Publications by authors named "Joao Morais"

157 Publications

Polyurethane derived from castor oil monoacylglyceride (Ricinus communis) for bone defects reconstruction: characterization and in vivo testing.

J Mater Sci Mater Med 2021 Apr 1;32(4):39. Epub 2021 Apr 1.

Department of Pathology and Dental Clinic, Health Sciences Center, Federal University of Piauí, Ininga Campus, Teresina, Brazil.

Biomaterials used in tissue regeneration processes represent a promising option for the versatility of its physical and chemical characteristics, allowing for assisting or speeding up the repair process stages. This research has characterized a polyurethane produced from castor oil monoacylglyceride (Ricinus communis L) and tested its effect on reconstructing bone defects in rat calvaria, comparing it with commercial castor oil polyurethane. The characterizations of the synthesized polyurethane have been performed by spectroscopy in the infrared region with Fourier transform (FTIR); thermogravimetric analysis (TG/DTG); X-ray diffraction (XRD) and Scanning Electron Microscopy (SEM). For the in vivo test, 24 animals have been used, divided into 3 groups: untreated group (UG); control group treated with Poliquil® castor polyurethane (PCP) and another group treated with castor polyurethane from the Federal University of Piauí - UFPI (CPU). Sixteen weeks after surgery, samples of the defects were collected for histological and histomorphometric analysis. FTIR analysis has shown the formation of monoacylglyceride and polyurethane. TG and DTG have indicated thermal stability of around 125 °C. XRD has determined the semi-crystallinity of the material. The polyurethane SEM has shown a smooth morphology with areas of recesses. Histological and histomorphometric analyzes have indicated that neither CPU nor PCP induced a significant inflammatory process, and CPU has shown, statistically, better performance in bone formation. The data obtained shows that CPU can be used in the future for bone reconstruction in the medical field.
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http://dx.doi.org/10.1007/s10856-021-06511-zDOI Listing
April 2021

The association between the initial adhesion and cyanobacterial biofilm development.

FEMS Microbiol Ecol 2021 Mar 30. Epub 2021 Mar 30.

LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.

Although laboratory assays provide valuable information about the antifouling effectiveness of marine surfaces and the dynamics of biofilm formation, they may be laborious and time-consuming. This study aimed to determine the potential of short-time adhesion assays to estimate how biofilm development may proceed. The initial adhesion and cyanobacterial biofilm formation were evaluated using glass and a polymer epoxy resin surface at two hydrodynamic conditions and compared using linear regression models. For initial adhesion, the polymer epoxy resin surface was significantly associated with a lower number of adhered cells when compared to glass (-1.27×105 cells.cm-2). Likewise, the number of adhered cells was significantly lower (-1.16×105 cells.cm-2) at 185 than at 40 rpm. This tendency was maintained during biofilm development and was supported by the biofilm wet weight, thickness, chlorophyll α content, and structure. Results indicated a significant correlation between the number of adhered and biofilm cells (r = 0.800, p <0.001). Moreover, the number of biofilm cells on day 42 was dependent on the number of adhered cells at the end of the initial adhesion and hydrodynamic conditions (R2 = 0.795, p <0.001). These findings demonstrated the high potential of initial adhesion assays to estimate marine biofilm development.
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http://dx.doi.org/10.1093/femsec/fiab052DOI Listing
March 2021

Sleep Indices and Cardiac Autonomic Activity Responses during an International Tournament in a Youth National Soccer Team.

Int J Environ Res Public Health 2021 Feb 20;18(4). Epub 2021 Feb 20.

Portugal Football School, Portuguese Football Federation, FPF, 1495-433 Cruz Quebrada, Portugal.

This study aimed to describe habitual sleep and nocturnal cardiac autonomic activity (CAA), and their relationship with training/match load in male youth soccer players during an international tournament. Eighteen elite male youth soccer players (aged 14.8 ± 0.3 years; mean ± SD) participated in the study. Sleep indices were measured using wrist actigraphy, and heart rate (HR) monitors were used to measure CAA during night-sleep throughout 5 consecutive days. Training and match loads were characterized using the session-rating of perceived exertion (s-RPE). During the five nights 8 to 17 players slept less than <8 h and only one to two players had a sleep efficiency <75%. Players' sleep duration coefficient of variation (CV) ranged between 4 and 17%. Nocturnal heart rate variability (HRV) indices for the time-domain analyses ranged from 3.8 (95% confidence interval, 3.6; 4.0) to 4.1 ln[ms] (3.9; 4.3) and for the frequency-domain analyses ranged from 5.9 (5.6; 6.5) to 6.6 (6.3; 7.4). Time-domain HRV CV ranged from 3 to 10% and frequency-domain HRV ranged from 2 to 12%. A moderate within-subjects correlation was found between s-RPE and sleep duration [r = -0.41 (-0.62; -0.14); = 0.003]. The present findings suggest that youth soccer players slept less than the recommended during the international tournament, and sleep duration was negatively associated with training/match load.
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http://dx.doi.org/10.3390/ijerph18042076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924379PMC
February 2021

Atherosclerosis: The cost of illness in Portugal.

Rev Port Cardiol 2021 Feb 22. Epub 2021 Feb 22.

Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Unidade de Farmacologia Clínica, Centro Hospitalar Lisboa Central EPE, Lisboa, Portugal.

Introduction And Objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs.

Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion.

Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%).

Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
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http://dx.doi.org/10.1016/j.repc.2020.08.007DOI Listing
February 2021

Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: a joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis.

Eur Heart J Acute Cardiovasc Care 2020 Nov 7. Epub 2020 Nov 7.

Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark.

The formation of a thrombus in an epicardial artery may result in an acute myocardial infarction (AMI). Despite major advances in acute treatment using network approaches to allocate patients to timely reperfusion and optimal antithrombotic treatment, patients remain at high risk for thrombotic complications. Ongoing activation of the coagulation system as well as thrombin-mediated platelet activation may both play a crucial role in this context. Whether measurement of circulating biomarkers of coagulation and fibrinolysis could be useful for risk stratification in secondary prevention is currently not fully understood. In addition, measurement of such biomarkers could be helpful to identify thrombus formation as the leading mechanism for AMI. The introduction of biomarkers of myocardial injury such as high-sensitivity cardiac troponins made rule-out of AMI even more precise. However, elevated markers of myocardial injury cannot provide proof of a type 1 AMI, let alone thrombus formation. The combined measurement of markers of myocardial injury with biomarkers reflecting ongoing thrombus formation might be helpful for the fast and correct diagnosis of an atherothrombotic type 1 AMI. This position paper gives an overview of the current knowledge and possible role of biomarkers of coagulation and fibrinolysis for the diagnosis of AMI, risk stratification, and individualized treatment strategies in patients with AMI.
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http://dx.doi.org/10.1093/ehjacc/zuaa025DOI Listing
November 2020

Five years of Stent for Life in Portugal.

Rev Port Cardiol 2021 Feb 16;40(2):81-90. Epub 2021 Feb 16.

Cardiology Department, Santo André Hospital, Leiria, Portugal.

Objective: To analyze changes in performance indicators five years after Portugal joined the Stent for Life (SFL) initiative.

Methods: National surveys were carried out annually over one-month periods designated as study Time Points between 2011 (Time Zero) and 2016 (Time Five). In this study, 1340 consecutive patients with suspected ST-elevation myocardial infarction (STEMI) who underwent coronary angiography, admitted to 18 24/7 primary percutaneous coronary intervention (PCI) centers, were enrolled.

Results: There was a significant reduction in the proportion of patients who attended primary healthcare centers (20.3% vs. 4.8%, p<0.001) and non-PCI-capable centers (54.5% vs. 42.5%, p=0.013). The proportions of patients who called 112, the national emergency medical services (EMS) number (35.2% vs. 46.6%, p=0.022) and of those transported via the EMS to a PCI-capable center (13.1% vs. 30.5%, p<0.001) increased. The main improvement observed in timings for revascularization was a trend toward a reduction in patient delay (114 min in 2011 vs. 100 min in 2016, p=0.050). System delay and door-to-balloon time remained constant, at a median of 134 and 57 min in 2016, respectively.

Conclusion: During the lifetime of the SFL initiative in Portugal, there was a positive change in patient delay indicators, especially the lower proportion of patients who attended non-PCI centers, along with an increase in those who called 112. System delay did not change significantly over this period. These results should be taken into consideration in the current Stent - Save a Life initiative.
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http://dx.doi.org/10.1016/j.repc.2020.05.018DOI Listing
February 2021

Dual antiplatelet therapy in myocardial infarction with non-obstructive coronary artery disease - insights from a nationwide registry.

Rev Port Cardiol 2020 12 21;39(12):679-684. Epub 2020 Nov 21.

Cardiology Department, Centro Hospitalar de Leiria, Leiria, Portugal.

Introduction And Objectives: Dual antiplatelet therapy (DAPT) is a mainstay for myocardial infarction (MI) therapy. However, in patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA), clear recommendations are lacking in the literature. This study aims to identify the cases in which DAPT is currently prescribed at discharge for MINOCA.

Methods: The authors analyzed a cohort of patients from a multicenter national registry enrolling patients who suffered their first MI between 2010 and 2017, and underwent coronary angiography revealing absence of stenosis ≥50%. Individual antithrombotic therapy was identified. A logistic regression analysis was applied to search for predictors of DAPT.

Results: From a total of 16 237 patients analyzed, 709 (4.4%) were categorized as MINOCA. Mean age was 64±13 years, 46.3% (n=409) were females. 390 (55.0%) of MINOCA patients were discharged on DAPT. Males (OR 1.67, CI 95 [1.05-2.38], p=0.027), active smokers (OR=1.82, CI 95 [1.05-3.16], p=0.033), previous percutaneous intervention (OR 3.18, CI 95 [1.48-6.81], p=0.003), ST elevation MI (OR 2.70, CI 95 [1.59-4.76], p<0.001) and sinus rhythm at admission (OR=3.94, CI 95 [2.07-7.48], p<0.001) were independent predictors of DAPT use.

Conclusion: In this nationwide registry, DAPT was prescribed at discharge in 55% of MINOCA patients. Beyond sinus rhythm, the variables presented as independent predictors for DAPT use identify subgroups of patients who are classified as more prone to thrombotic events. The issue of how to handle antithrombotic agents in MINOCA patients is a topic open for discussion.
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http://dx.doi.org/10.1016/j.repc.2020.05.008DOI Listing
December 2020

Phasic Activation of Dorsal Raphe Serotonergic Neurons Increases Pupil Size.

Curr Biol 2021 Jan 12;31(1):192-197.e4. Epub 2020 Nov 12.

Champalimaud Centre for the Unknown, 1400-038 Lisbon, Portugal. Electronic address:

Transient variations in pupil size (PS) under constant luminance are coupled to rapid changes in arousal state, which have been interpreted as vigilance, salience, or a surprise signal. Neural control of such fluctuations presumably involves multiple brain regions and neuromodulatory systems, but it is often associated with phasic activity of the noradrenergic system. Serotonin (5-HT), a neuromodulator also implicated in aspects of arousal such as sleep-wake transitions, motivational state regulation, and signaling of unexpected events, seems to affect PS, but these effects have not been investigated in detail. Here we show that phasic 5-HT neuron stimulation causes transient PS changes. We used optogenetic activation of 5-HT neurons in the dorsal raphe nucleus (DRN) of head-fixed mice performing a foraging task. 5-HT-driven modulations of PS were maintained throughout the photostimulation period and sustained for a few seconds after the end of stimulation. We found no evidence that the increase in PS with activation of 5-HT neurons resulted from interactions of photostimulation with behavioral variables, such as locomotion or licking. Furthermore, we observed that the effect of 5-HT on PS depended on the level of environmental uncertainty, consistent with the idea that 5-HT could report a surprise signal. These results advance our understanding of the neuromodulatory control of PS, revealing a tight relationship between phasic activation of 5-HT neurons and changes in PS.
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http://dx.doi.org/10.1016/j.cub.2020.09.090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808753PMC
January 2021

Bacterial cellulose aerogels: Influence of oxidation and silanization on mechanical and absorption properties.

Carbohydr Polym 2020 Dec 13;250:116927. Epub 2020 Aug 13.

Embrapa Agroindústria Tropical - Rua Dra. Sara Mesquita 2270, 60511-110 Fortaleza, Ceará, Brazil. Electronic address:

Biodegradable aerogels may help to develop eco-friendly technological pathways to increase the efficiency of chemical processes. In the present work, we describe the preparation of a novel bacterial cellulose aerogel oxidized by TEMPO, nanofibrillated in a blender, and silanized with methyltrimethoxysilane, resulting in four different types of aerogel. The aerogels produced from the double-functionalized cellulose suspension (BC) were compared to other non-oxidized (BC and BC) and non-silanized (BC) aerogels All aerogels were very light (density 10-14 kg.m) and very porous (porosity >99 %). The aerogels of BC showed better mechanical properties (tension of 13.0 kPa, modulus of elasticity of 39.4 kPa) and hydrophobicity, and could absorb organic solvents of different polarities. The BC could be recycled at least 7 times after absorbing organic solvents while retaining an absorption capacity of 83 %. This material can be used as a standard for the further development of aerogels based on bacterial biopolymers.
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http://dx.doi.org/10.1016/j.carbpol.2020.116927DOI Listing
December 2020

Myocardial Involvement in Sweet Syndrome: A Rare Finding in a Rare Condition.

Arq Bras Cardiol 2020 04;115(1 suppl 1):6-9

Departamento de Dermatologia, Centro Hospitalar de Leiria, Leiria - Portugal.

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http://dx.doi.org/10.36660/abc.20190249DOI Listing
April 2020

Flexible Nanocellulose/Lignosulfonates Ion-Conducting Separators for Polymer Electrolyte Fuel Cells.

Nanomaterials (Basel) 2020 Aug 29;10(9). Epub 2020 Aug 29.

Department of Chemistry, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.

The utilization of biobased materials for the fabrication of naturally derived ion-exchange membranes is breezing a path to sustainable separators for polymer electrolyte fuel cells (PEFCs). In this investigation, bacterial nanocellulose (BNC, a bacterial polysaccharide) and lignosulfonates (LS, a by-product of the sulfite pulping process), were blended by diffusion of an aqueous solution of the lignin derivative and of the natural-based cross-linker tannic acid into the wet BNC nanofibrous three-dimensional structure, to produce fully biobased ion-exchange membranes. These freestanding separators exhibited good thermal-oxidative stability of up to about 200 °C, in both inert and oxidative atmospheres (N and O, respectively), high mechanical properties with a maximum Young's modulus of around 8.2 GPa, as well as good moisture-uptake capacity with a maximum value of ca. 78% after 48 h for the membrane with the higher LS content. Moreover, the combination of the conducting LS with the mechanically robust BNC conveyed ionic conductivity to the membranes, namely a maximum of 23 mS cm at 94 °C and 98% relative humidity (RH) (in-plane configuration), that increased with increasing RH. Hence, these robust water-mediated ion conductors represent an environmentally friendly alternative to the conventional ion-exchange membranes for application in PEFCs.
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http://dx.doi.org/10.3390/nano10091713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557763PMC
August 2020

Characterization of planktonic and biofilm cells from two filamentous cyanobacteria using a shotgun proteomic approach.

Biofouling 2020 07 26;36(6):631-645. Epub 2020 Jul 26.

LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, Porto, Portugal.

Cyanobacteria promote marine biofouling with significant impacts. A qualitative proteomic analysis, by LC-MS/MS, of planktonic and biofilm cells from two cyanobacteria was performed. Biofilms were formed on glass and perspex at two relevant hydrodynamic conditions for marine environments (average shear rates of 4 s and 40 s). For both strains and surfaces, biofilm development was higher at 4 s. Biofilm development of sp. LEGE 06145 was substantially higher than sp. LEGE 06119, but no significant differences were found between surfaces. Overall, 377 and 301 different proteins were identified for sp. LEGE 06145 and sp. LEGE 06119. Differences in protein composition were more noticeable in biofilms formed under different hydrodynamic conditions than in those formed on different surfaces. Ribosomal and photosynthetic proteins were identified in most conditions. The characterization performed gives new insights into how shear rate and surface affect the planktonic to biofilm transition, from a structural and proteomics perspective.
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http://dx.doi.org/10.1080/08927014.2020.1795141DOI Listing
July 2020

Cardiac intensive care in Portugal: The time for change.

Rev Port Cardiol 2020 Jul 15;39(7):401-406. Epub 2020 Jul 15.

Serviço de Cardiologia, Centro Hospitalar Leiria, Leiria, Portugal.

In recent years, the number of patients requiring acute cardiac care has increased, with progressively more complex cardiovascular conditions, often complicated by acute or chronic non-cardiovascular comorbidities, which affects the management and prognosis of these patients. Coronary care units have evolved into cardiac intensive care units, which provide highly specialized health care for the critical heart patient. In view of the limited human and technical resources in this area, we consider that there is an urgent need for an in-depth analysis of the organizational model for acute cardiac care, including the definition of the level of care, the composition and training of the team, and the creation of referral networks. It is also crucial to establish protocols and to adopt safe clinical practices to improve levels of quality and safety in the treatment of patients. Considering that acute cardiac care involves conditions with very different severity and prognosis, it is essential to define the level of care to be provided for each type of acute cardiovascular condition in terms of the team, available techniques and infrastructure. This will lead to improvements in the quality of care and patient prognosis, and will also enable more efficient allocation of resources.
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http://dx.doi.org/10.1016/j.repc.2020.04.007DOI Listing
July 2020

Chlorosphaerolactylates A-D: Natural Lactylates of Chlorinated Fatty Acids Isolated from the Cyanobacterium sp. LEGE 00249.

J Nat Prod 2020 06 1;83(6):1885-1890. Epub 2020 Jun 1.

Interdisciplinary Centre of Marine and Environmental Research (CIIMAR/CIMAR), Terminal de Cruzeiros do Porto de Leixões, University of Porto, 4450-208 Matosinhos, Portugal.

Four natural lactylates of chlorinated fatty acids, chlorosphaerolactylates A-D (-), were isolated from the methanolic extract of the cyanobacterium sp. LEGE 00249 through a combination of bioassay-guided and MS-guided approaches. Compounds - are esters of (mono-, di-, or tri)chlorinated lauric acid and lactic acid, whose structures were assigned on the basis of spectrometric and spectroscopic methods inclusive of 1D and 2D NMR experiments. High-resolution mass-spectrometry data sets also demonstrated the existence of other minor components that were identified as chlorosphaero(bis)lactylate analogues. The chlorosphaerolactylates were tested for potential antibacterial, antifungal, and antibiofilm properties using bacterial and fungal clinical isolates. Compounds - showed a weak inhibitory effect on the growth of S54F9 and SMI416, as well as on the biofilm formation of coagulase-negative FI31.
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http://dx.doi.org/10.1021/acs.jnatprod.0c00072DOI Listing
June 2020

Response to the Letter to the Editor "When sacubitril/valsartan met neprilysin and B-type natriuretic peptide in the labyrinth of biochemistry".

Rev Port Cardiol 2020 03 4;39(3):179-180. Epub 2020 May 4.

Clínica de Insuficiência cardíaca, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.

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http://dx.doi.org/10.1016/j.repc.2020.03.010DOI Listing
March 2020

A method to improve cotton fiber length measurement for laboratory analysis.

MethodsX 2020 12;7:100859. Epub 2020 Mar 12.

Texas Tech University, USA.

Cotton fiber length is an essential parameter for the cotton industry and cotton research. However, differences between industry- and laboratory-scale ginning may lead to inconsistencies between research and industry results for measured length. Seedcotton from farms is processed in large industry-scale gins, while researchers typically use small laboratory-scale gins. The proposed method successfully reduces the differences in fiber length parameters between these two types of ginning. Only one new step is needed before assessing fiber quality in lint from a laboratory-scale gin to simulate the processing effect of an industry-scale gin.•Cotton seeds and lint are separated from seedcotton with a laboratory-scale gin.•Lint is post-processed with a laboratory-scale lint cleaner, the micro dust and trash analyzer 3.•The length fiber quality profile resembles the results of industry-scale ginned samples.
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http://dx.doi.org/10.1016/j.mex.2020.100859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139154PMC
March 2020

Physiological and Metabolic Responses of Marine Mussels Exposed to Toxic Cyanobacteria and .

Toxins (Basel) 2020 03 20;12(3). Epub 2020 Mar 20.

CIIMAR- Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Terminal de Cruzeiros do Porto de Leixões, Av. General Norton de Matos, s/n, 4450-208 Porto, Portugal.

Toxic cyanobacterial blooms are a major contaminant in inland aquatic ecosystems. Furthermore, toxic blooms are carried downstream by rivers and waterways to estuarine and coastal ecosystems. Concerning marine and estuarine animal species, very little is known about how these species are affected by the exposure to freshwater cyanobacteria and cyanotoxins. So far, most of the knowledge has been gathered from freshwater bivalve molluscs. This work aimed to infer the sensitivity of the marine mussel to single as well as mixed toxic cyanobacterial cultures and the underlying molecular responses mediated by toxic cyanobacteria. For this purpose, a mussel exposure experiment was outlined with two toxic cyanobacteria species, and at 1 × 10 cells/mL, resembling a natural cyanobacteria bloom. The estimated amount of toxins produced by and were respectively 0.023 pg/cell of microcystin-LR (MC-LR) and 7.854 pg/cell of cylindrospermopsin (CYN). After 15 days of exposure to single and mixed cyanobacteria, a depuration phase followed, during which mussels were fed only non-toxic microalga . The results showed that the marine mussel is able to filter toxic cyanobacteria at a rate equal or higher than the non-toxic microalga . Filtration rates observed after 15 days of feeding toxic microalgae were 1773.04 mL/ind.h (for ), 2151.83 mL/ind.h (for ), 1673.29 mL/ind.h (for the mixture of the 2 cyanobacteria) and 2539.25 mL/ind.h (for the non-toxic ). Filtering toxic microalgae in combination resulted in the accumulation of 14.17 ng/g dw MC-LR and 92.08 ng/g dw CYN. Other physiological and biochemical endpoints (dry weight, byssus production, total protein and glycogen) measured in this work did not change significantly in the groups exposed to toxic cyanobacteria with regard to control group, suggesting that mussels were not affected with the toxic microalgae. Nevertheless, proteomics revealed changes in metabolism of mussels related to diet, specially evident in those fed on combined cyanobacteria. Changes in metabolic pathways related with protein folding and stabilization, cytoskeleton structure, and gene transcription/translation were observed after exposure and feeding toxic cyanobacteria. These changes occur in vital metabolic processes and may contribute to protect mussels from toxic effects of the toxins MC-LR and CYN.
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http://dx.doi.org/10.3390/toxins12030196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150937PMC
March 2020

A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli.

Case Rep Cardiol 2020 11;2020:3192957. Epub 2020 Mar 11.

Cardiology Department, Leiria Hospital Center, Portugal.

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.
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http://dx.doi.org/10.1155/2020/3192957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086418PMC
March 2020

The Relative Importance of Shear Forces and Surface Hydrophobicity on Biofilm Formation by Coccoid Cyanobacteria.

Polymers (Basel) 2020 Mar 12;12(3). Epub 2020 Mar 12.

LEPABE-Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.

Understanding the conditions affecting cyanobacterial biofilm development is crucial to develop new antibiofouling strategies and decrease the economic and environmental impact of biofilms in marine settings. In this study, we investigated the relative importance of shear forces and surface hydrophobicity on biofilm development by two coccoid cyanobacteria with different biofilm formation capacities. The strong biofilm-forming was used along with the weaker biofilm-forming sp. Biofilms were developed in defined hydrodynamic conditions using glass (a model hydrophilic surface) and a polymeric epoxy coating (a hydrophobic surface) as substrates. Biofilms developed in both surfaces at lower shear conditions contained a higher number of cells and presented higher values for wet weight, thickness, and chlorophyll content. The impact of hydrodynamics on biofilm development was generally stronger than the impact of surface hydrophobicity, but a combined effect of these two parameters strongly affected biofilm formation for the weaker biofilm-producing organism. The antibiofilm performance of the polymeric coating was confirmed at the hydrodynamic conditions prevailing in ports. Shear forces were shown to have a profound impact on biofilm development in marine settings regardless of the fouling capacity of the existing flora and the hydrophobicity of the surface.
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http://dx.doi.org/10.3390/polym12030653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183090PMC
March 2020

The SHIFT model combines clinical, electrocardiographic and echocardiographic parameters to predict sudden cardiac death in hypertrophic cardiomyopathy.

Rev Port Cardiol 2019 12 11;38(12):847-853. Epub 2020 Mar 11.

Cardiology Department, Leiria Hospital Center, Leiria, Portugal.

Introduction: Limitations have been pointed out in the clinical risk prediction model for sudden cardiac death (SCD) of the European Society of Cardiology (ESC), which is recommended for hypertrophic cardiomyopathy (HCM) patients. The aim of this study was to determine the SCD risk of the HCM patients enrolled in a Portuguese nationwide registry and to develop a new SCD risk prediction model applicable to our population.

Methods And Results: The cohort consisted of 1022 patients (mean age 53.2±16.4 years, 59% male) enrolled in a Portuguese national HCM registry. During the follow-up period (median five years), 19 patients (1.9%) died suddenly or had aborted SCD or appropriate implantable cardioverter-defibrillator (ICD) shock therapy. Through a Cox proportional hazards model, four variables were independently associated with SCD or equivalent: unexplained Syncope, Heart failure signs, Interventricular septum thickness ≥19 mm and FragmenTed QRS complex. These predictors were included in the SHIFT model and individual risk probabilities of SCD at five years were estimated. This model was internally validated using bootstrapping. The C-index of the SHIFT model was 0.81 (95% CI: 0.77-0.83) and the C-index of the ESC model (performed in a subgroup of 349 HCM patients) was 0.77 (95% CI: 0.73-0.81) (p=0.246).

Conclusion: The SHIFT model may potentially provide prognostic value and contribute to the clinical decision-making process for ICD implantation for primary prevention of SCD.
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http://dx.doi.org/10.1016/j.repc.2019.05.012DOI Listing
December 2019

The sex gap in hypertrophic cardiomyopathy.

Rev Esp Cardiol (Engl Ed) 2020 Dec 28;73(12):1018-1025. Epub 2020 Feb 28.

Serviço de Cardiologia, Centro Hospitalar de Leiria, Leiria, Portugal.

Introduction And Objectives: Key sex differences have been explored in multiple cardiac conditions. However, sex impact in hypertrophic cardiomyopathy outcome is unclear. We aimed to characterize sex impact in overall and cardiovascular (CV) mortality in a nationwide hypertrophic cardiomyopathy registry.

Methods: We analyzed 1042 adult patients, 429 (41%) women, from a national registry of hypertrophic cardiomyopathy, with mean age at diagnosis 53±16 years and a mean follow-up of 65±75 months. At baseline, women were older (56±16 vs 51±15 years; P <.001), more symptomatic (56.4%, vs 51.7%; P <.001) and had more heart failure (42.0% vs 24.2%. P <.001), diastolic dysfunction (75.2% vs 64.1% P=.001), moderate/severe mitral regurgitation (33.4% vs 21.7%; P=.003), and higher B-type natriuretic peptide levels (920 [366-2412] mg/dL vs 487 [170-1087] mg/dL; P <.001). Women underwent fewer stress tests and cardiac magnetic resonance.

Results: Kaplan-Meier survival curves showed higher overall (8.4% vs 5.0%; P=.026) and CV mortality (5.5% vs 2.2%; P=.004) in women. Cox proportional hazard regression showed that female sex was an independent predictor of overall (HR, 2.05; 95%CI, 1.11-3.78; P=.021) and CV mortality (HR, 3.16; 95%CI, 1.25-7.99; P=.015). Women had more heart failure-related death (2.6% vs 0.8%, P=.024). Despite similar sudden cardiac death (SCD) risk, women received fewer implantable cardioverter-defibrillators (10.9% vs 15.6%; P=.032) and, in patients without cardioverter-defibrillators, SCD occurred more commonly in women (1.8% vs 0.4%; P=.031).

Conclusions: In this nationwide registry, female sex was an independent predictor of overall and CV-related death, with more heart failure-related death. Despite similar SCD risk, women were undertreated with implantable cardioverter-defibrillators. These data highlight the need for an improved clinical approach in women with HCM.
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http://dx.doi.org/10.1016/j.rec.2020.01.007DOI Listing
December 2020

Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt.

Arq Neuropsiquiatr 2020 01;78(1):9-12

Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil.

Introduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts.

Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery.

Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery.

Discussion: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea.

Conclusion: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
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http://dx.doi.org/10.1590/0004-282X20190135DOI Listing
January 2020

Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Eur Heart J Cardiovasc Pharmacother 2021 Mar;7(2):125-140

Department of Pharmacology, Catholic University School of Medicine, Rome, Italy.

Timely and effective antithrombotic therapy is critical to improving outcome, including survival, in patients with acute coronary syndrome (ACS). Achieving effective platelet inhibition and anticoagulation, with minimal risk, is particularly important in high-risk ACS patients, especially those with cardiogenic shock (CS) or those successfully resuscitated following out-of-hospital cardiac arrest (OHCA), who have a 30-50% risk of death or a recurrent ischaemic event over the subsequent 30 days. There are unique challenges to achieving effective and safe antithrombotic treatment in this cohort of patients that are not encountered in most other ACS patients. This position paper focuses on patients presenting with CS or immediately post-OHCA, of presumed ischaemic aetiology, and examines issues related to thrombosis and bleeding risk. Both the physical and pharmacological impacts of CS, namely impaired drug absorption, metabolism, altered distribution and/or excretion, associated multiorgan failure, co-morbidities and co-administered treatments such as opiates, targeted temperature management, renal replacement therapy and circulatory or left ventricular assist devices, can have major impact on the effectiveness and safety of antithrombotic drugs. Careful attention to the choice of antithrombotic agent(s), route of administration, drug-drug interactions, therapeutic drug monitoring and factors that affect drug efficacy and safety, may reduce the risk of sub- or supra-therapeutic dosing and associated adverse events. This paper provides expert opinion, based on best available evidence, and consensus statements on optimising antithrombotic therapy in these very high-risk patients, in whom minimising the risk of thrombosis and bleeding is critical to improving outcome.
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http://dx.doi.org/10.1093/ehjcvp/pvaa009DOI Listing
March 2021

Efficacy and safety of edoxaban in patients with diabetes mellitus in the ENGAGE AF-TIMI 48 trial.

Int J Cardiol 2020 04 31;304:185-191. Epub 2020 Jan 31.

TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America. Electronic address:

Background: Diabetes mellitus is an independent risk factor for stroke and atrial fibrillation. Therefore, the risk/benefit profile of the oral factor Xa inhibitor edoxaban stratified by diabetes is of clinical interest.

Methods: 21,105 patients enrolled in ENGAGE AF-TIMI 48 were stratified into 2 pre-specified groups: without (N = 13,481) and with diabetes (N = 7,624).

Results: On average, patients with diabetes were younger, and had a higher body mass index, CHADS-VASc score and baseline endogenous Factor Xa activity. After multivariate adjustments, patients with diabetes had a similar rate of stroke and systemic embolism compared to those without diabetes (adjusted hazard ratio (HR) 1.08; 95% confidence interval (CI) 0.94-1.24; p = 0.28). However, the risk of major bleeding was significantly higher in patients with diabetes (HR 1.28; 95% CI 1.14-1.44; p < 0.001). The treatment effect of edoxaban (vs warfarin) was not modified by diabetes (all p-interactions > 0.05), a finding supported by the preserved edoxaban concentrations and inhibition of Factor Xa regardless of diabetes. The HRs of stroke and systemic embolism in patients receiving the higher-dose edoxaban regimen vs warfarin were 0.93 and 0.84 (p-interaction = 0.54) in those with and without diabetes respectively. The higher-dose edoxaban regimen reduced major bleeding (by 19-21%) and cardiovascular death (by 7-17%) regardless of diabetes (p-interactions = 0.81 and 0.33 respectively).

Conclusion: Patients with diabetes in ENGAGE AF-TIMI 48 had higher bleeding risk, but after adjustment similar stroke risk, compared to those without diabetes. The higher-dose edoxaban regimen had similar efficacy compared to warfarin, while reducing bleeding and cardiovascular mortality, irrespective of diabetes.
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http://dx.doi.org/10.1016/j.ijcard.2020.01.009DOI Listing
April 2020

Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study.

Rev Port Cardiol 2019 08 7;38(8):559-569. Epub 2019 Nov 7.

Centro Hospitalar de Leiria, EPE, Hospital de Santo André, Cardiology Division, Leiria, Portugal.

Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target.

Methods: DISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months.

Results: A total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933).

Conclusion: These observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.
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http://dx.doi.org/10.1016/j.repc.2019.02.009DOI Listing
August 2019

Biofilm formation behaviour of marine filamentous cyanobacterial strains in controlled hydrodynamic conditions.

Environ Microbiol 2019 11 10;21(11):4411-4424. Epub 2019 Oct 10.

LEPABE-Department of Chemical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal.

Marine biofouling has severe economic impacts and cyanobacteria play a significant role as early surface colonizers. Despite this fact, cyanobacterial biofilm formation studies in controlled hydrodynamic conditions are scarce. In this work, computational fluid dynamics was used to determine the shear rate field on coupons that were placed inside the wells of agitated 12-well microtiter plates. Biofilm formation by three different cyanobacterial strains was assessed at two different shear rates (4 and 40 s ) which can be found in natural ecosystems and using different surfaces (glass and perspex). Biofilm formation was higher under low shear conditions, and differences obtained between surfaces were not always statistically significant. The hydrodynamic effect was more noticeable during the biofilm maturation phase rather than during initial cell adhesion and optical coherence tomography showed that different shear rates can affect biofilm architecture. This study is particularly relevant given the cosmopolitan distribution of these cyanobacterial strains and the biofouling potential of these organisms.
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http://dx.doi.org/10.1111/1462-2920.14807DOI Listing
November 2019

Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Coronary Syndrome Treated Medically or With Percutaneous Coronary Intervention or Undergoing Elective Percutaneous Coronary Intervention: Insights From the AUGUSTUS Trial.

Circulation 2019 12 26;140(23):1921-1932. Epub 2019 Sep 26.

Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (R.D.L., T.M., C.B.G., G.H., W.S.J., J.H.A.).

Background: The safety and efficacy of antithrombotic regimens may differ between patients with atrial fibrillation who have acute coronary syndromes (ACS), treated medically or with percutaneous coronary intervention (PCI), and those undergoing elective PCI.

Methods: Using a 2×2 factorial design, we compared apixaban with vitamin K antagonists and aspirin with placebo in patients with atrial fibrillation who had ACS or were undergoing PCI and were receiving a P2Y inhibitor. We explored bleeding, death and hospitalization, as well as death and ischemic events, by antithrombotic strategy in 3 prespecified subgroups: patients with ACS treated medically, patients with ACS treated with PCI, and those undergoing elective PCI.

Results: Of 4614 patients enrolled, 1097 (23.9%) had ACS treated medically, 1714 (37.3%) had ACS treated with PCI, and 1784 (38.8%) had elective PCI. Apixaban compared with vitamin K antagonist reduced International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding in patients with ACS treated medically (hazard ratio [HR], 0.44 [95% CI, 0.28-0.68]), patients with ACS treated with PCI (HR, 0.68 [95% CI, 0.52-0.89]), and patients undergoing elective PCI (HR, 0.82 [95% CI, 0.64-1.04]; =0.052) and reduced death or hospitalization in the ACS treated medically (HR, 0.71 [95% CI, 0.54-0.92]), ACS treated with PCI (HR, 0.88 [95% CI, 0.74-1.06]), and elective PCI (HR, 0.87 [95% CI, 0.72-1.04]; =0.345) groups. Compared with vitamin K antagonists, apixaban resulted in a similar effect on death and ischemic events in the ACS treated medically, ACS treated with PCI, and elective PCI groups (=0.356). Aspirin had a higher rate of bleeding than did placebo in patients with ACS treated medically (HR, 1.49 [95% CI, 0.98-2.26]), those with ACS treated with PCI (HR, 2.02 [95% CI, 1.53-2.67]), and those undergoing elective PCI (HR, 1.91 [95% CI, 1.48-2.47]; =0.479). For the same comparison, there was no difference in outcomes among the 3 groups for the composite of death or hospitalization (=0.787) and death and ischemic events (=0.710).

Conclusions: An antithrombotic regimen consisting of apixaban and a P2Y inhibitor without aspirin provides superior safety and similar efficacy in patients with atrial fibrillation who have ACS, whether managed medically or with PCI, and those undergoing elective PCI compared with regimens that include vitamin K antagonists, aspirin, or both.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02415400.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.119.043308DOI Listing
December 2019

Atrial fibrillation with percutaneous coronary intervention: Navigating the minefield of antithrombotic therapies.

Atherosclerosis 2019 10 30;289:118-125. Epub 2019 Aug 30.

Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

This review aims to provide insights into contemporary therapeutic options for the treatment of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) and compares current international guidelines. AF is a common cardiac arrhythmia and a major risk factor for stroke. The risk of stroke can be reduced with the use of oral anticoagulant (OAC) therapy. However, for patients with AF, PCI necessitates the use of combined antithrombotic therapies (OAC and antiplatelet therapies) to reduce thrombotic coronary complications. Optimal combinations and durations of OAC and/or antiplatelet therapy remains an area of clinical debate. Nuances exist within the current guidelines regarding duration and combination of antithrombotic therapy for AF patients requiring PCI. However, consensus was found across the following key points: (i) recent evidence supports a preferred role for a dual antithrombotic approach (OAC plus 1 antiplatelet); (ii) limited use of triple antithrombotic therapy is recommended across all guidelines for patients where the ischemic risk outweighs the risk of bleeding, with the duration to be kept as short as possible; and (iii) lifelong management using monotherapy with an OAC from 12 months post PCI is recommended for stable patients across all guidelines.
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http://dx.doi.org/10.1016/j.atherosclerosis.2019.08.021DOI Listing
October 2019

Sacubitril/valsartan: A practical guide revisited.

Rev Port Cardiol 2019 07 4;38(7):527-529. Epub 2019 Sep 4.

Clínica de Insuficiência Cardíaca e Transplante, Centro Hospitalar de São João, Serviço de Cardiologia, Faculdade de Medicina da Universidade do Porto, Portugal.

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http://dx.doi.org/10.1016/j.repc.2019.05.007DOI Listing
July 2019