical variables were obtained. The Valve Academic Research Consortium-2 (VARC-2) composite endpoint of early (30-days) safety was assessed. VARC-2 predictors of 30-days and 1-year all-cause mortality were identified.

Results: Between January 2007 and December 2018, 2346 consecutive patients underwent TAVI (2242 native, 104 valve-in-valve; mean age 81±7 years, 53.2% female, EuroSCORE-II - EuroS-II, 4.3%). Device success was 90.1% and numerically lower for non-TF (87.0%). Thirty-day all-cause mortality was 4.8%, with the TF route rendering a lower mortality rate (4.3% vs. 10.1%, p=0.001) and higher safety endpoint (86.4% vs. 72.6%, p<0.001). The one-year all-cause mortality rate was 11.4%, and was significantly lower for TF patients (10.5% vs. 19.4%, p<0.002). After multivariate analysis, peripheral artery disease, previous percutaneous coronary intervention, left ventricular dysfunction and NYHA class III-IV were independent predictors of 30-day all-cause mortality. At one-year follow-up, NYHA class III-IV, non-TF route and occurrence of life-threatening bleeding predicted mortality. Kaplan-Meier survival analysis of the first year of follow-up shows decreased survival for patients with an EuroS-II>5% (p<0.001) and who underwent non-TF TAVI (p<0.001).

Conclusion: Data from our national real-world registry showed that TAVI was safe and effective. The use of a non-transfemoral approach demonstrated safety in the short term. Long-term prognosis was, however, adversely associated with this route, with comorbidities and the baseline clinical status.
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http://dx.doi.org/10.1016/j.repc.2020.02.014DOI Listing
December 2020

Infectious Proctitis due to : Venereal Diseases in Proctology.

GE Port J Gastroenterol 2020 Nov 17;27(6):439-440. Epub 2020 Apr 17.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova Gaia, Porto, Portugal.

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http://dx.doi.org/10.1159/000507205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670375PMC
November 2020

Gastrointestinal and renal involvement in systemic vasculitis.

Rev Esp Enferm Dig 2020 Dec;112(12):952-953

Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal.

Vasculitis can also present with GI or solid organ involvement. IgA and ANCA associated vasculitis are more likely to have GI involvement. A 56-year-old female was admitted to the ER due to nausea, vomiting, epigastric pain and fever. The patient had a medical history of acromegaly and chronic kidney disease of an undetermined etiology, elevated C-reactive protein and renal dysfunction. Abdominal-CT revealed duodenal parietal thickening and pancreatic head edema. On esophagogastroduodenoscopy (EGD), duodenal mucosa had a diffusely nodular aspect with ulcerated areas. The following differential diagnosis were made, infectious enteritis, Whipple disease, infiltrative disorder and GI vasculitis. After discussion between a multidisciplinary team of Gastroenterology and Nephrology, they decided to initiate oral glucocorticoids due to worsening of the renal function, which lead to the resolution of digestive symptoms and renal function stabilization. Myeloperoxidase antineutrophilic-cytoplasmic antibodies (MPO-ANCA) were subsequently positive and histology confirmed duodenal involvement by vasculitis. The patient was asymptomatic after 4-weeks, with endoscopic healing and renal function stabilization. GI involvement limited to the duodenum in the setting of ANCA-MPO vasculitis is a rare condition. Moreover, histopathologic confirmation of vasculitis in endoscopic biopsy samples is exceptional.
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http://dx.doi.org/10.17235/reed.2020.6965/2020DOI Listing
December 2020

Fecal microbiota transplantation in the intestinal decolonization of carbapenamase-producing enterobacteriaceae.

Rev Esp Enferm Dig 2020 Dec;112(12):925-928

Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal.

Background And Aims: fecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection (CDI). Intestinal decolonization of carbapenamase-producing enterobacteriaceae (CPE) can prevent transmission and infection by these agents. The aim of this study was to assess CPE decolonization after FMT.

Methods: this was a case-series study that consecutively included all CPE-carriers that underwent FMT between 2014 and 2019. The indications included refractory/recurrent CDI and CPE-decolonization.

Results: out of 21 CPE-carriers, eight were excluded due to incomplete post-FMT testing. CPE decolonization was confirmed in 76.9 % (n = 10). The median decolonization time was 16-weeks (IQR-23) and ranged from two to 53 weeks.

Conclusion: FMT may be used in the clinical practice for CPE-decolonization as an alternative to combined antibiotic regimens.
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http://dx.doi.org/10.17235/reed.2020.7150/2020DOI Listing
December 2020

Patient's perspective on the implementation of measures to contain the SARS-CoV-2 pandemic in a Portuguese Gastroenterology Department.

Eur J Gastroenterol Hepatol 2021 04;33(4):527-532

Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal.

Background And Aims: As the COVID-19 pandemic emerged, departments had to adapt their activities, jeopardizing patient's best interests. Our aim is to evaluate the patient's perspective to the implementation of SARS-CoV-2 measures in a gastroenterology department in a Portuguese Hospital.

Methods: A survey with 13 questions was created and available to patients with at least one gastroenterology appointment at our center in the year 2019.

Results: Nine hundred seventy-three patients completed the survey, 51.6% (n = 502) females, and 82.6% (n = 804) with less than 65 years of age. 50.7% of 962 patients were not working. 49.5% had an appointment for monitoring a suspected or established inflammatory bowel disease (IBD). 76.8% and 69.6% subjects agreed in postponing endoscopic and non-endoscopic procedures, respectively. 93.6%, 94.3% and 95.7% patients declared to be worried about the postponing of endoscopic procedures, non-endoscopic procedures and medical visits, respectively. 88.8% supported remote consultations and 77.3% were satisfied with this type of appointment, independently of the age group (P = 0.66). 80.9% of IBD patients treated with immunosuppression or biologics were concerned about a severe infection by COVID-19.

Conclusion: A great part of our respondents belong to IBD appointments. The majority of our patients agreed in postponing procedures, although they feel concerned. Almost all patients supported remote consultations and most patients found them positive.
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http://dx.doi.org/10.1097/MEG.0000000000001942DOI Listing
April 2021

Does urgent balloon-assisted enteroscopy impact rebleeding and short-term mortality in overt obscure gastrointestinal bleeding?

Scand J Gastroenterol 2020 Oct 10;55(10):1243-1247. Epub 2020 Sep 10.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Porto, Portugal.

Background And Aims: The diagnostic yield (DY) and therapeutic yield (TY) of balloon-assisted enteroscopy (BAE) in overt obscure gastrointestinal bleeding (OGIB) is higher in the first 72 h. This study aimed to evaluate if this higher DY and TY after urgent BAE impacted the rebleeding rate, time to rebleed and short-term mortality.

Methods: Retrospective cohort-study, which consecutively included all patients submitted to BAE for overt OGIB, between 2010 and 2019. Patients were distributed in 2 groups: (1) Urgent BAE; (2) Non-urgent BAE. Rebleeding was defined as an Hb drop >2 g/dL, need for transfusional support or presence of melena/hematochezia.

Results: Fifty-four patients were included, of which 17 (31.5%) were submitted to BAE in the first 72 h. DY and TY of urgent BAE (DY 88.2%;  = 15; TY 94.1%;  = 16) was higher compared to non-urgent BAE (DY 59.5%;  = 22; TY 45.9%;  = 17) (DY  = .03) (TY  = .001). The rebleeding rate at 1, 2, and 5 years was 32.0%, 34.0%and 37.0%, respectively. Rebleeding was lower after urgent BAE (17.6%;  = 3) compared to non-urgent BAE (45.9%;  = 17) ( = .04). Rebleeding tended to occurr earlier in non-urgent BAE, being at 6-months (32.5%) and 36 months (41.3%) ( = .05). OGIB related 30-day mortality was 5.4% ( = 2) for non-urgent BAE and 0% for urgent BAE ( = .5).

Conclusion: Urgent BAE might be associated with higher DY and TY with lower rebleeding and trend toward higher rebleeding-free time.
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http://dx.doi.org/10.1080/00365521.2020.1813800DOI Listing
October 2020

Refractory tracheoesophageal fistula management with Amplatzer Occluder® placement.

Rev Esp Enferm Dig 2020 Sep;112(9):733-734

Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho.

Tracheoesophageal fistulas (TEF) in adults can be managed either surgically or endoscopically, depending on their etiology, size, anatomy and patient comorbidities. A 68-year-old female was admitted to the ER due to dysphagia and a cough. The patient had a medical history of TEF resulting from a tracheostomy and prolonged mechanical ventilation. Previous endoscopic treatment had failed, namely 3-attempts of closure with an over-the-scope clip (OTSC®). The patient refused surgery. After a multidisciplinary discussion (Gastroenterology, Pneumology, Surgery and Interventional-Cardiology), we decided to attempt Amplatzer-Occluder® placement. An 8mm Amplatzer-Occluder® was placed from the tracheal side, with sequential opening of the esophageal and tracheal strands (under endoscopic, bronchofibroscopic and fluoroscopic visualization). Nevertheless, migration of the device occurred 8-weeks later. Percutaneous endoscopic gastrostomy (PEG) was placed and the patient was referred to surgery. When there is extensive fibrosis that is not amendable to the application of clips, atrial septal defect occluder devices can be considered to manage TEF. Nevertheless, there is a need to develop strategies to minimize migration risk.
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http://dx.doi.org/10.17235/reed.2020.6719/2019DOI Listing
September 2020

Endoscopic and histologic activity assessment considering disease extent and prediction of treatment failure in ulcerative colitis.

Scand J Gastroenterol 2020 Oct 8;55(10):1157-1162. Epub 2020 Aug 8.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Porto, Portugal.

Background And Aims: DUBLIN score allows evaluation of disease activity and extent in ulcerative colitis (UC). This study aimed to evaluate DUBLIN score as a predictor of therapeutic failure as well as to associate endoscopic and histological activity scores to assess their joint performance.

Methods: Retrospective cohort study, with consecutive inclusion of patients undergoing total colonoscopy with serial biopsies between 2016 and 2019. DUBLIN score (0-9) was calculated as the product of Mayo endoscopic score (MSe 0-3) by disease extent (E1-E3). Histological activity was evaluated through Nancy score (0-4). Activity scores were correlated with biomarkers, treatment failure (therapeutic escalation, hospitalization and/or colectomy) and clinical remission at 6 months (Mayo partial score ≤ 1).

Results: One-hundred and seven patients were included. In 38.3% ( = 41) there was evidence of endoscopic activity (MSe ≥ 2) and in 50.5% ( = 54) histological activity (Nancy ≥ 2). MSe and DUBLIN scores showed good correlation ( = 0.943;  < .001) and both were significantly higher in patients with histological activity ( < .001). Therapeutic failure occurred in 25.2% ( = 27). MSe, DUBLIN, and Nancy scores were significantly associated with therapeutic failure ( < .001). The areas under the (AUC) ROC curve were 0.74 (MSe;  < .001), 0.78 (DUBLIN;  < .001) and 0.84 (Nancy;  < .001). Joint evaluation of endoscopic and histological activity by combining DUBLIN and Nancy scores was associated with therapeutic failure with a significantly higher AUC of 0.84 ( < .001) compared to the Dublin score alone ( = .003).

Conclusion: Mayo and DUBLIN endoscopic scores correlated with each other and with histological activity. The joint evaluation of endoscopic and histological activity allowed to predict with greater accuracy treatment failure.
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http://dx.doi.org/10.1080/00365521.2020.1803397DOI Listing
October 2020

Leaf metabolic profiles of two soybean genotypes differentially affect the survival and the digestibility of Anticarsia gemmatalis caterpillars.

Plant Physiol Biochem 2020 Oct 25;155:196-212. Epub 2020 Jul 25.

Department of Biochemistry and Molecular Biology, UFV, BIOAGRO/INCT-IPP, Viçosa-MG, Brazil; Center for Biomolecules Analysis, NuBioMol, Universidade Federal de Viçosa, Viçosa-MG, Brazil. Electronic address:

Insect pests such as Anticarsia gemmatalis cause defoliation and yield losses. Soybean breeding has obtained resistant genotypes, however the mechanism remains unknown. Studies indicated the presence of deterrents compounds in the resistant genotype IAC17, and their leaf metabolite profiles were compared to the susceptible genotype UFV105, which was elicited or not by caterpillar infestation. Cluster analysis indicated a significative distinction between these profiles as well as differences in plant defense pathways. Methylquercetins were constitutively present in the largest concentrations, specifically in the IAC17. Relationship between the resistance and the levels of phytohormones jasmonic acid, abscisic acid and salicylic acid was not observed. However, 1-aminocyclopropane -1carboxylic acid levels indicated that the ethylene may be involved in the constitutive biosynthesis of bioactive compounds. Extracts were added to the diets at three different concentrations to evaluate the effect on caterpillar survival. Lowest survival rates were observed when extracts from the resistant IAC 17 were used, at the lowest concentrations. Survival rates were not higher when IAC 17 infested by caterpillars were used. On the other hand, when extracts from the susceptible were used, the survival reductions were only observed in the highest extract concentrations. These supplementations of the diet reduced the digestive capacity, agreeing with the proteolytic activities, whereas malformations of the intestinal cells were dose dependent. The inhibitory effects persisted in higher dilutions only for the IAC17. Constitutive resistance was also explained by higher levels of protease inhibition. These results can be useful to elucidate the genes and cascades controlling the resistance.
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http://dx.doi.org/10.1016/j.plaphy.2020.07.010DOI Listing
October 2020

Predicting the risk of rebleeding after capsule endoscopy in obscure gastrointestinal bleeding - External validation of the RHEMITT Score.

Dig Dis 2020 Jul 8. Epub 2020 Jul 8.

Background And Aims: Prediction of rebleeding after small bowel capsule endoscopy (SBCE) in obscure gastrointestinal bleeding (OGIB) is challenging. The recently described RHEMITT score includes 7 variables: chronic kidney disease (CKD); heart failure (HF); P1/P2 lesions (Saurin's classification); major bleeding; incomplete examination; smoking and endoscopic treatment. This tool has been shown to accurately predict the risk of recurrence after a SBCE study. The primary aim of this study was to perform an external validation of the RHEMITT score.

Methods: Retrospective cohort-study, which consecutively included all patients submitted to SBCE (Mirocam®) for OGIB between January 2017 and December 2018. Rebleeding was defined as: (1) a drop in hemoglobin>2g/dL or (2) Melena or hematochezia. The RHEMITT score was calculated and subsequently the accuracy of the score for the prediction of rebleeding was assessed.

Results: One-hundred and sixty patients were enrolled. Mean age was 65.8±13.6years and 58.1% (n=93) were female. The mean follow-up time was 20 (SD 9) months. Rebleeding occurred in 14.4% (n=23). Rebleeding at 6, 12, 18 and 24 months was 6.3%, 12.0%, 14.2% and 15.5% respectively. There was a significant association between the RHEMITT score and rebleeding (p <0.001). The area under the (AUC) ROC curve was 0.756 (p<0.001). Rebleeding occurred earlier in intermediate and high-risk patients (RHEMITT score >3) being at 6-months 13.6% and 24 months 28.4% (p<0.01).

Conclusion: The present study carried out in an external validation cohort confirms the usefulness and accuracy of the RHEMITT score in predicting rebleeding after SBCE.
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http://dx.doi.org/10.1159/000509986DOI Listing
July 2020

Prediction of adenoma recurrence after piecemeal endoscopic mucosal resection: interobserver agreement and utilization of the Sydney EMR recurrence tool.

Scand J Gastroenterol 2020 Apr 23;55(4):492-496. Epub 2020 Apr 23.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes, Vila Nova de Gaia, Porto, Portugal.

Piecemeal endoscopic mucosal resection (pEMR) allows resection of larger non-invasive colorectal lesions. Adenoma recurrence is an important limitation and occurs in ≤20%. The present study aimed to validate the Sydney EMR recurrence tool (SERT) score as a predictor of both endoscopic and histologic recurrence and evaluate interobserver agreement in adenoma recurrence based on endoscopic scar assessment, among nonexperts in EMR. Retrospective cohort and cross-sectional study, in which all patients submitted to pEMR in a tertiary care center in Portugal, between 2012 and 2018 were included. SERT-score was calculated for all lesions and compared with the SMSA (size, morphology, site, access) score already validated as a predictor of adenoma recurrence. Image based offline analysis was performed to evaluate adenoma recurrence prediction and assess the interobserver agreement within a heterogeneous group of participants, mostly composed by nonexperts in EMR. There was a moderate positive correlation between the SERT and SMSA scores ( <.001;  = 0.61). SERT-score was significantly associated with endoscopic recurrence ( =.005) and histologic recurrence ( = .015). Endoscopic prediction of recurrence had high coefficient of agreement (k-0.806;  < .001). Histologic recurrence after pEMR can be predicted by SERT score and optical diagnosis of recurrent adenoma has high interobserver agreement between nonexperts in EMR.
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http://dx.doi.org/10.1080/00365521.2020.1749296DOI Listing
April 2020

Bleeding malignant gastric ulcer: successful endoscopic hemostasis with an over-the-scope clip.

VideoGIE 2020 Apr 5;5(4):146-147. Epub 2020 Feb 5.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal.

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http://dx.doi.org/10.1016/j.vgie.2019.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125396PMC
April 2020

Obscure gastrointestinal bleeding in the setting of blue rubber bleb nevus syndrome with extensive small bowel involvement.

Rev Esp Enferm Dig 2020 Apr;112(4):323-324

Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple vascular malformations of the gastrointestinal (GI) tract, skin and less frequently in solid organs. An 85-year-old male was admitted to the ER due to melena and was under apixaban anticoagulation. Dorsal hemangiomas were identified on physical examination. On admission, he had hemoglobin levels of 7.6g/dl, esophagogastroduodenoscopy was negative and colonoscopy revealed blood clots in all segments, including the terminal ileum. Capsule endoscopy revealed multiple polypoid vinaceous-colored formations in the proximal jejunum and distally active bleeding resulting in limited mucosal observation. The abdominal-CT was normal. Balloon-assisted enteroscopy (BAE) allowed the identification of multiple hemangioma-like purplish blue lesions in the jejunum and ileum without active bleeding. A diagnosis of BRBNS was made based on clinical, imaging and endoscopic findings. Supportive treatment was decided, considering the extent of the lesions and the comorbidities of the patient. Treatment depends on the site, size and number of lesions. Surgical resection is more suitable for limited or life-threatening lesions. Endoscopic treatment with polidocanol, coagulation, band ligation and endoscopic mucosal resection are also available. Sirolimus has been successfully used. However, tolerability and adverse effects limits its use as a rescue therapy.
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http://dx.doi.org/10.17235/reed.2020.6963/2020DOI Listing
April 2020

The rebleeding rate in patients evaluated for obscure gastrointestinal bleeding after negative small bowel findings by device assisted enteroscopy.

Rev Esp Enferm Dig 2020 Apr;112(4):262-268

Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho.

Background: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce.

Objective: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed.

Methods: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy.

Results: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission.

Conclusions: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission.
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http://dx.doi.org/10.17235/reed.2020.6833/2019DOI Listing
April 2020

Chondrogenic differentiation of mesenchymal stem/stromal cells on 3D porous poly (ε-caprolactone) scaffolds: Effects of material alkaline treatment and chondroitin sulfate supplementation.

J Biosci Bioeng 2020 Jun 25;129(6):756-764. Epub 2020 Feb 25.

Department of Bioengineering and iBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal. Electronic address:

Cartilage defects resultant from trauma or degenerative diseases (e.g., osteoarthritis) can potentially be repaired using tissue engineering (TE) strategies combining progenitor cells, biomaterial scaffolds and bio-physical/chemical cues. This work examines promoting chondrogenic differentiation of human bone marrow mesenchymal stem/stromal cells (BM-MSCs) by combining the effects of modified poly (ε-caprolactone) (PCL) scaffolds hydrophilicity and chondroitin sulfate (CS) supplementation in a hypoxic 5% oxygen atmosphere. 3D-extruded PCL scaffolds, characterized by μCT, featured a 21 mm surface area to volume ratio, 390 μm pore size and approximately 100% pore interconnectivity. Scaffold immersion in sodium hydroxide solutions for different periods of time had major effects in scaffold surface morphology, wettability and mechanical properties, but without improvements on cell adhesion. In-situ chondrogenic differentiation of BM-MSC seeded in 3D-extruded PCL scaffolds resulted in higher cell populations and ECM deposition along all scaffold structure, when chondrogenesis was preceded by an expansion phase. Additionally, CS supplementation during BM-MSC expansion was crucial to enhance aggrecan gene expression, known as a hallmark of chondrogenesis. Overall, this study presents an approach to tailor the wettability and mechanical properties of PCL scaffolds and supports the use of CS-supplementation as a biochemical cue in integrated TE strategies for cartilage regeneration.
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http://dx.doi.org/10.1016/j.jbiosc.2020.01.004DOI Listing
June 2020

Does disease activity explain psychological differences in Inflammatory Bowel Disease?

Neurogastroenterol Motil 2020 03;32(3):e13775

Gastroenterology Department, Centro Hospitalar Vila Nova de Gaia Espinho, Porto, Portugal.

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http://dx.doi.org/10.1111/nmo.13775DOI Listing
March 2020

Fifteen years of coronary intravascular ultrasound in percutaneous coronary intervention in Portugal.

Rev Port Cardiol (Engl Ed) 2019 Nov 11;38(11):779-785. Epub 2020 Feb 11.

Hospital de Santo António, Centro Hospitalar do Porto EPE, Porto, Portugal; Associação Portuguesa de Intervenção Cardiovascular.

Introduction: Coronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal.

Methods: A retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized.

Results: A total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C-type or bifurcated coronary lesions, and in-stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery.

Conclusion: Coronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.
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http://dx.doi.org/10.1016/j.repc.2019.02.007DOI Listing
November 2019

Adjuvant antithrombotic therapy in ST-elevation myocardial infarction: Contemporaneous Portuguese cross-sectional data.

Rev Port Cardiol (Engl Ed) 2019 Nov 29;38(11):809-814. Epub 2020 Jan 29.

Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.

Introduction: The standard of care for acute ST-elevation myocardial infarction (STEMI) includes the activation of a STEMI care network, the administration of adjuvant medical therapy, and reperfusion through primary percutaneous coronary intervention (PCI). While primary PCI is nowadays the first option for the treatment of patients with STEMI, antithrombotic therapy, including antiplatelet and anticoagulant agents, is the cornerstone of pharmacological treatment to optimize their clinical outcomes.

Objective: The aim of this study was to describe contemporaneous real-world patterns of use of antithrombotic treatments in Portugal for STEMI patients undergoing primary PCI.

Methods: An observational, retrospective cross-sectional study was performed for the year 2016, based on data from two national registries: the Portuguese Registry on Acute Coronary Syndromes (ProACS) and the Portuguese Registry on Interventional Cardiology (PRIC). Data on oral antiplatelet and procedural intravenous antithrombotic drugs were retrieved.

Results: In 2016, the ProACS enrolled 534 STEMI patients treated with primary PCI, while the PRIC registry reported data on 2625 STEMI patients. Of these, 99.6% were treated with aspirin and 75.6% with dual antiplatelet therapy (mostly clopidogrel). GP IIb/IIIa inhibitors (mostly abciximab) were used in 11.6% of cases. Heparins were used in 80% of cases (78% unfractionated heparin [UFH] and 2% low molecular weight heparin). None of the patients included in the registry were treated with cangrelor, prasugrel or bivalirudin. Missing data are one of the main limitations of the registries.

Conclusions: In 2016, according to data from these national registries, almost all patients with STEMI were treated with aspirin and 76% with dual antiplatelet agents, mostly clopidogrel. GP IIb/IIIa inhibitors were used in few patients, and UFH was the most prevalent parenteral anticoagulant drug.
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http://dx.doi.org/10.1016/j.repc.2019.02.015DOI Listing
November 2019

A Case of Gastric Ischemia: Management and Prognosis.

GE Port J Gastroenterol 2020 Jan 22;27(1):53-55. Epub 2019 May 22.

Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

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http://dx.doi.org/10.1159/000499723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959090PMC
January 2020

Duodenal Crohn's Disease Complicated by Pancreatitis and Common Bile Duct Obstruction.

GE Port J Gastroenterol 2020 Jan 23;27(1):33-36. Epub 2019 May 23.

Gastroenterology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.

Introduction: Crohn's disease (CD) is characterized by segmental and transmural involvement of any portion of the gastrointestinal tract from the mouth to the anus. Duodenal CD is a rare clinical entity, with the majority of the patients being symptomless - its diagnosis requires a high level of clinical suspicion.

Case Presentation: We present the case of a 29-year-old male patient with a 2-month history of weight loss, epigastric pain and postprandial vomiting. He underwent upper endoscopy, which revealed a circumferential duodenal ulcer causing non-transposable luminal stenosis and was medicated with proton pump inhibitors. While awaiting gastroenterology consultation, he presented at the emergency department for sudden onset of abdominal pain with dorsal irradiation, nausea and vomiting. Laboratory tests showed anaemia and increased liver enzymes, amylase and lipase. Abdominal computed tomography showed ectasia of the common bile duct (CBD) and intrahepatic biliary tract and a small amount of gas in the main pancreatic duct associated with duodenal thickening. The case was interpreted as probable CD complicated by pancreatitis and obstruction of the CBD, and he was hospitalized under antibiotic therapy and hydrocortisone with improvement of the condition. After discharge, he underwent colonoscopy that revealed several ulcers in the ileum and magnetic resonance imaging that showed distension of the stomach with reduction of the calibre of the transition from the duodenal bulb to the second portion of the duodenum in a 10- to 15-mm extension, as well as associated dilatation of the intrahepatic bile ducts and CBD and diffuse and regular ectasia of the main pancreatic duct. Combination therapy with azathioprine and infliximab was initiated; the patient presented clinical response at 12 weeks and endoscopic/imaging remission at 9 months.

Discussion/conclusion: Hepatobiliary and pancreatic manifestations are common in CD patients involving multiple mechanisms. In this case report, we pre-sent a patient with duodenal CD complicated with pancreatitis and CBD obstruction due to distortion phenomena by duodenal stenosis, a condition that is rarely described.
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http://dx.doi.org/10.1159/000499767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959094PMC
January 2020

Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes.

JAMA Cardiol 2020 03;5(3):272-281

Department of Cardiologie, Centre Hospitalier La Durance, Avignon, France.

Importance: Approximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned.

Objective: To evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography.

Design, Setting, And Participants: This cross-sectional study used data from the PRIME-FFR study derived from the merger of the POST-IT study (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease [March 2012-November 2013]) and R3F study (French Study of FFR Integrated Multicenter Registries Implementation of FFR in Routine Practice [October 2008-June 2010]), 2 prospective multicenter registries that shared a common design. A population of all-comers for whom angiography disclosed ambiguous lesions was analyzed for rates, patterns, and outcomes associated with management reclassification, including revascularization deferral, in patients with vs without diabetes. Data analysis was performed from June to August 2018.

Main Outcomes And Measures: Death from any cause, myocardial infarction, or unplanned revascularization (MACE) at 1 year.

Results: Among 1983 patients (1503 [77%] male; mean [SD] age, 65 [10] years), 701 had diabetes, and FFR was performed for 1.4 lesions per patient (58.2% of lesions in the left anterior descending artery; mean [SD] stenosis, 56% [11%]; mean [SD] FFR, 0.81 [0.01]). Reclassification by FFR was high and similar in patients with and without diabetes (41.2% vs 37.5%, P = .13), but reclassification from medical treatment to revascularization was more frequent in the former (142 of 342 [41.5%] vs 230 of 730 [31.5%], P = .001). There was no statistical difference between the 1-year rates of MACE in reclassified (9.7%) and nonreclassified patients (12.0%) (P = .37). Among patients with diabetes, FFR-based deferral identified patients with a lower risk of MACE at 12 months (25 of 296 [8.4%]) compared with those undergoing revascularization (47 of 257 [13.1%]) (P = .04), and the rate was of the same magnitude of the observed rate among deferred patients without diabetes (7.9%, P = .87). Status of insulin treatment had no association with outcomes. Patients (6.6% of the population) in whom FFR was disregarded had the highest MACE rates regardless of diabetes status.

Conclusions And Relevance: Routine integration of FFR for the management of coronary artery disease in patients with diabetes may be associated with a high rate of treatment reclassification. Management strategies guided by FFR, including revascularization deferral, may be useful for patients with diabetes.
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http://dx.doi.org/10.1001/jamacardio.2019.5097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990935PMC
March 2020

Rare mesenchymal antral gastric tumors: Case reports of glomus tumor and plexiform fibromyxoma.

Radiol Case Rep 2020 Jan 9;15(1):71-76. Epub 2019 Nov 9.

Centro Hospitalar Vila Nova de Gaia - Espinho, Radiology Department, Rua Conceição Fernandes 1282, Vila Nova de Gaia, Portugal.

Gastrointestinal stromal tumors account for the majority of the mesenchymal neoplasms of the gastric antrum, but other entities should also be considered. We present the case of a 70-year-old man with an ulcerated well-circumscribed polypoid submucosal mass in the gastric antrum which was proven to be a glomus tumor. CT showed progressive contrast enhancement. Magnetic resonance imaging showed a high T2 signal intensity and heterogeneous arterial contrast enhancement which became more homogeneous in later phases. We also present the case of a 50-year-old woman with a large polypoid mass occupying half the circumference of the distal gastric antrum that was proven to be a plexiform fibromyxoma. Contrast-enhanced CT and magnetic resonance imaging revealed a pattern of progressive and heterogeneous enhancement. Although gastrointestinal stromal tumors are the most frequent gastric mesenchymal neoplasms, other rare mesenchymal tumors such as glomus tumor and plexiform fibromyxoma may arise in the gastric antrum.
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http://dx.doi.org/10.1016/j.radcr.2019.10.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849420PMC
January 2020

Acute Mesenteric Ischemia Diagnosed after Emergent Single-Balloon Enteroscopy.

GE Port J Gastroenterol 2019 Jul 31;26(4):290-292. Epub 2018 Aug 31.

Department of Gastroenterology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.

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http://dx.doi.org/10.1159/000492065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624664PMC
July 2019

Mechanism of the drought tolerance of a transgenic soybean overexpressing the molecular chaperone BiP.

Physiol Mol Biol Plants 2019 Mar 14;25(2):457-472. Epub 2019 Feb 14.

1Laboratory of Plant Molecular Biology, Department of Biochemistry and Molecular Biology, Universidade Federal de Viçosa, BIOAGRO/INCT-IPP, Viçosa, MG Brazil.

Drought is one of major constraints that limits agricultural productivity. Some factors, including climate changes and acreage expansion, indicates towards the need for developing drought tolerant genotypes. In addition to its protective role against endoplasmic reticulum (ER) stress, we have previously shown that the molecular chaperone binding protein (BiP) is involved in the response to osmotic stress and promotes drought tolerance. Here, we analyzed the proteomic and metabolic profiles of BiP-overexpressing transgenic soybean plants and the corresponding untransformed line under drought conditions by 2DE-MS and GC/MS. The transgenic plant showed lower levels of the abscisic acid and jasmonic acid as compared to untransformed plants both in irrigated and non-irrigated conditions. In contrast, the level of salicylic acid was higher in transgenic lines than in untransformed line, which was consistent with the antagonistic responses mediated by these phytohormones. The transgenic plants displayed a higher abundance of photosynthesis-related proteins, which gave credence to the hypothesis that these transgenic plants could survive under drought conditions due to their genetic modification and altered physiology. The proteins involved in pathways related to respiration, glycolysis and oxidative stress were not signifcantly changed in transgenic plants as compared to untransformed genotype, which indicate a lower metabolic perturbation under drought of the engineered genotype. The transgenic plants may have adopted a mechanism of drought tolerance by accumulating osmotically active solutes in the cell. As evidenced by the metabolic profiles, the accumulation of nine primary amino acids by protein degradation maintained the cellular turgor in the transgenic genotype under drought conditions. Thus, this mechanism of protection may cause the physiological activities including photosynthesis to be active under drought conditions.
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http://dx.doi.org/10.1007/s12298-019-00643-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419710PMC
March 2019