Public involvement in chronic respiratory diseases research: A qualitative study of patients', carers' and citizens' perspectives

INTRODUCTION

Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation.

METHODS

A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi-structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team.

RESULTS

Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18-72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life.

CONCLUSION

Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal.

PATIENT OR PUBLIC CONTRIBUTION

This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network-a collaborative network of research in respiratory health.

PUBLIC SUMMARY

In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.

Rituximab therapy for childhood onset idiopathic nephrotic syndrome: experience of a Portuguese tertiary center

INTRODUCTION

Rituximab (RTX) is a therapeutic option in pediatric difficult-to-treat idiopathic nephrotic syndrome (NS). We aimed to assess the efficacy and safety of RTX use in these patients.

METHOD

A retrospective study of all patients with idiopathic NS treated with RTX was conducted in a pediatric nephrology division of a tertiary hospital. Demographic, anthropometric, clinical and analytical data were collected prior to treatment and at 6, 12, and 24 months.

RESULTS

Sixteen patients were included (11 males), with a median (25th-75th percentile, P25-P75) age at diagnosis of 2 (2.0-2.8) years. Fifteen were steroid-sensitive and 1 was steroid-resistant and sensitive to cyclosporine. The median age at administration of RTX was 10 (6.3-14.0) years. Throughout a median follow-up time of 2.5 (1.0-3.0) years, 6 (37.5%) patients achieved partial remission and 7 (43.8%) had no relapses and were not taking any immunosuppressants at the 24-month follow-up visit. Regarding complications, 1 patient presented persistent hypogammaglobulinemia. Compared with the 12-month period before RTX, there was a decrease in the median number of relapses at 6 and 12 months [3 (3.0-4.0) vs 0 (0-0.8) and 0.50 (0-1.0), respectively; p = 0.001] and in the daily steroids dose (mg/kg/day) at 6, 12, and 24 months [0.29 (0.15-0.67)vs [0.10 (0.07-0.13); p = 0.001], [0.12 (0.05-0.22); p = 0.005] and [0.07(0.04-0.18); p = 0.021]], respectively. There was also a reduction in the median BMI z score at 24 months [2.11 (0.45-3.70) vs. 2.93 (2.01-3.98); p = 0.049].

CONCLUSION

Our results confirm the efficacy and safety of RTX use in pediatric idiopathic NS and highlight its' potential cardiometabolic benefits.

Modelling the response of urban lichens to broad-scale changes in air pollution and climate

To create more resilient cities, it is important that we understand the effects of the global change drivers in cities. Biodiversity-based ecological indicators (EIs) can be used for this, as biodiversity is the basis of ecosystem structure, composition, and function. In previous studies, lichens have been used as EIs to monitor the effects of global change drivers in an urban context, but only in single-city studies. Thus, we currently do not understand how lichens are affected by drivers that work on a broader scale. Therefore, our aim was to quantify the variance in lichen biodiversity-based metrics (taxonomic and trait-based) that can be explained by environmental drivers working on a broad spatial scale, in an urban context where local drivers are superimposed. To this end, we performed an unprecedented effort to sample epiphytic lichens in 219 green spaces across a continental gradient from Portugal to Estonia. Twenty-six broad-scale drivers were retrieved, including air pollution and bio-climatic variables, and their dimensionality reduced by means of a principal component analysis (PCA). Thirty-eight lichen metrics were then modelled against the scores of the first two axes of each PCA, and their variance partitioned into pollution and climate components. For the first time, we determined that 15% of the metric variance was explained by broad-scale drivers, with broad-scale air pollution showing more importance than climate across the majority of metrics. Taxonomic metrics were better explained by air pollution, as expected, while climate did not surpass air pollution in any of the trait-based metric groups. Consequently, 85% of the metric variance was shown to occur at the local scale. This suggests that further work is necessary to decipher the effects of climate change. Furthermore, although drivers working within cities are prevailing, both spatial scales must be considered simultaneously if we are to use lichens as EIs in cities at continental to global scales.

Terapia com Rituximabe para síndrome nefrótica idiopática de início na infância: experiência de um centro terciário português

Resumo Introdução: Rituximabe (RTX) é uma opção terapêutica na síndrome nefrótica (SN) idiopática pediátrica de difícil tratamento. Visamos avaliar eficácia e segurança do uso de RTX nestes pacientes. Método: Realizou-se estudo retrospectivo de todos os pacientes com SN idiopática tratados com RTX, em uma unidade de nefrologia pediátrica de um hospital terciário. Dados demográficos, antropométricos, clínicos e analíticos foram coletados antes do tratamento e aos 6, 12 e 24 meses. Resultados: Incluímos 16 pacientes (11 do sexo masculino), com idade mediana (percentil 25–75, P25–P75) de 2 (2,0–2,8) anos ao diagnóstico. Quinze eram sensíveis a esteroides, e 1 resistente a esteroides e sensível à ciclosporina.A idade mediana na administração do RTX foi 10 (6,3–14,0) anos. Durante um tempo mediano de acompanhamento de 2,5(1,0–3,0) anos, 6 (37,5%) pacientes alcançaram remissão parcial e 7 (43,8%) não tiveram recidivas e não estavam tomando imunossupressor no acompanhamento aos 24 meses. Quanto às complicações,1 paciente apresentou hipogamaglobulinemia persistente. Comparado ao período de12 meses anterior ao RTX, houve diminuição no número mediano de recidivas em 6 e 12 meses [3 (3,0–4,0) vs 0 (0–0,8) e 0,50 (0–1,0), respectivamente; p = 0,001] e na dose diária de esteroides (mg/kg/dia) aos 6, 12 e 24 meses [0,29 (0,15–0,67) >vs [0,10 (0,07–0,13); p = 0,001], [0,12 (0,05–0,22); p = 0,005] e [0,07 (0,04–0,18); p = 0,021], respectivamente. Houve também redução na mediana do escore z do IMC aos 24 meses [2,11 (0,45–3,70) vs 2,93 (2,01–3,98);p = 0,049]. Conclusões: Nossos resultados confirmam a eficácia e segurança do uso de RTX em SN idiopática pediátrica, destacando seus potenciais benefícios cardiometabólicos.

MO1026: Performance of Creatinine and Cystatin-Based Estimates of GFR in Paediatric Kidney Transplant Recipients. Comparison of the CKD-EPI Age- Adjusted Creatinine eGFR with Previous Formulas

BACKGROUND AND AIMS

Estimation of glomerular filtration rate (GFR) is essential for renal function evaluation and the surveillance of kidney transplant recipients. We aimed to compare the GFR estimation by different formulas using creatinine and/or cystatin C, in paediatric kidney transplant recipients and to compare the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation with age-adjusted creatinine values for height-independent estimated GFR (eGFR) calculation. We also intend to evaluate the impact of body mass index (BMI) influence on eGFR.

METHOD

Data on paediatric renal transplant patients (n = 35) with stable graft function for more than 6 months post-transplantation were enrolled. eGFR was calculated using the revised Schwartz (bedside Cr), CKD-EPI (Cr), CKiD (CysC), Zappitelli (CysC), combined Schwartz (Cr/CysC) and combined Zappitelli (Cr/CysC) formulas. The estimation by CKD-EPI formula used age and sex-adjusted creatinine values to adult levels with 40 as assigned age (CKD-EPI40).

RESULTS

A total of 35 patients were included, 26 (76%) were male, with a median age of 16 (4–18) years and a median BMI of 21.27 (15.20–32.29) with a Z-score median of 3.26 (2–5). The median eGFR obtained by the Schwartz [64.39 (23.96–115.16) mL/min/1.73 m2] and by the CKD-EPI40 equation [64.99 (13.98-141.80) mL/min/1.73 m2] was similar (P = .176). When compared with the Schwartz estimation, Cys-based eGFR were significantly lower (by CKiD-CysC, 49.48 (25.47–84.68) (P < .001), by Zappitelli formula 51.31 (24.74–92.61) (P < .001), by combined Schwartz 51.37 (24.07–85.31), (P < .001), by combined Zappitelli 54.83 (20.64–109.68).The correlations between eGFR by all formulas were strong and statistically significant, especially between the combined Schwartz and the combined Zappitelli (r = 0.97). The same pattern of differences between the eGFR estimations was observed when BMI groups (normal versus overweight) were analysed separately, with all formulas being significantly different for Schwartz except for CKD-EPI.

CONCLUSION

As expected, formulas with creatinine were similar to each other but significantly different when compared with formulas that included cystatin. As demonstrated in previous studies, the combined formulas appear to be the closest estimates of the GFR calculated by exogenous methods. Thus, estimates that consider only creatinine may overestimate the GFR. The eGFR obtained by the adjusted CDK-EPI formula is similar to that obtained by the Schwartz bedside, unlike the other formulas. In this study, we did not find differences regarding the BMI, probably due to the number of this sample.

Genetic atypical hemolytic uremic syndrome in children: a 20-year experience from a tertiary center

Introduction:

Atypical hemolytic uremic syndrome (aHUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury, which primarily affects preschool-aged children. This study’s aim was to describe the clinical profile, management, and long-term outcome of the genetic aHUS patients admitted to a tertiary care pediatric nephrology center during 20 years.

Methods:

We performed a retrospective analysis of the clinical records of all aHUS patients younger than 18 years with identified genetic mutations. Data on clinical features, genetic study, therapeutic interventions, and long-term outcomes were reviewed.

Results:

Five cases of aHUS with an identified genetic mutation were included; all were inaugural cases with the youngest being 4 months old. Complement factor H gene mutation was identified in four patients. Therapeutic plasma exchange was performed for acute management in 4 patients, one of whom also needed acute renal replacement therapy (peritoneal dialysis). All patients went on complete remission, 2 had more than one relapse but only 1 of these progressed to chronic kidney disease during the follow-up period (median (25th-75th percentile), 136 (43.5-200.5) months).

Conclusion:

In children, the prognosis of renal function seems to be strongly dependent on the genetic background, thus being crucial to perform genetic study in all aHUS cases. In our cohort, 2 patients presented genetic mutations not previously described. Recent innovations on the genetic field leading to the identification of new mutations has lead to a better understanding of aHUS pathogenesis, but further studies, focusing on the genotype-phenotype correlation, with longer follow-up periods, are needed.

MO1022CENTRAL VENOUS CATHETERS FIRST - THE ACHILLES’ HEEL IN PEDIATRIC HEMODIALYSIS VASCULAR ACCESS

Background and Aims

Management of children with end-stage kidney disease (ESKD) requiring dialysis is always challenging and particular concerns exists regarding vascular access. International reports through the years are not satisfactory, with a high rate of central venous catheter (CVC), when “Fistula First” is the goal in Hemodialysis (HD). Suggested reasons for this phenomenon include, for example, age-related anatomical limitations, shorter awaiting times for or “scheduled” transplantation, pain and anxiety related to punctures or lack of pediatric/surgical expertise. Here we present the results of the last 13 years of experience in pediatric HD vascular access from a reference center in northern Portugal.

Method

A retrospective descriptive study of patients admitted to our pediatric HD Unit between January 2007 and December 2020. Clinical data was collected from medical records.

Results

40 patients were enrolled, mainly boys (n=22, 55%), mean age at admission 10.9±5.3 years (1-17 years), 63% weighing more than 30 kg (n =25) and 15% less than 15kg (n=6). More than half were incident patients starting on HD (n=22, 55%), 42.5% were transferred from peritoneal dialysis (PD) and one patient had a previous kidney transplant (KT). Regarding CKD etiology, 52.5% (n=21) were mainly due to congenital anomalies of the kidney and urinary tract; chronic glomerulonephritis was responsible for 20% of cases (n=8). Most patients initiated HD with a CVC (n=35, 87.5%), including two patients with an arteriovenous fistula (AVF) who required a temporary CVC until fistula maturation. At the end of follow-up, about 45% of the patients ended up with an AVF (comparing to 17.5% at the beginning) and, not unexpectedly, 88.9% (n=16) of them weighed more than 30kg and only one child less than 15 kg. The mean duration of dialysis was 1.2±1.8 years (1 month-8 years); 24 patients were submitted to KT (60%), 6 transferred to PD (15%) and only 4 remain on HD. Average waiting times for KT are quite longer in patients with AFV (1.7±2 years), in comparison to CVC (0.4±0.3 years).

Conclusion

CVC is by far the most used access in incident patients starting on HD. In our center it seems justified by the anatomical limitations of younger and smaller patients, as wells as expected shorter awaiting time for KT. Infectious and mechanical complications must be weighed when using CVC, mainly considering the probable need for different renal replacing techniques over the years. Although our data is quite similar to several international reports and other center experiences, we still aim for the best, with an expected improvement of these results within the coming years. For now, a notable increase in AVF placement at the end of the follow-up is already an encouraging fact.

Functional Traits in Lichen Ecology: A Review of Challenge and Opportunity

Community ecology has experienced a major transition, from a focus on patterns in taxonomic composition, to revealing the processes underlying community assembly through the analysis of species functional traits. The power of the functional trait approach is its generality, predictive capacity such as with respect to environmental change, and, through linkage of response and effect traits, the synthesis of community assembly with ecosystem function and services. Lichens are a potentially rich source of information about how traits govern community structure and function, thereby creating opportunity to better integrate lichens into 'mainstream' ecological studies, while lichen ecology and conservation can also benefit from using the trait approach as an investigative tool. This paper brings together a range of author perspectives to review the use of traits in lichenology, particularly with respect to European ecosystems from the Mediterranean to the Arctic-Alpine. It emphasizes the types of traits that lichenologists have used in their studies, both response and effect, the bundling of traits towards the evolution of life-history strategies, and the critical importance of scale (both spatial and temporal) in functional trait ecology.

Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings

BACKGROUND

This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3).

METHODS

Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity.

RESULTS

The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established.

LIMITATIONS

Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties.

CONCLUSIONS

Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.

How much matching there is in functional, phylogenetic and taxonomic optima of epiphytic macrolichen communities along a European climatic gradient?

Adopting an integrative approach that explicitly includes the different facets of biodiversity is crucial to assess the response of biological communities to changing environments. The identification of the optimal climatic conditions where communities maximize their functional, phylogenetic and taxonomic diversity is useful to compare whether the optima of the different facets of biodiversity match. Using a wide climatic gradient across Europe, we quantified the functional, phylogenetic and taxonomic diversity of epiphytic macrolichen communities, which are valuable early-warning ecological indicators. We ordinated 22 environmental variables and simultaneously illustrated non-parametric regressions of the diversity metrics against the climatic space using the 'hilltop plot' method to detect the climatic conditions in which the different diversity facets peaked and to compare the match between them. Functional diversity predicted at least part of the peaks of phylogenetic and taxonomic diversity, but phylogenetic and taxonomic hotspots did not overlap. Epiphytic macrolichen communities maximized their functional and phylogenetic diversity in the southernmost forests, with the Mediterranean region appearing as a biodiversity hotspot. Regarding the studied traits, photobiont type and growth form showed clearly defined optima while the quantitative physiological traits and families' optima did not show this pattern in response to climate. The different facets of biodiversity were not surrogates of each other highlighting the need for an integrative approach to assess the effect of environmental changes on communities and to establish conservation priorities. As functional traits mediated the response of lichen communities to climate, preserving high functional diversity might indirectly preserve high phylogenetic and taxonomic diversity. Relevant ecological indicators useful to develop rapid assessment methods to evaluate the effects of climatic changes include the photobiont type and growth form. The lack of relation between quantitative traits and climate call for further research to unveil their role as ecological indicators of small-scale variables or as effect traits.

First report of Kudoa sp. in the palate and pharyngeal musculature of Gobioides grahamae Palmer and Wheeler, 1955 (Perciformes, Gobiidae) from Marajó Island, Brazil

ABSTRACT The aim of this study was to describe the first occurrence ofKudoasp. inGobioides grahamae, contributing to the understanding of this group of parasites in the Amazonian ichthyofauna. Forty specimens ofG. grahamaecollected from the natural environment were analyzed. Cysts ofKudoasp. were diffusely distributed through the striated skeletal muscle fibers with severe edema and inflammatory infiltrate composed of lymphocytes were observed in 30% of the specimens. Edema and marked coagulation necrosis of the muscle fibers was associated with infection byKudoasp. spores, which had accumulated inside the skeletal muscle fibers. Although there are no records of foodborne outbreaks caused by Kudoa spp. in Brazil, it is of paramount importance that we evaluate its occurrence, since the consumption of fish, especially raw fish, has increased because of the adoption of Japanese cuisine. To minimize the economic impacts on the fisheries market and the risk of this parasite to public health, it is necessary to initiate a program to monitor the presence of this likely underdiagnosed, emerging parasite.

476 An unusual location and size of a papillary fibroelastoma

Background

The incidence of primary cardiac tumours is low. Although histologically benign, left-sided, larger sized (≥ 1 cm) and highly mobile tumors have a higher risk of embolization.

Papillary fibroelastomas frequently occur on the aortic or mitral valves, with only 10% arising from nonvalvular surfaces. Since they are small and usually attached to moving valves, CT and MRI technique modalities have more difficulty in detecting them, with echocardiography remaining the most common exam for the diagnosis.

Clinical case description:

A 69-year-old woman, with known history of breast cancer treated with chest radiation ten years ago. She was completely asymptomatic, but in a routine echocardiography a left ventricular heterogeneous round mass with 22x25mm with a likely pedunculated attachment in the apical region was diagnosed. The remaining exam was remarkably normal, namely with normal left ventricular size and function with no wall motion abnormalities.

Because the wall motion appeared normal, the mass was interpreted as a tumour. However, a thrombus could not be excluded. After four weeks of therapy with Warfarin and aspirin, a MRI was performed. The apical mass had similar dimensions (22x23mm) and the exam was inconclusive (myxoma? fibroma? thrombus?) despite no signs of left ventricular fibrosis with late gadolinium enhancement.

Since the risk of embolization was high and there was no reduction in size with anticoagulation therapy, surgery was performed. Using a transaortic valve route, a 28x30mm mass with a pedunculated attachment in the apical region was removed. The mass had a macroscopic appearance of a sea anemone with gelatinous material. Histological examination made the final diagnosis of a papillary fibroelastoma.

Conclusion

Large, left-sided mobile tumors should be excised to prevent sudden death and embolization. Here we present the case of a papillary fibroelastoma with a rare localization and an unusual size. Some clinical cases have raised the question for a relation between previous chest radiotherapy and the occurrence of papillary fibroelastomas.

Abstract 476 Figure.

Are measures of marital satisfaction valid for women with depressive symptoms? The examination of factor structure and measurement invariance of the Couple Satisfaction Index-4 across depression levels in Portuguese women

Marital satisfaction (MS) is a key indicator of mental and physical health. Factor structure of MS measures in individuals with clinical levels of depression as well as their measurement invariance across groups with different levels of depressive symptoms were not yet explored. The lack of evidence of measurement invariance might compromise valid comparisons between individuals with elevated and minimal depressive symptoms in MS. This study examined the factor structure of the Couple Satisfaction Index-4 (CSI-4) among women with clinical levels of depression, tested the CSI-4 measurement invariance across depression levels groups, and investigated CSI-4 convergent and divergent validity. Participants were 891 heterosexual married/cohabiting women who were assigned into one of two groups based on assessment of their levels of depressive symptoms. Participants completed the CSI-4 and self-reported measures used to examine convergent and divergent validity. Support was found for the factor structure of the CSI-4 for the total sample and both elevated depressive symptoms and minimal depressive symptoms groups. Subsequent multigroup confirmatory factor analyses supported the measurement invariance of the CSI-4 across depression levels groups. The CSI-4 revealed excellent values of internal consistency and convergent and divergent validity. Our findings suggest that CSI-4 produces comparable response patterns across depression groups and thus meaningful comparisons between groups can be performed.

Spatially modelling the risk areas of chronic exposure to hydrothermal volcanic emissions using lichens

Human populations living in volcanically active areas are chronically exposed to volcanogenic air pollution, potentially contributing to long-term adverse health effects. However, mapping chronic exposure is difficult due to low spatial resolution of monitoring data on air pollutants and the need for time integration. To overcome these problems, lichens were tested as ecological indicators of hydrothermal volcanic air pollution, considering their bioaccumulation capacity over time, by transplanting them from a reference area to several sites (n = 39) in a volcanic area. The test was developed at Furnas volcano (Azores, Portugal). A stratified sampling design was followed using previous measurements of soil CO₂ flux at ground level and the distance to the main fumarolic fields. After 6 months of exposure, lichen transplants were analyzed for S isotopic ratio (δ³⁴S), which strongly related with the distance to fumarolic fields on a logarithmic regression, serving as an appropriate hydrothermal exposure biomarker. Considering kriging interpolated δ³⁴S values as tracer of airborne hydrothermal emissions and habitational areas as proxy of ongoing human presence, a map was built relating both information per area unit to spatially model risk areas. It was estimated that 26% of habitational areas in the study area stand at high or very high risk of outdoors chronic exposure to airborne hydrothermal emissions. This methodologic approach to produce chronic exposure risk maps is applicable to other volcanically active and inhabited areas of the world, with time-integration and high spatial resolution, contributing in this way for spatially focusing future human health assessments.

Modeling the provision of air-quality regulation ecosystem service provided by urban green spaces using lichens as ecological indicators

The UN Sustainable Development Goals states that urban air pollution must be tackled to create more inclusive, safe, resilient and sustainable cities. Urban green infrastructures can mitigate air pollution, but a crucial step to use this knowledge into urban management is to quantify how much air-quality regulation can green spaces provide and to understand how the provision of this ecosystem service is affected by other environmental factors. Considering the insufficient number of air quality monitoring stations in cities to monitor the wide range of natural and anthropic sources of pollution with high spatial resolution, ecological indicators of air quality are an alternative cost-effective tool. The aim of this work was to model the supply of air-quality regulation based on urban green spaces characteristics and other environmental factors. For that, we sampled lichen diversity in the centroids of 42 urban green spaces in Lisbon, Portugal. Species richness was the best biodiversity metric responding to air pollution, considering its simplicity and its significative response to the air pollutants concentration data measured in the existent air quality monitoring stations. Using that metric, we then created a model to estimate the supply of air quality regulation provided by green spaces in all green spaces of Lisbon based on the response to the following environmental drivers: the urban green spaces size and its vegetation density. We also used the unexplained variance of this model to map the background air pollution. Overall, we suggest that management should target the smallest urban green spaces by increasing green space size or tree density. The use of ecological indicators, very flexible in space, allow the understanding and the modeling of the provision of air-quality regulation by urban green spaces, and how urban green spaces can be managed to improve air quality and thus improve human well-being and cities resilience.

Local topographic and edaphic factors largely predict shrub encroachment in Mediterranean drylands

Shrub encroachment influences several ecosystem services in drylands worldwide. Yet, commonly used strategies to reduce encroachment show a low medium-term success, calling for a better understanding of its causes. Previous works identified multiple drivers responsible for this phenomenon, including anthropogenic and environmental causes. However, the relative effect of climate, topography and edaphic factors on shrub encroachment is not fully understood nor has been properly quantified in Mediterranean Basin drylands. Also, understanding how these drivers lead to changes in plant communities' functional traits associated to shrub encroachment is crucial, considering traits influence ecosystem processes and associated ecosystem services. Here, we studied the understory of a Mediterranean dryland ecosystem composed of savanna-like Holm-oak woodlands, along a regional climatic gradient. We specifically assessed (i) how climatic, topographic and edaphic factors influence understory relative shrub cover (RSC) and (ii) their direct and indirect effects (via RSC) on plant functional traits. We studied the mean and diversity of 12 functional traits related to plant regeneration, establishment, and dispersal, at the community-level. We found that, under similar low-intensity land use, topographic and edaphic factors, namely slope variations and soil C:N ratio, were the most important predictors of shrub encroachment, determining communities' functional characteristics. Climate, namely summer precipitation, had a much lesser influence. Our model explained 52% of the variation in relative shrub cover. Climate had a stronger effect on a set of functional traits weakly involved in shrub encroachment, related to flowering and dispersal strategies. We show that shrub encroachment is largely predicted by topo-edaphic factors in Mediterranean drylands subject to conventional low-intensity land use. Hence, management strategies to reduce encroachment need to take these drivers into account for efficient forecasting and higher cost-effectiveness. Our results suggest that climate change might not greatly impact shrub encroachment in the Mediterranean Basin, but may affect functional structure and reduce functional diversity of plant communities, thus affecting ecosystem functioning.

Selecting lichen functional traits as ecological indicators of the effects of urban environment

Air pollution and the urban heat island effect are known to directly affect ecosystems in urban areas. Lichens, which are widely known as good ecological indicators of air quality and of climatic conditions, can be a valuable tool to monitor environmental changes in urban environments. The objective of this work was to select lichen functional traits and functional groups that can be used as ecological indicators of the effects of urbanization, with emphasis in the Southern subtropics, where this had never been done. For that, we assessed lichen functional composition in urban sites with different population density, which was considered as proxy for grouping sites in two levels of urbanization (low and medium/high). This a priori grouping was based on their significantly differences on air pollutants and land cover. Urbanization and air pollution showed to affect all lichen functional traits, with different responses depending on the functional group. Medium/high density urbanization was associated to an increase on the mean relative abundance of lichens with chlorococcoid green algae, foliose narrow lobes, soredia as the main reproduction strategy, pruinose thallus and containing secondary metabolites for chemical protection. Lower density urbanization showed a higher relative frequency of cyanolichens and lichens with Trentepohlia as the main algae, loosely attached crustose thallus and isidia as the main reproductive structure. The differences found on photobiont and growth form traits in response to the environmental variables used as proxies of microclimatic conditions (forest cover and number of trees around the sampling units), enabled us to detect the urban heat island effect (drier conditions in more urbanized sites).

Bioactivity of Acanthus mollis - Contribution of benzoxazinoids and phenylpropanoids

ETHNOPHARMACOLOGICAL RELEVANCE

Acanthus mollis is a plant native to the Mediterranean region, traditionally used as diuretic, anti-inflammatory and soothing of the mucous membranes of the digestive and urinary tract and externally as healing of wounds and burns, also demonstrating analgesic and anti-inflammatory activities. However, studies focused on its phytochemical composition as well as scientific proof of Acanthus mollis efficacy are scarce.

AIM OF THE STUDY

The proposed work aims to perform a phytochemical characterization and evaluation of the therapeutic potential of Acanthus mollis, based on biological properties that support its traditional uses.

MATERIAL AND METHODS

In this study, an 96% ethanol extract from Acanthus mollis leaves was obtained and its phytochemical composition evaluated using High Performance Liquid Chromatography with Photodiode Array Detector coupled to Electrospray Ionization Mass Spectrometry (HPLC-PDA-ESI/MSⁿ). The chemical structure of the compound isolated was elucidated using ¹H and ¹³C Nuclear Magnetic Resonance (NMR), ¹H-correlation spectroscopy (¹H-COSY), heteronuclear single quantum correlation (HSQC) and heteronuclear multiple-bond correlation (HMBC). The quantification of the constituents was performed using two external standards (2,4-dihydroxy-1,4-benzoxazin-3-one and verbascoside). The antioxidant activity was determined by the 2,2-diphenyl-1-pycrylhydrazyl (DPPH) assay. Anti-inflammatory activity was determined measuring the inhibition of nitric oxide production by RAW 264.7 macrophages stimulated with the TLR4 agonist lipopolysaccharide (LPS) and through lipoxygenase (LOX) inhibition assay. The cytotoxicity was screened on two lines (RAW 264.7 and HaCaT) using the resazurin assay.

RESULTS

Compounds such as verbascoside and its derivatives, as well as benzoxazinoids were found as the main constituents. A percentage of 5.58% was verified for the 2,4-dihydroxy-1,4-benzoxazin-3-one (DIBOA) derivatives. DIBOA was the main compound of the extract. Significant concentrations were also found for phenylpropanoids, which constitute about 4.39% of the total compounds identified. This extract showed antioxidant capacity against DPPH (IC₅₀ = 40.00 ± 1.59 μg/mL) and superoxide anion (IC₅₀ = 29.42 ± 1.99 μg/mL). It also evidenced anti-inflammatory potential in RAW 264.7 macrophages, presenting capacity for nitric oxide reduction (IC₅₀ = 28.01 μg/mL). Moreover, in vitro studies have shown that this extract was able to inhibit the lipoxygenase, with an IC₅₀ of 104.39 ± 4.95 µg/mL. Importantly, all effective concentrations were devoid of cytotoxicity in keratinocytes, thus highlighting the safety of the extract for the treatment of skin inflammatory related diseases. Concerning macrophages it was also possible to disclose concentrations showing anti-inflammatory activity and without cytotoxicity (up to 30 µg/mL). The benzoxazinoid DIBOA demonstrated a considerable anti-inflammatory activity suggesting its important contribution to this activity.

CONCLUSIONS

These results corroborate the anti-inflammatory properties traditionally attributed to this plant. Among the compounds identified in this study, benzoxazinoids exhibited a significant anti-inflammatory activity that was never previously described. Ethanol seems to be a good option for the extraction of these bioactive compounds, since relevant antioxidant/anti-radical and anti-inflammatory activities were found for this extract.

Green spaces are not all the same for the provision of air purification and climate regulation services: The case of urban parks

The growing human population concentrated in urban areas lead to the increase of road traffic and artificial areas, consequently enhancing air pollution and urban heat island effects, among others. These environmental changes affect citizen's health, causing a high number of premature deaths, with considerable social and economic costs. Nature-based solutions are essential to ameliorate those impacts in urban areas. While the mere presence of urban green spaces is pointed as an overarching solution, the relative importance of specific vegetation structure, composition and management to improve the ecosystem services of air purification and climate regulation are overlooked. This avoids the establishment of optimized planning and management procedures for urban green spaces with high spatial resolution and detail. Our aim was to understand the relative contribution of vegetation structure, composition and management for the provision of ecosystem services of air purification and climate regulation in urban green spaces, in particular the case of urban parks. This work was done in a large urban park with different types of vegetation surrounded by urban areas. As indicators of microclimatic effects and of air pollution levels we selected different metrics: lichen diversity and pollutants accumulation in lichens. Among lichen diversity, functional traits related to nutrient and water requirements were used as surrogates of the capacity of vegetation to filter air pollution and to regulate climate, and provide air purification and climate regulation ecosystem services, respectively. This was also obtained with very high spatial resolution which allows detailed spatial planning for optimization of ecosystem services. We found that vegetation type characterized by a more complex structure (trees, shrubs and herbaceous layers) and by the absence of management (pruning, irrigation and fertilization) had a higher capacity to provide the ecosystems services of air purification and climate regulation. By contrast, lawns, which have a less complex structure and are highly managed, were associated to a lower capacity to provide these services. Tree plantations showed an intermediate effect between the other two types of vegetation. Thus, vegetation structure, composition and management are important to optimize green spaces capacity to purify air and regulate climate. Taking this into account green spaces can be managed at high spatial resolutions to optimize these ecosystem services in urban areas and contribute to improve human well-being.

Infection of the muscle tissue of the filter-feeding cichlid, Chaetobranchopsis orbicularis Steindachner, 1875, by Kudoa orbicularis (Myxozoa: Multivalvulidae) on Marajó Island in the Brazilian Amazon region

ABSTRACT This study describes aspects of infections caused by the myxosporidian Kudoa orbicularis in filter-feeding cichlids, Chaetobranchopsis orbicularis, caught in the Arari River in the municipality of Cachoeira do Arari, on Marajó Island, Pará, Brazil. The parasite forms pseudocysts scattered throughout the striated epaxial and hypaxial muscles. Samples embedded in paraffin were analyzed histologically using hematoxylin-eosin, Gömöri, Ziehl-Neelsen, and Giemsa staining. Necropsy of the C. orbicularis specimens revealed that 100% (50/50) were infected with K. orbicularis. The specimens presented grossly abnormal muscle texture, resulting in extensive inconsistencies and weakness. Progressive softening of the muscles was observed during necropsy, indicating the rapid enzymatic autolysis of the tissue. The parasite found in the muscle tissue of C. orbicularis was identified as K. orbicularis, with clinical signs of disease being observed in the fish. The necropsy revealed extensive damage to the host organism, with well-established fibrocystic infections in the muscle fibers, associated with post mortem myoliquefaction.

Ecological impacts of atmospheric pollution and interactions with climate change in terrestrial ecosystems of the Mediterranean Basin: Current research and future directions

Mediterranean Basin ecosystems, their unique biodiversity, and the key services they provide are currently at risk due to air pollution and climate change, yet only a limited number of isolated and geographically-restricted studies have addressed this topic, often with contrasting results. Particularities of air pollution in this region include high O₃ levels due to high air temperatures and solar radiation, the stability of air masses, and dominance of dry over wet nitrogen deposition. Moreover, the unique abiotic and biotic factors (e.g., climate, vegetation type, relevance of Saharan dust inputs) modulating the response of Mediterranean ecosystems at various spatiotemporal scales make it difficult to understand, and thus predict, the consequences of human activities that cause air pollution in the Mediterranean Basin. Therefore, there is an urgent need to implement coordinated research and experimental platforms along with wider environmental monitoring networks in the region. In particular, a robust deposition monitoring network in conjunction with modelling estimates is crucial, possibly including a set of common biomonitors (ideally cryptogams, an important component of the Mediterranean vegetation), to help refine pollutant deposition maps. Additionally, increased attention must be paid to functional diversity measures in future air pollution and climate change studies to establish the necessary link between biodiversity and the provision of ecosystem services in Mediterranean ecosystems. Through a coordinated effort, the Mediterranean scientific community can fill the above-mentioned gaps and reach a greater understanding of the mechanisms underlying the combined effects of air pollution and climate change in the Mediterranean Basin.

The application of lichens as ecological surrogates of air pollution in the subtropics: a case study in South Brazil

The use of lichens as ecological surrogates has been an important tool to evaluate the impact of air pollution in both ecosystem and human health but remains underused in the subtropics due to lack of knowledge. Aiming to support the application of lichen as ecological surrogates of the effects of air pollution in the subtropics, we hypothesized that urbanization was an important driver of changes on lichen diversity, composition, and vitality. For that, we quantified several lichen diversity metrics (richness, cover, and community composition) and photobiont vitality in relation to atmospheric pollution or its surrogates (modeled pollutant gases, pollutants in lichen thallus, and land cover). We confirmed that air pollution was a key driver for lichen diversity. Changes in lichen community composition and vitality were very significantly related to air pollution and integrated the effect of multiple stressors (particulate matter, NOx, and Cu), thus being powerful ecological indicators of air pollution in the subtropics.

Effects of gamma radiation on wastewater microbiota

Wastewater treatment by gamma radiation is a promising technology, with the capacity to reduce the impact of chemical and biological pollution of effluents in the environment. The aim of this study was to find out the effect of gamma radiation on the inactivation response of wastewater microorganisms. Wastewater samples were irradiated at a Co-60 facility, at different dose rates and at sublethal doses. The D10-values of total coliforms and mesophilic microbiota were determined for each sample and dose rate. Radio-resistant microorganisms in wastewater samples were isolated and their growth and inactivation kinetics in different composition substrates were determined, to find out the capacity of these bacteria to biodegrade the organic content of the wastewater. The results obtained suggest that irradiation substrate and dose rate influence the response of microorganisms to gamma radiation and could be also important factors for bioremediation.

Adult bronchiolitis--a clinical and pathological interpretative classification

INTRODUCTION

Bronchiolitis is a heterogeneous group of diseases of an inflammatory nature, centered on small conducting airways and often associated with other pulmonary disorders. No single classification scheme for bronchiolar diseases has been widely accepted. In this retrospective study, it was decided to apply a new clinical and pathological interpretative classification.

OBJECTIVES

To propose a new clinical and pathological interpretative classification for adult bronchiolitis, based on statistical analysis of a population of 193 patients with histopathological diagnosis of bronchiolitis.

MATERIALS AND METHODS

A retrospective study analyzed the epidemiological characteristics, co-morbidities and radiological findings present in a group of patients with histopathological diagnosis of bronchiolitis.

RESULTS

This trial involved 193 cases collected over a period of eleven years; 48 (24.9%) patients had simultaneous pulmonary disease; non-pulmonary diseases, such as cardiovascular diseases, type II Diabetes mellitus and dyslipidemia were present in 57 cases. The image study was extremely important in order to integrate clinical and pathological aspects. In this study respiratory bronchiolitis related to smoking dominated. The radiological findings confirmed the secondary nature of the histopathological features, with prevalence of ground-glass patterns, pneumothorax and patterns of interstitial involvement, as described in the literature. It was also verified that clinical behavior of different forms of bronchiolitis was important to distinguish the various types, since they could progress without typical anatomopathological aspects.

CONCLUSION

This trial showed that the vast majority of diagnosis obtained corresponded to bronchiolitis as secondary to pulmonary pathology. In most cases, morphological findings had to be complemented with clinical and radiological characteristics, in order to obtain the final diagnosis.

Alternative functional criteria to assess airflow-limitation reversibility in asthma

INTRODUCTION

International guidelines define significant bronchodilator response as absolute and percentage change from baseline in forced expiratory volume (FEV1) in the first second and/or forced vital capacity (FVC) ≥12% and 200 mL. However, bronchodilator effects on other lung function parameters have also been correlated to some degree of reversible airflow limitation.

OBJECTIVES

To determine whether changes in other lung function parameters apart from FEV1 and FVC detect functional responses to bronchodilator in asthmatic patients.

MATERIALS AND METHODS

Spirometry and body plethysmography were performed at baseline conditions and after administration of 400 μg of salbutamol by metered-dose inhaler through a space chamber device in asthmatic patients. Paired t-tests were used to compare lung function parameters between those with and without criteria for reversibility of airway obstruction according to ATS/ERS criteria. Cut-off values were obtained from the corresponding ROC curves. Measurements evaluated were FEV1, FVC, maximum mid-forced expiratory flow (FEF25-75%), residual volume (RV), inspiratory capacity (IC), airway resistance (Raw) and specific airway conductance (sGaw).

RESULTS

From a total of 100 consecutive asthmatics patients (46% of them men; average age 58.7±14.1 years; 76% with mild to moderate obstruction), 50 patients had a significant bronchodilator response. All of these had noteworthy variations (p<0.004) in PEF, FEF25-75%, RV, Raw and sGaw. The most accurate in predicting a significant bronchodilator response were the absolute and percentage improvements in PEF (≥0.4 L/s and 8%), FEF25-75% (≥0.087 L/s and 27%) and the percentage of sGaw compared with that at baseline (≥25%). Based on these cut-off values, a sizeable number of the patients defined as non-responders had important changes in airway caliber. 17 patients had significant increments in the percentage of PEF and 10 had changes in absolute volume; 6 patients had increments in percentage and 16 in absolute change of FEF25-75%; 22 patients had increments in the percentage change of sGaw.

CONCLUSIONS

Changes of FEV1 and/or FVC may underestimate significant functional response to bronchodilators in asthmatic patients with airway obstruction when considering the change in other lung function parameters.

WITHDRAWN: Alternative functional criteria to assess airflow-limitation reversibility in asthma

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.08.002. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

A role for the mitochondrial-associated protein p32 in regulation of trophoblast proliferation

p32 is a conserved eukaryotic protein which is primarily expressed in the mitochondria and regulates cell proliferation, migration and metabolism in various tissues. In this study, we sought to examine the expression and function of p32 in the human placenta. p32 was highly expressed in the syncytiotrophoblast, the underlying cytotrophoblast (CTB), the vascular endothelium and by a proportion of cells in the villous stroma in first trimester and term placenta. p32 mRNA and protein expression was significantly higher in the first trimester of pregnancy than at term, and expression in the trophoblast was significantly reduced in placentas from women with fetal growth restriction (FGR). Small interfering RNA (siRNA)-mediated knockdown of p32 in term placental explants significantly reduced the number of Ki67-positive CTB, but did not alter CTB apoptosis or necrosis. p32 knockdown increased lactate production, reduced glucose extraction from culture medium and was associated with reduced MitoTracker dye accumulation in trophoblast mitochondria. p32 knockdown was also associated with a significant reduction in expression of the mitochondrial respiratory complexes I and IV. These data suggest that p32 expression is important for CTB proliferation, via a mechanism involving regulation of normal mitochondrial function. As p32 expression is reduced in FGR placentas, this may contribute to some of the observed placental pathology, such as reduced CTB proliferation and mitochondrial dysfunction.

Ultrastructure of novel thrombocytes in the dog snapper Lutjanus jocu

Myxosporean cysts containing spores of Henneguya sp. were observed in the gills of the dog snapper Lutjanus jocu. Adjacent to the cysts were capillaries, allowing observation of peripheral blood cells. Numerous white blood cells displaying uncommon cytoplasmic projections were observed amongst the erythrocytes. Their morphology allowed them to be identified as thrombocytes (TCs). Each TC displayed 18-26 cytoplasmic projections, most of which were in close proximity to erythrocytes. At their apical end, each cytoplasmic projection presented an ellipsoidal vacuole (c. 0·6 µm × 0·3 µm) from which a secretory tubule, 0·3-0·4 µm long and c. 120 nm in total diameter, extended towards the periphery of the TC plasmalemma and fused with the cellular membrane. From this opening, contents of vacuoles were apparently released into the lumen of the capillaries. Other vacuoles with similar features, and containing an electron-lucent matrix, were observed in the cytoplasm of the TC. This is the first description of fish TC with these ultrastructural features and organization, which suggest that they perform a secretory function.

One year of Lamivudine therapy for portuguese patients with chronic hepatitis B

OBJECTIVE

To assess the efficacy of lamivudine treatment on hepatitis B e antigen (HBeAg) and/or hepatitis B surface antigen (HBsAg) seroconversion, on other virological and serological markers of response including hepatitis B virus (HBV) DNA and serum aminotransferases, and the safety of lamivudine treatment in hepatitis B patients.

PATIENTS

This phase III open-label study evaluated the virological and biochemical response to lamivudine in 70 Portuguese patients with HBeAg positive chronic hepatitis B. Patients were treated with lamivudine 100mg once daily for 12 months.

METHODS

Antiviral activity was assessed by measuring alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels at all protocol visits, and hepatitis B serology and HBV DNA were performed at baseline and at month 12 visits. Evaluation of safety and tolerance was based on clinical adverse events and laboratory analyses.

RESULTS

The primary endpoint was virological response at month 12, defined as loss of detectable HBeAg from serum with a reduction of HBV DNA to undetectable levels, and this was observed in 19/69 (27.5%) of patients. Almost half of the patients were HBV DNA negative by this time. Mean ALT values decreased steadily during treatment and by 12 months 61% of patients had values within the normal range. HBeAg seroconversion (HBeAg negative, HBeAb positive) was achieved in 27.9% of patients by 12 months, although all patients remained HBsAg positive.

CONCLUSION

Lamivudine was well tolerated and the incidence of adverse events was similar to those reported in previous studies. Lamivudine treatment resulted in virological and biochemical improvements in HBeAg positive chronic hepatitis B patients, with HBeAg seroconversion in one-third of patients.