Characterisation of Patients With Chronic Obstructive Pulmonary Disease (COPD) From an Urban Municipality in the Northern Region of Portugal: A Cross-Sectional Study.

Background Pulmonary rehabilitation (PR) is formally indicated to all COPD patients in groups B and E. It positively impacts dyspnoea, health-related quality of life and exercise tolerance, reducing admissions among people with chronic obstructive pulmonary disease (COPD) who have had a recent exacerbation and symptoms of anxiety and depression. There is limited access to PR programmes in Portugal, partially due to insufficient resources or referrals. This study aims to characterise COPD patients and assess whether they have criteria for PR programmes. Data from this study may provide strategic information for healthcare organisations to differentiate and innovate their response to COPD patients. Methodology A cross-sectional study was conducted in an urban municipality in the northern region of Portugal. The sample was randomly extracted from the national primary electronic health records. The sample size (n = 339) was determined considering the population of COPD patients in this region (N = 2818), a 95% confidence level and a margin of error of 5%. Results In this population, the prevalence of COPD is 1.8%. Furthermore, in this sample, 40% (n = 136) of people diagnosed with COPD have a formal indication to participate in PR programmes, although only 14.2% (n = 48) of these patients had access to PR. Conclusion COPD is probably underdiagnosed in this Portuguese region. Most COPD patients have eligibility criteria to be offered PR programmes, although most of them do not benefit from this vital treatment. Investing in community and home-based programmes may increase PR access, reducing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admissions.

Neuroprotective effects of hepatoma-derived growth factor in models of Huntington's disease.

Huntington's disease (HD) is a movement disorder caused by a mutation in the Huntingtin gene that leads to severe neurodegeneration. Molecular mechanisms of HD are not sufficiently understood, and no cure is currently available. Here, we demonstrate neuroprotective effects of hepatoma-derived growth factor (HDGF) in cellular and mouse HD models. We show that HD-vulnerable neurons in the striatum and cortex express lower levels of HDGF than resistant ones. Moreover, lack of endogenous HDGF exacerbated motor impairments and reduced the life span of R6/2 Huntington's disease mice. AAV-mediated delivery of HDGF into the brain reduced mutant Huntingtin inclusion load, but had no significant effect on motor behavior or life span. Interestingly, both nuclear and cytoplasmic versions of HDGF were efficient in rescuing mutant Huntingtin toxicity in cellular HD models. Moreover, extracellular application of recombinant HDGF improved viability of mutant Huntingtin-expressing primary neurons and reduced mutant Huntingtin aggregation in neural progenitor cells differentiated from human patient-derived induced pluripotent stem cells. Our findings provide new insights into the pathomechanisms of HD and demonstrate neuroprotective potential of HDGF in neurodegeneration.

The AAA+ chaperone VCP disaggregates Tau fibrils and generates aggregate seeds in a cellular system.

Amyloid-like aggregates of the microtubule-associated protein Tau are associated with several neurodegenerative disorders including Alzheimer's disease. The existence of cellular machinery for the removal of such aggregates has remained unclear, as specialized disaggregase chaperones are thought to be absent in mammalian cells. Here we show in cell culture and in neurons that the hexameric ATPase valosin-containing protein (VCP) is recruited to ubiquitylated Tau fibrils, resulting in their efficient disaggregation. Aggregate clearance depends on the functional cooperation of VCP with heat shock 70 kDa protein (Hsp70) and the ubiquitin-proteasome machinery. While inhibition of VCP activity stabilizes large Tau aggregates, disaggregation by VCP generates seeding-active Tau species as byproduct. These findings identify VCP as a core component of the machinery for the removal of neurodegenerative disease aggregates and suggest that its activity can be associated with enhanced aggregate spreading in tauopathies.

The eHealth4all@eu Pipeline of Course Development: TIGER Recommendations in Action.

This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.

The impact of small-group virtual patient simulator training on perceptions of individual learning process and curricular integration: a multicentre cohort study of nursing and medical students.

BACKGROUND: The COVID-19 pandemic has precipitated rapid changes in medical education to protect students and patients from the risk of infection. Virtual Patient Simulators (VPS) provide a simulated clinical environment in which students can interview and examine a patient, order tests and exams, prioritize interventions, and observe response to therapy, all with minimal risk to themselves and their patients. Like high-fidelity simulators (HFS), VPS are a tool to improve curricular integration. Unlike HFS, VPS require limited infrastructure investment and can be used in low-resource settings. Few studies have examined the impact of VPS training on clinical education. This international, multicenter cohort study was designed to assess the impact of small-group VPS training on individual learning process and curricular integration from the perspective of nursing and medical students. METHODS: We conducted a multi-centre, international cohort study of nursing and medical students. Baseline perceptions of individual learning process and curricular integration were assessed using a 27-item pre-session questionnaire. Students subsequently participated in small-group VPS training sessions lead by a clinical tutor and then completed a 32-item post-session questionnaire, including 25 paired items. Pre- and post-session responses were compared to determine the impact of the small-group VPS experience. RESULTS: Participants included 617 nursing and medical students from 11 institutions in 8 countries. At baseline, nursing students reported greater curricular integration and more clinical and simulation experience than did medical students. After exposure to small-group VPS training, participants reported significant improvements in 5/6 items relating to individual learning process and 7/7 items relating to curricular integration. The impact of the VPS experience was similar amongst nursing and medical students. CONCLUSIONS: In this multi-centre study, perceptions of individual learning process and curricular integration improved after exposure to small-group VPS training. Nursing and medical students showed similar impact. Small-group VPS training is an accessible, low-risk educational strategy that can improve student perceptions of individual learning process and curricular integration.

Amyloid-like aggregating proteins cause lysosomal defects in neurons via gain-of-function toxicity.

The autophagy-lysosomal pathway is impaired in many neurodegenerative diseases characterized by protein aggregation, but the link between aggregation and lysosomal dysfunction remains poorly understood. Here, we combine cryo-electron tomography, proteomics, and cell biology studies to investigate the effects of protein aggregates in primary neurons. We use artificial amyloid-like ß-sheet proteins (ß proteins) to focus on the gain-of-function aspect of aggregation. These proteins form fibrillar aggregates and cause neurotoxicity. We show that late stages of autophagy are impaired by the aggregates, resulting in lysosomal alterations reminiscent of lysosomal storage disorders. Mechanistically, ß proteins interact with and sequester AP-3 µ1, a subunit of the AP-3 adaptor complex involved in protein trafficking to lysosomal organelles. This leads to destabilization of the AP-3 complex, missorting of AP-3 cargo, and lysosomal defects. Restoring AP-3µ1 expression ameliorates neurotoxicity caused by ß proteins. Altogether, our results highlight the link between protein aggregation, lysosomal impairments, and neurotoxicity.

Anestesia peribulbar na cirurgia da catarata / Peribulbar anesthesia in cataract surgery

Os autores examinaram, de modo retrospectivo, um total de 2672 cirurgias de extraçäo da catarata, pela técnica extracapsular planejada, com indicaçäo para implantaçäo de lente intraocular em todos os casos, dos quais 1446 sob anestesia geral e 1226 com bloqueio peribulbar. Os resultados mostraram que, quando houve ruptura da cápsula posterior sem perda de vítreo, foi possível implantar o cristalino artificial em todos os casos, independente do tipo de anestesia empregada. Sob anestesia geral, tal ruptura ocorreu em 66 casos (4,56 por cento) dos quais 28 (1,93 por cento) perderam vítreo. Quando sob anestesia peribulbar, tais valores foram de 45 casos (3,67 por cento) e 19 (1,55 por cento), respectivamente. Quanto à implantaçäo de lente intraocular de câmara posterior em situaçöes de perda de vítreo, observamos que ela foi mais freqüente na anestesia peribulbar (0,73 por cento = 7 casos) do que sob anestesia geral (0,43 por cento = 3 casos). Tais resultados demonstram a eficácia do bloqueio peribulbar, e suas vantagens se tornam ainda mais patentes a medida que o cirurgiäo adquire mais experiência com o seu manuseio.

Lente intraocular e hipermetropia / Intraocular lens and hyperopia

Foram estudados 96 olhos com comprimento axial menor que 22.0 mm, submetidos a facectomia extracapsular com implante de lente intraocular de câmara posterior. O "folow-up" mínimo foi de 3 meses e o máximo de 84, com média de 24 meses, o poder dióptrico das lentes variou de 20.0 a 28.0, com média de 23.5. Näo foram observadas complicaçöes intra e pós-operatórias que comprometessem a acuidade visual final, com 89.6% dos casos alcançando 20/40 ou melhor. Do ponto de vista refracional, obtivemos com a fórmula SRKII um erro menor que 0.50, 1.25 e 2.00 dioptrias em 23.9%,61.4% e 87.5% dos casos, respectivamente. Com a fórmula SRK, observamos percentuais similares (28.1%, 66.7% e 83.3%). Porém, foi observada a tendência de se manter o olho pseudofácico hipermétrope em 66.7% dos casos, com a SRK e míope em igual percentual com a SRKII

Lente intra-ocular em alta miopia: resultados clínicos e refracionais / Intraocular lens in high myopia: clinical and refraction results

Foram analisados 129 olhos submetidos a extraçäo extracapsular de catarata com implante de cristalino de câmara posterior, com comprimento axial variando de 25,00 mm a 31,90 mm, com média de 26,80 mm. O follow-up mínimo foi de 4 meses e máximo de 76 meses, com média de 23 m. Este estudo retrospectivo evidenciou uma incidência de 4,7//(6 casos) de descolamento de retina, dos quais em 4 (66,66//) a cápsula posterior foi aberta de forma primária, e nos demais, a cápsula estava intacta. A incidência de edema cistóide de mácula foi de 3//, sendo a metade de caráter permanente e os restantes tendo respondido satisfatoriamente ao tratamento instituido. No cômputo final, com os casos de DR operados e os de ECM tratados, e afastadas as causas pré-operatórias de baixa de acuidade visual (coroidose miópica, degeneraçäo macular, ambliopia anisometrópica), 94,95//dos casos lograram alcançar alcançar AV igual ou melhor que 20/40. Quanto ao aspecto refracional, os autores observaram que a utilizaçäo da fórmula SRK (Sanders-Retzlaff-Kraff) segue sendo mais adequada do que a SRK-II para o cálculo do poder dióptrico das lentes intra-oculares, principalmente nos olhos extremamente longos (com comprimento axial >= 28,50 mm). Ao se comparar os resultados obtidos com o emprego das duas fórmulas, conclui-se que as primeiras delas, dá margem de acerto de até 0,50 diptria, em 41,5//, enquanto que com a segunda, tal percentual cai para 35,6//. Se tal margem é ampliada para até 1,25 dioptrias, tais valores se alteram para 73//(com a SRK) e 62//(com a SRK-II). Outro dado importante a ser considerado neste estudo, é o da tendência que a fórmula SRK tem em miopizar os olhos operados (55,4//), enquanto que com a SRK-II, a tendência é de hipermetropizá-los (57,4//), o que näo é o desejável para o paciente que sempre conviveu com a situaçäo de portador de miopia

Experiência de 2 anos com lentes intra-oculares de modelo circular / Two years experience with intraocular lens circular model

Os AA. descrevem sua experiência com os implantes de lentes intra-oculares de câmara posterior de desenho circular (modelo CHIP), combinados com a técnica intercapsular de extraçäo da catarata, analisando nível de dificuldade com o seu manuseio, centralizaçäo, acuidade visual pós-operatória, complicaçöes e incidência de opacificaçäo da cápsula posterior. Após a realizaçäo de 54 implantes deste tipo, e com um "follow-up" entre 7 e 26 meses, foi observado que a implantaçäo é täo fácil quanto aquela realizada com modelos em J ou C modificado, uma vez dominada a técnica intercapsular, em todos os caso se logrou colocar as lentes dentro do saco cristalineano, alcançando excelente centralizaçäo; a acuidade visual e complicaçöes se mostraram com resultados similares às demais lentes de câmara posterior. No entanto, a incidência de opacificaçäo da cápsula posterior näo mostrou a diminuiçäo que era de se esperar em se tratando de um modelo com alça totalmente fechada, toda em PMMA: cerca de 13 olhos (24 p/cento) vieram a apresentar tal opacificaçäo, até o presente momento

Complicaçöes da cirurgia da catarata com implantes intra-oculares / Complications of catarat extraction with intra-ocular implants

As principais complicaçöes de cirurgia de catarata e da colocaçäo de implantes intra-oculares, säo discutidas bem como os meios empregados durante, antes e depois da cirurgia, para evitá-los

Progressos na cirurgia da catarata congênita / Progress in congenital cataracts surgery

A utilizaçäo rotineira de microscópio cirúrgico e de técnicas adequadas representa um avanço no tratamento das cataratas congenitas. A cirurgia se torna mais fácil com as técnicas de aspiraçäo irrigaçäo e está indicada em todos os casos assim que o diagnóstico for feito. Os resultados do tratamento da catarata congenita ainda säo influenciados pela dificuldade de correçäo optica, a existência de complicaçöes como irites e a persistência de opacidades na cápsula posterior