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- Implementation of a mobile app (TeenPower) to prevent overweight and obesityPublication . Dias, Sara Simões; Frontinia, Roberta; Sousa, Pedro; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); ElsevierThe world is facing an enormous challenge: the vital need to prevent noncommunicable diseases such as overweight and obesity. Prevention programs must be not only valid and effective, but also attractive to young people. In fact, if the tool or program used is not attractive, the adherence to the treatment may not occur. The TeenPower project intended to create a platform for promoting healthy behaviors and fight overweight/obesity. This paper presents the preliminary results of the program regarding adolescents' lifestyle and the usability tests. Adolescents from three different schools in the center of Portugal were recruited. Results showed that adolescents presented moderate healthy lifestyles, with the Interpersonal Relationships subscale showing higher values. Boys presented higher values in the subscale of Interpersonal Relationships compared to girls (p<0.001) and there are statistical differences between schools relating to the Stress Management subscale (p=0.014). Most users made a positive assessment in terms of perception of utility, perception of ease and attitude towards the TeenPower app. Nonetheless only 33.2% of the adolescents invited activated their profile at the TeenPower app. This final assessment was important to gather information and feedback to improve future prevention programs, which should focus on motivating these adolescents and their parents to use this type of apps. In a future research it will be also important to understand the reasons for teenager's refusal to join this kind of programs.
- CBViewPublication . Brito, Gabriel Correia; Fonseca-Pinto, Rui; Guarino, Maria P.; Lajes, Marlene; Lopes, Nuno Vieira; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); ElsevierThe metabolic syndrome is a set of risk factors associated with increased cardiovascular risk. These changes to the standard metabolic functions are associated with increased blood insulin and with insulin resistance, which is the common feature of disease pathophysiology. Although with admissible genetic inheritance, the metabolic syndrome symptoms increase with age, sedentarism, weight gain, tobacco, and poor dietetic habits. Due to their characteristics, clinical manifestations of metabolic diseases are perceived by the patient at advanced stages of metabolic dysfunction, when the risk of an acute cardiovascular event is high. Early detection of disturbed glucose homeostatic mechanisms, by recording efferent responses to stimuli like meal ingestion, is, therefore, a methodology with diagnostic potential acting as a predictive measure of metabolic dysfunction. This work presents a novel software (CBView) that analyses the records of physiological responses mediated by the carotid bodies to provocation tests, obtained by a new medical device (CBMeter) aiming to the early tracking of changes in autonomic responses that control metabolism, and thus providing quantitative metrics to assess metabolic dysfunction.
- Pediatric-onset and adult-onset separation anxiety disorder across countries in the world mental health surveyPublication . Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas-de-Almeida, José M.; De Girolamo, Giovanni; De Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C.; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); APA - American Psychiatric AssociationObjective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. Results: Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%26.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. Conclusions: Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.
- A model of free tissue transferPublication . Casal, Diogo; Pais, Diogo; Iria, Inês; Mota-Silva, Eduarda; Almeida, Maria Angélica; Alves, Sara; Pen, Cláudia; Farinho, Ana; Mascarenhas-Lemos, Luís; Ferreira-Silva, José; Ferraz-Oliveira, Mário; Vassilenko, Valentina; Videira, Paula A.; O'Neill, João Erse de Goyri; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); Faculdade de Ciências e Tecnologia (FCT); UCIBIO - Applied Molecular Biosciences Unit; DF – Departamento de Física; DCV - Departamento de Ciências da Vida; MYJoVE CorporationFree tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat. This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue. Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.
- HLA-DR expression in cytotoxic T lymphocytesPublication . Salvador, Rute; Correia, Bruna Filipa; Grosa, Daniela; Martins, Telma; Soares Baal, Suelen Cristina; Saraiva, Diana Pereira; Cristóvão-Ferreira, Sofia; Pereira, Isabel Lopes; Rebelo de Almeida, Cátia; Fior, Rita; Jacinto, Antonio; Mathias, Carolina; Braga, Sofia; Cabral, M. Guadalupe; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); iNOVA4Health - pólo NMS; FrontiersT cell-based therapies, involving ex vivo expansion of patients’ T lymphocytes, hold significant promise for chemotherapy resistant cases of breast cancer (BC), although their effectiveness remains challenging. Building on our previous findings that the expression of the antigen presenting molecule, HLA-DR, is crucial on tumor-infiltrating cytotoxic T lymphocytes (CTLs) for a favorable response to neoadjuvant chemotherapy, we further investigated the role of HLA-DR-expressing CTLs in anti-tumor responses and evaluated strategies to amplify these cells. Through in vitro and in vivo experiments, we demonstrated that HLA-DR expression on CTLs is important for effective tumor cell elimination. Notably, blocking HLA-DR or depleting CD4+ T cells impaired CTLs activation, suggesting a critical role for antigen presentation by CTLs to CD4+ T cells through HLA-DR in promoting robust anti-tumor responses. Based on these findings we optimized an ex vivo stimulation protocol that increases the proportion of HLA-DR+CTLs with improved cytotoxicity, prioritizing cell quality over yield. Moreover, we showed that adding anti-PD-1 to the stimulation, further upregulated HLA-DR expression, and intensified CTLs’ cytotoxic ability. This aligns with our in silico analysis suggesting a potential regulatory link between PD-1 and HLA-DR via non-coding RNAs. Overall, our findings open new avenues for advancing T cell-based therapies and improve the outcomes of chemotherapy-resistant-BC.
- The effect of osteoarthritis definition on prevalence and incidence estimatesPublication . Pereira, D.; Peleteiro, B.; Araújo, J.; Branco, Jaime; Branco, Jaime; Santos, R. A.; Ramos, E.; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); ELSEVIER SCI LTDObjective: To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. Method: A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through meta-analysis and between-study heterogeneity was quantified. Results: Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence meta-analysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn't allow us to make any comparison according to joint site or OA definition. Conclusions: Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions.
- A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life settingPublication . Bruyère, Olivier; Cooper, Cyrus; Pelletier, Jean Pierre; Maheu, Emmanuel; Rannou, François; Branco, Jaime; Branco, Jaime; Luisa Brandi, Maria; Kanis, John A.; Altman, Roy D.; Hochberg, Marc C.; Martel-Pelletier, Johanne; Reginster, Jean Yves; Centro de Estudos de Doenças Crónicas (CEDOC); NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); ElsevierThe European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) published a treatment algorithm for the management of knee osteoarthritis (OA) in 2014, which provides practical guidance for the prioritization of interventions. Further analysis of real-world data for OA provides additional evidence in support of pharmacological interventions, in terms of management of OA pain and function, avoidance of adverse events, disease-modifying effects and long-term outcomes, e.g., delay of total joint replacement surgery, and pharmacoeconomic factors such as reduction in healthcare resource utilization. This article provides an updated assessment of the literature for selected interventions in OA, focusing on real-life data, with the aim of providing easy-to-follow advice on how to establish a treatment flow in patients with knee OA in primary care clinical practice, in support of the clinicians' individualized assessment of the patient. In step 1, background maintenance therapy with symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) is recommended, for which high-quality evidence is provided only for the prescription formulations of patented crystalline glucosamine sulfate and chondroitin sulfate. Paracetamol may be added for rescue analgesia only, due to limited efficacy and increasing safety signals. Topical non-steroidal anti-inflammatory drugs (NSAIDs) may provide additional symptomatic treatment with the same degree of efficacy as oral NSAIDs without the systemic safety concerns. Oral NSAIDs maintain a central role in step 2 advanced management of persistent symptoms. However, oral NSAIDs are highly heterogeneous in terms of gastrointestinal and cardiovascular safety profile, and patient stratification with careful treatment selection is advocated to maximize the risk:benefit ratio. Intra-articular hyaluronic acid as a next step provides sustained clinical benefit with effects lasting up to 6 months after a short-course of weekly injections. As a last step before surgery, the slow titration of sustained-release tramadol, a weak opioid, affords sustained analgesia with improved tolerability.
- Corneal sub-basal nerve plexus assessment and its association with phenotypic features and lymphocyte subsets in Sjögren's SyndromePublication . Barcelos, Filipe; Hipólito-Fernandes, Diogo; Barcelos, Filipe; Martins, Catarina; Ângelo-Dias, Miguel; Cardigos, Joana; Martins, Catarina; Monteiro, Ricardo; Alves, Nuno; Ângelo-Dias, Miguel; Vaz-Patto, José; Branco, Jaime; Borrego, Luís Miguel; Branco, Jaime; BORREGO, LUIS MIGUEL; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); WileyPurpose: To assess and compare corneal sub-basal nerve plexus morphology with circulating lymphocyte subsets, immunologic status and disease activity in Sjögren syndrome (SjS) patients. Methods: Fifty-five SjS patients, 63 Sicca patients (not fulfilling SjS criteria), 18 rheumatoid arthritis (RA) patients and 20 healthy controls (HC) were included. Systemic disease activity in SjS was assessed with the ESSDAI score. Lymphocyte subpopulations were studied with flow cytometry. Corneal confocal microscopy and ImageJ software were used to characterize corneal sub-basal nerve plexus in terms of nerve density (CNFD), length (CNFL) and tortuosity (CNFT). Conventional dry eye tests were also performed. Results: CNFL and CNFD were lower in SjS, Sicca and RA groups, compared to HC (p < 0.001 for both SjS and Sicca); CNFL p = 0.005, CNFD p = 0.018 in RA). CNFT was higher in SjS, followed by Sicca, RA and HC. A negative correlation was found between ESSDAI score and CNFL (r=−0.735, p = 0.012). CNFL correlated negatively with IL21+CD8+T cells (r=−0.279, p = 0.039) and a positively with total memory (r = 0.299, p = 0.027), unswitched memory (r = 0.281, p = 0.038) and CD24HiCD27+ (r = 0.278, p = 0.040) B cells. CNFD showed a tendency to significance in its negative correlation with ESSDAI (r=−0.592, p = 0.071) and in its positive correlation with switched memory B cells (r = 0.644, p = 0.068). Conclusions: This is the first study aiming to correlate ocular findings with lymphocyte subsets in SjS. The associations founded between CNFL and CNFD and disease activity, IL21+ follicular T cells and some B-cell subsets suggest that corneal nerve damage may parallel systemic disease activity and inflammatory cells' dynamics.
- A new decision tree for diagnosis of osteoarthritis in primary carePublication . Martel-Pelletier, Johanne; Maheu, Emmanuel; Pelletier, Jean Pierre; Alekseeva, Ludmila; Mkinsi, Ouafa; Branco, Jaime; Branco, Jaime; Monod, Pierre; Planta, Frédéric; Reginster, Jean Yves; Rannou, François; Centro de Estudos de Doenças Crónicas (CEDOC); NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Springer Science and Business Media Deutschland GmbHBackground and aims: Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. Methods: To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA. The IRB used American College of Rheumatology diagnostic criteria. Results: Care pathways based on clinical and radiological findings were developed to identify intervention thresholds for GPs/specialists. To optimize usefulness in the primary care setting, the guidelines were formatted as an uncomplicated, but comprehensive one-page decision tree for each topology, highlighting key aspects of the evaluation process and incorporating red flags. In a two-phase validation stage, the draft guidelines were evaluated by rheumatologists and GPs for project execution, content and perceived benefit. The strength of the guidelines lies in their user-friendly diagram and potential for broad application. Such guidelines will allow GPs to make an easy but definite diagnosis of OA and offer clear guidance about situations requiring an expert opinion. The guidelines have potential to improve patient outcomes and reduce the number of unnecessary procedures. Discussion and conclusions: This project demonstrated the feasibility of developing easy-to-use and effective visual decision trees to facilitate the diagnosis and management of OA of the hip, knee and hand/finger in primary care. The next step should be to conduct a large impact study of implementation of these recommendations in the diagnostic management of OA in general practice in different areas.
- Cohort ProfilePublication . Dias, Sara Simões; Dias, Sara Simões; Rodrigues, Ana Maria; Maria Rodrigues, Ana; Gregório, Maria João; Gregório, Maria João; de Sousa, Rute Dinis; Sousa, RD; Branco, Jaime; Branco, Jaime; Canhão, Helena; Canhão, Helena; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Centro de Estudos de Doenças Crónicas (CEDOC); Oxford University Press