FCB2-Artigos (em revistas ou actas indexadas)
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- Standardizing the assistant's role during robotic total mesorectal excision: step by step, single‐docking modular approach—a video vignettePublication . Cunha, Miguel F.; Tomada, Elisa Paoluzzi; Domingos, Hugo; Azevedo, José; Fernandez, Laura Melina; Parvaiz, AmjadTotal mesorectal excision requires precise dissection within a narrow pelvic space. Robotic platforms improve visualization and instrument articulation, but safe progression still depends on coordinated bedside assistance [1–3]. The assistant's role is often learned informally and may vary between cases. We describe a simple modular approach that standardizes assistant role during robotic total mesorectal excision (TME).
- Inclusion of carotenoids and Eicosapentaenoic Acid (EPA) in sea urchin (Paracentrotus lividus) broodstock diets improves gonad development and oocyte qualityPublication . Gomes da Silva, Ana Paula; Rodrigues, A. F.; Neves, M.; Roseiro, C.; Cardoso, H.; Violante, A. P.; Gavaia, Paulo; Suckling, C.; Lourenço, S.In aquaculture, broodstock conditioning diets are essential for enhancing reproductive performance, particularly as offspring survival remains a primary bottleneck in sea urchin production. This study investigated the effects of different broodstock diets on gonad development, fatty acid profiles, and oocyte size in the sea urchin Paracentrotus lividus. To determine if maternal investment could be enhanced through specific nutrients, three diets that differed in both ingredient matrix and pigment profile were tested over a two-month feeding period: 1) a formulated pumpkin/algal diet (PA) enriched with β-carotene via pumpkin and Nannochloropsis sp.; 2) a formulated pea/corn diet (PC) with a low-pigment profile, and 3) a natural kelp diet based on Saccorhiza polyschides, representing one of the natural foods for P. lividus in its local habitat. This Kelp diet provided a mixed-pigment reference with relatively high total carotenoids. Following the feeding trial, several key parameters were assessed, including gonadosomatic index (GSI), reproductive stage, fatty acid composition, oocyte size, and fertilization success. Results indicated that females fed the PA diet produced oocytes that were 18% larger and achieved a 7% higher fertilization rate than those on the PC diet. This enhancement is likely linked to the significantly higher deposition of carotenoids and omega-3 polyunsaturated fatty acids (n-3 PUFA) in the gonads. In contrast, while the PC diet promoted a high GSI, it resulted in smaller oocytes and lower fertilization rates, due to a deficiency in n-3 PUFA in their gonads. Females fed the Kelp diet presented the slowest gonadal development and failed to spawn, suggesting that seaweed is insufficient as a sole food source for short-term broodstock conditioning to support reproduction. This research provides valuable insights into developing broodstock conditioning diets by exploring alternative nutrient sources, such as pumpkin and microalgae, to enhance reproductive traits, particularly for emerging species like sea urchins.
- From clinical theory to user reality: A multi-phase co-design protocol of an analog serious game for fall preventionPublication . Tome, Ana Maria; Tomás, Maria Teresa; Pais, Sandra; de Almeida Fontes, Ana Paula; Rosa, MarleneIntroduction: Developing serious games for geriatric rehabilitation requires bridging the gap between clinical guidelines and user engagement. This study presents a novel methodological protocol used in the co-development of an analog serious game for fall prevention in older adults. The objective was to validate a comprehensive co-design framework that integrates multidisciplinary stakeholder insights with end-user creativity through a sequential, participatory methodology, ensuring both clinical fidelity and high playability.
- ANCA-associated vasculitis: From immunopathogenesis to diagnosis and toward precision therapyPublication . Graça Domingos, Tomás; Borges, Henrique; Silvestre-Teixeira, Vítor; Jerónimo, Teresa M.Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a group of rare, potentially life-threatening autoimmune disorders characterized by necrotizing inflammation of small vessels. Over recent decades, remarkable advances have been made in unraveling its immunopathogenesis, emphasizing the interplay between genetic predisposition, environmental triggers, loss of immune tolerance, neutrophil extracellular trap formation, and complement-mediated neutrophil activation. This review provides an integrative synthesis of recent mechanistic and clinical insights into AAV, bridging fundamental immunology with translational and therapeutic advances. Based on an extensive literature search of PubMed and Scopus, studies were selected according to methodological quality and clinical relevance. Distinct ANCA specificities, proteinase 3 (PR3) and myeloperoxidase (MPO), define overlapping yet prognostically divergent subsets, with PR3-ANCA linked to relapsing multisystem disease and MPO-ANCA to renal involvement and progression to kidney failure. Therapeutic paradigms have evolved from cyclophosphamide-based induction toward rituximab-centered and glucocorticoid-sparing regimens, with mepolizumab further improving efficacy and safety profiles. Despite five-year survival rates exceeding 85%, long-term morbidity persists, driven by relapse and treatment-related toxicity. However, precision therapy in AAV remains incomplete, as current treatment selection is still guided mainly by disease severity, organ involvement, relapse risk, comorbidities, renal histology, and risk of glucocorticoid-toxicity rather than by validated molecular biomarkers. Emerging data on complement activation, urinary inflammatory biomarkers, B-cell kinetics, and tissue-based transcriptomic profiling may refine disease endotyping and individualized monitoring. Collectively, these advances herald a transition from empirical immunosuppression toward biologically informed, precision-oriented care in vasculitis.
- Avaliação do consentimento informado pelas comissões de ética em Portugal: Procedimentos e constrangimentos num estudo observacionalPublication . Gonçalves de Gouveia Maia Xavier, Joana; Barbosa, Carla ; Leitao, HelenaIntrodução: As comissões de ética (CE) desempenham um papel central na supervisão ética e na proteção dos participantes em investigação. Porém, os dados sobre a sua composição e atividade em Portugal permanecem limitados. Este estudo teve como objetivos caracterizar os membros das CE, avaliar a sua atividade e constrangimentos percecionados, e explorar as suas perspetivas sobre a avaliação do consentimento informado (CI) na investigação.Métodos: Foi realizado um estudo entre março e junho de 2025, com recurso a um questionário anónimo online distribuído a CE em instituições de saúde, ensino superior e centros de investigação. O questionário recolheu dados sociodemográficos, informação sobre a composição e o funcionamento das CE e perceções relativas aos documentos de CI.Resultados: Foram obtidas 81 respostas. A maioria dos inquiridos era do sexo feminino (63,0%), tinha 51 - 60 anos (33,3%) ou ≥ 61 anos (30,9%) e mais de cinco anos de experiência em CE (49,4%). As CE que responderam pertenciam sobretudo a instituições de saúde (50,6%) ou ensino superior (42,0%). Os principais constrangimentos identificados foram a falta de formação (87,7%) e a ausência de tempo de trabalho dedicado (79,0%), sendo frequente a ausência de formação em bioética (56,8%) e em proteção de dados (47,0%). A maioria referiu utilização de modelo padrão de CI (74,1%), mas os pedidos de revisão por linguagem pouco clara foram frequentes (91,4%). Vinte e um por cento classificaram os CI como fracos ou medianos, atribuindo-o à falta de formação dos investigadores. Quanto à revogação do CI, 35,8% consideraram-na dependente de formalidades e 5,0% não souberam responder. Além disso, 45,7% indicaram não ter experiência pessoal na obtenção de CI. Verificou-se variabilidade na importância atribuída a componentes como condições do estudo e procedimentos para novas informações, formato de conservação dos dados e contactos da CE e do encarregado da proteção de dados.Conclusão: O CI é reconhecido como central, mas as respostas revelam heterogeneidade na avaliação de alguns componentes, a par de constrangimentos estruturais relacionados com a formação e o tempo dedicado no horário de trabalho. O reforço da formação, a harmonização de orientações e maior apoio institucional poderão aumentar a consistência e o valor pedagógico da revisão ética.
- Levodopa and melanoma: practical recommendations for Parkinson's disease—international Parkinson and movement disorder society scientific issues committee viewpointPublication . Sciacca, Giorgia; Elsayed, Inas; Perez‐Lloret, Santiago; Outeiro, Tiago; Unni, Vivek K.; Kordower, Jeffery H.; Berg, Daniela; Kalia, Lorraine V.The potential association between Parkinson's disease (PD), melanoma, and levodopa (l-dopa) use can be a source of uncertainty and concern in clinical practice. Several etiopathological hypotheses have been proposed, including a possible role of the protein α-synuclein that, in addition to being a major component of Lewy bodies in PD, is expressed in melanocytes.1 However, a definitive mechanistic link between PD and melanoma has yet to be defined. Epidemiological data examining whether l-dopa treatment increases melanoma risk in PD patients have been contradictory, and a causal connection has not been established. Nonetheless, product monographs for l-dopa-containing medications continue to cite a history of melanoma as a contraindication and list malignant melanoma as a potential adverse effect. This discrepancy between regulatory language and the available evidence can create uncertainty for both clinicians and people with PD when initiating or continuing l-dopa therapy. The aim of this article is to provide practical recommendations for clinicians based on current evidence regarding the (1) risk of melanoma in PD independent of l-dopa treatment based on epidemiological evidence and shared pathobiological mechanisms, (2) potential risk of developing melanoma with l-dopa use in PD, and (3) safety of l-dopa treatment in PD patients with a history of melanoma
- Risk factors for recurrence in ischemic colitis: A 10-year retrospective studyPublication . Relvas, Luís; Carvalho, Isabel; Baltazar, Pedro Miguel; Gago, Tânia; Velasco, Francisco; Caldeira, Paulo; Peixe, BrunoBackground: recurrent ischemic colitis (IC) is uncommon but clinically relevant, and its risk factors remain poorly defined. This study aimed to assess the prevalence of recurrence and identify associated clinical predictors. Methods: a retrospective single-center cohort study was performed including all patients diagnosed with IC at the Algarve Local Health Unit (Faro, Portugal), between January 2011 and December 2021. Cases were identified using ICD-9/ICD-10 codes and confirmed by clinical presentation and at least one diagnostic modality (computed tomography [CT], colonoscopy, or histology). Patients younger than 18 years, pregnant women, and those with mechanical or inflammatory causes of colitis were excluded. Recurrent IC was defined as a new episode after a ≥ 30-day symptom-free interval. Demographic, clinical, imaging, and outcome data were collected. Associations with recurrence were analyzed using odds ratios (OR) with 95 % confidence intervals (CIs). Results: of 142 patients, eleven (7.7 %) had recurrent IC. Recurrence was associated with smoking (OR 5.6, 95 % CI: 1.5-20.3), coronary artery disease (OR 4.1, 95 % CI: 1.1-15.6), prior laparotomy (OR 5.8, 95 % CI: 1.3-26.0), and clopidogrel use (OR 5.2, 95 % CI: 1.3-20.1). Patients with recurrence required blood transfusion more often (OR 7.8, 95 % CI: 1.9-31.5) but presented with hematochezia less frequently (OR 0.16, 95 % CI: 0.04-0.57). Imaging and endoscopic findings were comparable across groups, although colonic necrosis was absent in recurrent cases. Conclusions: recurrent IC occurred in 7.7 % of patients and was linked to smoking, cardiovascular disease, prior laparotomy, and clopidogrel therapy. Its presentation was often less typical, which may hinder early recognition. Prospective, multicenter studies are required to confirm these findings.
- Disease modification in advanced parkinson’s disease: a review and roadmap for paving the way for next-generation interventionsPublication . Groppa, Sergiu; Fasano, Alfonso; Urso, Daniele; Yang, Xinjie; Popescu, Bogdan; Klivenyi, Peter; Laar, Teus van; Jost, Wolfgang; Garcia-Ruiz, Pedro J.; Bhidayasiri, Roongroj; Outeiro, TiagoParkinson’s disease (PD) exhibits highly heterogeneous clinical trajectories, yet “advanced PD” (aPD) lacks a standardized definition. Current reliance on clinical milestones (e.g., motor fluctuations, cognitive decline) is limited by non-linear progression and the absence of objective measures. Although biomarkers like aggregated α-synuclein, MRI, and PET are under investigation, their correlation with clinical progression remains modest. Robust, reproducible endpoints are urgently needed to evaluate disease-modifying therapies across diverse phenotypes, accounting for genetic background, age of onset, co-pathologies, and motor/autonomic/cognitive domains. Given this complexity, single-target interventions are likely insufficient. We propose a multi-domain therapeutic framework for aPD that integrates: (A) simultaneous targeting of key pathological cascades, including α-synuclein aggregation, mitochondrial dysfunction, oxidative stress, proteostasis imbalance, neuroinflammation, and the gut–brain axis; (B) biology-driven patient stratification using emerging biomarkers to match subgroups with targeted interventions; and (C) systematic management of comorbidities and lifestyle factors, such as cardiovascular health and exercise, to enhance neuroresilience. Finally, advancing aPD care requires addressing systemic determinants, including global healthcare inequities, and prioritizing caregiver well-being. Mechanistically informed, patient-centered strategies that combine multi-target therapies with precision stratification and holistic support will be essential to modify disease progression and improve long-term outcomes.
- Widespread metastatic uveal melanoma with gastrointestinal and gallbladder involvement: a case reportPublication . de Oliveira, Raquel; Portugal, Margarida; Roseira, Joana; Peixe, BrunoMelanoma is a malignant tumour arising from melanocytes, with cutaneous melanoma accounting for the vast majority of cases. Less frequently, melanomas originate from extracutaneous melanocytes, including those of the uveal tract. Although primary gastrointestinal melanomas exist, gastrointestinal involvement by melanoma more commonly represents metastatic disease. Recognition of gastrointestinal metastatic lesions and their variable endoscopic appearance has become increasingly relevant with the advances in systemic therapies. Case Presentation: We report a case of a 74-year-old man referred for investigation of irondeficiency anaemia. Esophagogastroduodenoscopy revealed multiple flat, dark millimetric lesions in the distal oesophagus, stomach, and duodenum. Histopathological examination with immunohistochemistry revealed melanoma. Cross-sectional imaging and positron emission tomography demonstrated widespread metastatic disease involving the liver, lungs, brain, bone, and gallbladder, as well as a hypermetabolic intraocular lesion. Ophthalmological and dermatological evaluation was consistent with primary uveal melanoma, with no evidence of a cutaneous primary. The patient experienced rapid neurological deterioration due to brain metastases and died shortly after diagnosis. Conclusion: Gastrointestinal metastases of melanoma are rare, particularly in uveal melanoma, and are often clinically silent. Endoscopic findings are heterogeneous and may be detected during the investigation of nonspecific symptoms such as anaemia. This case highlights the importance of recognising and sampling atypical pigmented gastrointestinal lesions, as endoscopy may play a key role in the diagnosis of advanced melanoma and prompt multidisciplinary management.
- Lewy bodies are not associated with neuronal or synaptic loss in dementia with lewy bodiesPublication . Hawksworth, Jade I.; Kirkby‐Geddes, Eddie; Thom, Searlait; O'Neill, Joe; Ikwue, Amelia; Wood, Lucy; Outeiro, Tiago; Erskine, DanielAims: The misfolding and accumulation of the protein α-synuclein (αSyn) into cytoplasmic inclusions termed Lewy bodies (LBs) and Lewy neurites is the defining neuropathological feature of LB diseases, such as Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The loss of neurons and/or synapses has been postulated to underlie the clinical syndrome of DLB. The present study sought to elucidate the relationship between LB burden and neuronal and synaptic loss in DLB. Methods: Post-mortem brain tissue from the cingulate gyrus and inferior temporal gyrus, two regions vulnerable to LB pathology, was obtained from DLB (N=20) and control cases (N=20). Formalin-fixed paraffin-embedded tissue was stained to quantify LB, Alzheimer-type pathology and a neuronal marker. Frozen tissue from the contralateral hemisphere was processed for immunoblotting to compare the abundance of synaptic markers across cases. Results: Across both regions, no evidence of reduced total neuronal density was observed, but a modest reduction in parvalbumin interneurons was observed in the cingulate gyrus, and there were only modest reductions in some synaptic markers in DLB. LB burden was markedly variable across DLB cases but was not associated with any synaptic marker abundance or neuronal density. Conclusions: Taken together, these findings do not support an association between LB density and neuronal or synaptic loss in DLB, even in regions with particularly high burdens of LBs, such as the cingulate gyrus. These findings suggest that the link between αSyn proteinopathy and disease requires further investigation.