Facing the challenges of air quality and health in a future climate: The Aveiro Region case study.

Air pollution and climate change are the most important environmental issues for European citizens. Despite the air quality improvements achieved in recent years, with most pollutants' concentrations below the European Union legislated values, it is necessary to understand whether this will continue in the future due to expected climate changes impacts. In this context, this work tries to answer two main questions: (i) What is the relative contribution of emission source regions/activities to air quality, now and in the future, considering a climate change scenario?; and (ii) What additional policies are needed to support win-win strategies for air quality and climate mitigation and/or adaptation, at urban scale? For that, a climate and air quality modelling system, with source apportionment tools, was applied to the Aveiro Region, in Portugal. Main results show that in the future, due to the implementation of carbon neutrality measures, air quality in the Aveiro Region may improve, with reduction up to 4 µg.m-3 for particulate matter (PM) concentrations and 22 µg.m-3 for nitrogen dioxide (NO2), and consequently, the premature deaths due to air pollution exposure will also decrease. The expected air quality improvement will ensure that, in the future, the limit values of the European Union (EU) Air Quality Directive will not be exceeded, but the same will not happen if the proposed revision of the EU Air Quality Directive is approved. Results also shown that, in the future, industrial sector will be the one with higher relative contribution for PM concentrations and the second one for NO2. For that sector, additional emission abatement measures were tested, showing that, in the future, it is possible to comply with all the new limit values proposed by the EU.

An integrated analysis of COVID-19 impacts on energy and environment: Lessons learnt.

Carbon neutrality, sustainable development and reducing our impact on the environment is the top priority in future measures. The COVID-19 pandemic brought challenges to every sector at a global scale but can provide valuable insight to reach these goals. The main objective of this work is to provide an integrated analysis of the impact of the COVID-19 pandemic, focused on energy and its related aspects, i.e., environment and costs. Mainland Portugal was used as a case study and two years were analysed, one pre pandemic (2019) and another post pandemic (2020). In 2020, the majority of sectors - Transport, Services, Industry and Agriculture & Fisheries - show a reduction of energy consumption, atmospheric emissions, carbon footprint and related monetary and social costs. In contrast, the Domestic sector presents an overall increase, with maximums of 25.4% in electricity consumption (during Spring), 0.72% in the PM10 (particulate matter) and NOx (nitrogen dioxides) emissions (in Summer), and 2.9% in carbon footprint (in Spring). The integrated analysis proposed in this work was crucial to identify the paths to a post pandemic world focused on the different aspects of sustainability - new concepts of mobility and workplace, as well as increased investment in energy performance and renewable energy sources. This study showed that changing our energy consumption patterns could significantly affect future greenhouse gas emissions, and contribute to the sustainable growth of the economy, while maintaining good progress towards climate-neutral goals.

Influence of Parity on the Colostrum Bacterial Community Composition in Holstein Cows.

The colostrum bacteriome of primiparous (P) and multiparous (M) Holstein cows was analysed by 16S rRNA sequencing. The species richness (Chao 1), diversity (Shannon and Simpson), and beta diversity did not differ between cow groups. The phyla Firmicutes, Tenericutes, Kiritimatiellaeota, and Fibrobacteres were more abundant in M cows, while Proteobacteria, Actinobacteria, Cloacimonetes, and Fusobacteria were more abundant in P cows. At the genus level, no significant differences were observed between groups (P < 0.05), and Prevotella_1 was the most abundant taxon. P and M cows shared 1030 taxonomic operational units (OTUs), with Acinetobacter showing greater abundance. In conclusion, parity did not affect the colostrum bacteriome of P and M cows and a healthy mammary gland could represent a reservoir of Acinetobacter in dairy farms. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-022-01016-x.

Rosmarinic and chlorogenic acid, isolated from ferns, suppress stem cell damage induced by hydrogen peroxide.

OBJECTIVES: Evaluating the effects of rosmarinic (RA) and cryptochlorogenic (CGA) acids isolated from Blechnum binervatum extract on stem cell viability, toxicity and the protective effect on oxidative cell damage. METHODS: MTT and LDH methods were employed, using stem cells from teeth. RA and CGA were evaluated at 100, 250 and 500 µM. The negative effect of hydrogen peroxide (H2O2) (200-2200 µM) and the capacity of RA and CGA (10-100 µM) as protective agents were also evaluated. DAPI followed by fluorescent microscopy was employed to photograph the treated and untreated cells. KEY FINDINGS: At all tested concentrations, RA and CGA demonstrated the ability to maintain cell viability, and with no cytotoxic effects on the treated stem cells. RA also induced an increase of the cell viability and a reduction in cytotoxicity. H2O2 (1400 µM) induced >50% of cytotoxicity, and both compounds were capable of suppressing H2O2 damage, even at the lowest concentration. At 100 µM, in H2O2 presence, total cell viability was observed through microscope imaging. CONCLUSIONS: These findings contribute to the continued research into natural substances with the potential for protecting cells against oxidative injury, with the consideration that RA and CGA are useful in the regeneration of damaged stem cells.

Benzodiazepine partially reverses tonic-clonic seizures induced by thiocolchicoside.

Seizures are a disorder caused by structural brain lesions, life-threatening metabolic derangements, or drug toxicity. The present study describes the behavior related to proconvulsant activity induced by thiocolchicoside (TCC) in rats and investigates the electrocorticographic patterns of this behavior and the effectiveness of classic antiepileptic drugs used to control these seizures. Forty-nine adult male Wistar rats were used and divided into two phases of our experimental design: 1) evaluation of seizure-related behavior and electrocorticographic patterns induced by TCC and 2) evaluation of the efficacy of classical antiepileptic drugs to control the proconvulsive activity caused by TCC. Our results showed that TCC induced tonic-clonic seizures that caused changes in electrocorticographic readings, characteristic of convulsive activity, with average amplitude greater than that induced by pentylenetetrazole. Treatment with anticonvulsants, especially diazepam, reduced the electrocorticographic outbreaks induced by TCC. The results suggested that TCC caused seizures with increased power in brain oscillations up to 40 Hz and that diazepam may partially reverse the effects.

Benzodiazepine partially reverses tonic-clonic seizures induced by thiocolchicoside

Seizures are a disorder caused by structural brain lesions, life-threatening metabolic derangements, or drug toxicity. The present study describes the behavior related to proconvulsant activity induced by thiocolchicoside (TCC) in rats and investigates the electrocorticographic patterns of this behavior and the effectiveness of classic antiepileptic drugs used to control these seizures. Forty-nine adult male Wistar rats were used and divided into two phases of our experimental design: 1) evaluation of seizure-related behavior and electrocorticographic patterns induced by TCC and 2) evaluation of the efficacy of classical antiepileptic drugs to control the proconvulsive activity caused by TCC. Our results showed that TCC induced tonic-clonic seizures that caused changes in electrocorticographic readings, characteristic of convulsive activity, with average amplitude greater than that induced by pentylenetetrazole. Treatment with anticonvulsants, especially diazepam, reduced the electrocorticographic outbreaks induced by TCC. The results suggested that TCC caused seizures with increased power in brain oscillations up to 40 Hz and that diazepam may partially reverse the effects.

Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery.

PURPOSE: The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS: This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS: The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ±â€¯0.37 D in the transepithelial group and 0.53 ±â€¯0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ±â€¯0.71 in the transepithelial group and 0.68 ±â€¯0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group. CONCLUSIONS: Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Are green roofs the path to clean air and low carbon cities?

Green roofs, as part of urban green structures, have been pointed out as the solution to pursuit the goal of healthy cities. This study aims to investigate the direct, focused on meteorological changes, and indirect, related to both meteorological and emissions changes, impacts of green roofs on air quality (PM10, NO2 and O3). For that, the numerical modelling system composed by the WRF-SLUCM-CHIMERE models was applied to a 1-year period (2017), having as case study the Porto urban area. The EnergyPlus model was also applied to estimate the green roofs impacts on the building's energy needs and related impacts on air quality and atmospheric emissions. The analysis of the direct impacts showed that green roofs promote a temperature increase during the autumn and winter seasons and a temperature decrease during the spring and summer seasons. Both negative - concentrations increase - and positive - concentrations decrease - impacts were obtained for the primary, PM10 and NO2, and secondary, O3, air pollutants, respectively, due to changes in the dynamical structure of the urban boundary layer. The indirect effects of green roofs showed their potential to enhance the buildings energy efficiency, reducing the cooling and heating needs. These changes in energy consumption promoted an overall decrease of the environmental and economic indicators. Regarding air quality, the impact was negligible. The obtained results highlight the need for a multipurpose evaluation of the impacts of green roofs, with the different effects having to be traded off against each other to better support the decision-making process.

Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas / Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Objetivo El objetivo del estudio fue comparar los resultados de las incisiones arcuatas (IA) intraestromales y transepiteliales para tratar el astigmatismo corneal en el momento de la cirugía de catarata asistida con láser de femtosegundo (FLACS). Método Este estudio retrospectivo incluyó 20 pacientes con astigmatismo corneal entre 0,70 y 2,00 dioptrías (D) que se sometieron a FLACS con IA intraestromales en un ojo e IA transepiteliales en el ojo adelfo. Los principales datos evaluados a los 2-3meses de seguimiento fueron la diferencia entre el cilindro corneal queratométrico preoperatorio y postoperatorio (Kcyl), el índice de corrección (IC) y el porcentaje de sobrecorrección. Resultados La diferencia media entre Kcyl preoperatorio y postoperatorio reveló un valor medio de 0,36±0,37D en el grupo transepitelial y 0,53±0,42D en el grupo intraestromal (p<0,001). El IC medio fue de 0,83±0,71 en el grupo transepitelial y de 0,68±0,29 en el grupo intraestromal (p=0,17). Cinco ojos (25%) tuvieron una sobrecorrección del astigmatismo en el grupo transepitelial y un ojo (5%) en el grupo intraestromal. Conclusiones Tanto las IA intraestromales como las IA transepiteliales mostraron potencial para la corrección de astigmatismo leve a moderado y parecen ser un procedimiento seguro. A pesar de que las IA transepiteliales presentaron un IC más alto, los resultados de las IA intraestromales fueron más predecibles (AU)

Purpose The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). Methods This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. Results The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group. Conclusions Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable (AU)

Robertsonian rearrangements in Neotropical Meliponini karyotype evolution (Hymenoptera: Apidae: Meliponini).

Genome changes, evidenced through karyotype or nuclear genome size data, can result in reproductive isolation, diversification and speciation. The aim of this study was to understand how changes in the karyotype such as chromosome number and nuclear genome size accompanied the evolution of neotropical stingless bees, and to discuss these data in a phylogenetic context focusing on the karyotype evolution of this clade. We sampled 38 species representing the three Neotropical Meliponini groups; 35 for karyotype analyses and 16 for 1C value measurement. The chromosome number varied from 2n = 16 to 2n = 34, with distinct karyotypic formulae and the presence of a few polymorphisms, such as B chromosomes in one species and arm size differences between homologous chromosomes in two species. The mean 1C value varied from 0.31 pg to 0.92 pg. We associated empirical data on chromosome number and mean 1C value to highlight the importance of Robertsonian fusion rearrangements, leading to a decrease in chromosome number during the Neotropical Meliponini evolution. These data also allowed us to infer the independent heterochromatin amplification in several genera. Although less frequent, Melipona species with 2n = 22 represent evidence of Robertsonian fissions. We also pointed out the importance of chromosomal rearrangements that did not alter chromosome number, such as inversions and heterochromatin amplification.

Evolutionary insights into the genomic organization of major ribosomal DNA in ant chromosomes.

The major rDNA genes are composed of tandem repeats and are part of the nucleolus organizing regions (NORs). They are highly conserved and therefore useful in understanding the evolutionary patterns of chromosomal locations. The evolutionary dynamics of the karyotype may affect the organization of rDNA genes within chromosomes. In this study, we physically mapped 18S rDNA genes in 13 Neotropical ant species from four subfamilies using fluorescence in situ hybridization. Furthermore, a survey of published rDNA cytogenetic data for 50 additional species was performed, which allowed us to detect the evolutionary patterns of these genes in ant chromosomes. Species from the Neotropical, Palearctic, and Australian regions, comprising a total of 63 species from 19 genera within six subfamilies, were analysed. Most of the species (48 out of 63) had rDNA genes restricted to a single chromosome pair in their intrachromosomal regions. The position of rDNA genes within the chromosomes appears to hinder their dispersal throughout the genome, as translocations and ectopic recombination are uncommon in intrachromosomal regions because they can generate meiotic abnormalities. Therefore, rDNA genes restricted to a single chromosome pair seem to be a plesiomorphic feature in ants, while multiple rDNA sites, observed in distinct subfamilies, may have independent origins in different genera.

How changing climate may influence air pollution control strategies for 2030?

Air pollution is a global threat leading to large impacts on human health and ecosystems. In Europe, air quality remains poor in many areas, despite reductions in emissions and ambient concentrations. Air pollution and climate change are the biggest environmental concerns for Europeans, implying concerted and integrated actions to tackle them. The revised 2016 European National Emission Ceilings Directive (NECD) enforces Member States to implement strategies, based on emission reduction measures, aimed to comply with targets by 2030 and achieve European Union (EU) and World Health Organization air quality objectives for environment and health protection. Despite those strategies are designed for 2030, the influence of climate change on air quality is not accounted for. In this sense, the purpose of this paper is the evaluation of the climate change impact on future air quality, taking into consideration emission reduction measures. The WRF-CAMx air quality modelling system was applied over Europe for one year selected as representative of a short-term changing climate (around 2030), and compared to a base case year, to estimate to what extent the climate variables by themselves could positively or negatively influence air quality. Results indicate that meteorological conditions may be decisive for the air quality state in the future. Differences between future and present simulations pointed to a global decrease of ozone levels in the future; increases and decreases in particulate matter and nitrogen dioxide concentrations over different seasons and European regions. This work is intended to contribute to a better understanding of the influence of climate variables on air quality improvement strategies as an additional support to European environmental authorities in developing the National Air Pollution Control Programmes in the scope of NECD.

Blood flow simulations in patient-specific geometries of the carotid artery: A systematic review.

Computational Fluid Dynamics (CFD) and Fluid-Structure Interaction (FSI) are currently widely applied in the study of blood flow parameters and their alterations under pathological conditions, which are important indicators for diagnosis of atherosclerosis. In this manuscript, a systematic review of the published literature was conducted, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, on the simulation studies of blood flow in patient-specific geometries of the carotid artery bifurcation. Scopus, PubMed and ScienceDirect databases were used in the literature search, which was completed on the 3rd of August 2020. Forty-nine articles were included after the selection process and were organized in two distinct categories: the CFD studies (36/49 articles), which comprise only the fluid analysis and the FSI studies (13/49 articles), which includes both fluid and Fluid-Structure domain in the analysis. The data of the research works was structured in different categories (Geometry, Viscosity models, Type of Flow, Boundary Conditions, Flow Parameters, Type of Solver and Validation). The aim of this systematic review is to demonstrate the methodology in the modelling, simulation and analysis of carotid blood flow and also identify potential gaps and challenges in this research field.

Insights into the antiviral activity of phospholipases A2 (PLA2s) from snake venoms.

Viruses are associated with several human diseases that infect a large number of individuals, hence directly affecting global health and economy. Owing to the lack of efficient vaccines, antiviral therapy and emerging resistance strains, many viruses are considered as a potential threat to public health. Therefore, researches have been developed to identify new drug candidates for future treatments. Among them, antiviral research based on natural molecules is a promising approach. Phospholipases A2 (PLA2s) isolated from snake venom have shown significant antiviral activity against some viruses such as Dengue virus, Human Immunodeficiency virus, Hepatitis C virus and Yellow fever virus, and have emerged as an attractive alternative strategy for the development of novel antiviral therapy. Thus, this review provides an overview of remarkable findings involving PLA2s from snake venom that possess antiviral activity, and discusses the mechanisms of action mediated by PLA2s against different stages of virus replication cycle. Additionally, molecular docking simulations were performed by interacting between phospholipids from Dengue virus envelope and PLA2s from Bothrops asper snake venom. Studies on snake venom PLA2s highlight the potential use of these proteins for the development of broad-spectrum antiviral drugs.

Experimental system for studying temperature gradient-driven fracture of oxide nuclear fuel out of reactor.

Temperature gradients in ceramic light water reactor (LWR) uranium dioxide (UO2) nuclear fuel pellets generate thermal stresses that cause fractures in the fuel, which begins early in the life of fresh fuel. The combination of heating due to fission and forced convective cooling on the exterior of LWR fuel rods generates a temperature profile that is difficult to replicate outside the reactor environment. In this study, a state-of-the-art experimental setup using electrical heating to study certain aspects of temperature driven fracture was built, and surrogate fuel materials such as ceria (CeO2) were used to validate the system. Cracking experiments were conducted on these surrogates by inducing reactivity-initiated-accident like temperature gradients in the pellets via induction and direct resistance heating. Induction heating was done using copper coils and molybdenum susceptors, which heated the surrogates to a threshold temperature that is sufficiently high for the fuel material to conduct current. Thereafter, direct resistance heating was achieved by passing current through the specimen using a DC power supply to introduce volumetric heating to replicate LWR operating conditions. The pellets were held against nickel electrodes and mounted on a boron nitride test-stand. All the tests were carried out in a stainless-steel vacuum chamber. Simultaneous real-time dual imaging of the surrogate pellet surface was implemented using an optical and infrared camera system that was mounted along axial and perpendicular directions to the pellet surface, respectively. A beam-splitter was used to split the incoming radiation from the sample into two halves. While one of the beams was transmitted from the splitter through a bandpass filter to obtain optical images, the other beam was reflected from the splitter to the thermal camera to capture full-field temperature gradients of the as-fabricated pellet surface during cracking. Some initial tests were conducted with a 2-color pyrometer that was later substituted with a forward-looking infrared thermal camera to capture the temperature profiles. A LabVIEW data acquisition system was set up for collecting useful data during experiments.

Multispecies biofilm formation by the contaminating microbiota in raw milk.

Biofilms can be formed on the surfaces of dairy processing equipment and are a potential source of product contamination. This study evaluated the diversity of multispecies biofilms formed on stainless steel (SS) due to the contaminating microbiota in raw milk. Samples of raw milk were used: one was fresh milk and the other maintained in refrigerated bulk tanks for up to 48 h. The mesophilic aerobic contamination was ∼104 CFU ml-1 in fresh milk and 106 CFU ml-1 in bulk milk. SS coupons were kept immersed in the milk at 7 ±2 °C for 10 days, and every two days, the raw milk was changed for samples of the same origin collected on the current day. After incubation for 10 days, sessile cells in the biofilm reached 105 CFU cm-2 in the presence of fresh milk, and 106 CFU cm-2 in the presence of bulk milk. The genetic diversity analysis showed that Gammaproteobacteria and Bacilli predominated in the biofilms throughout the incubation of both milk samples and these biofilms showed a reduction in diversity over time. The main classes of bacteria found in these biofilms have representatives of great importance since many of them have spoilage potential.

Development of a road traffic emission inventory with high spatial-temporal resolution in the world's most densely populated region-Macau.

With rapid economic growth, road transport is contributing substantial adverse effects on urban air quality, especially in densely populated cities with high growth rate of GDP per capita, such as Macau. A high spatial-temporal resolution road traffic emission inventory is essential for assessment of environmental stresses imposed by local vehicle movements. To improve the accuracy and temporal-spatial resolution for emission inventory, through a bottom-up approach, link-based road traffic emission inventory with a spatial resolution of 0.1 km ∗ 0.1 km and a temporal resolution of 1 h for Macau in 2014 was developed by using a traffic model (VISUM), a road traffic emission model (TREM), the Geographic Information System (GIS), and the most up-to-date information available. Results show that the total annual emissions of CO, CO2, PM, NOX, and VOC in 2014 were 14,770, 413,099, 69, 1151, and 2945 tons, respectively. The estimated fuel consumption agreed well also with the statistical fuel consumption in Macau. Meanwhile, analysis of 3 scenarios on changes of road traffic emissions due to the operation of a light railway transit (LRT) system, variation on share of diesel, electric, and gasoline within the vehicle fleet, and replacement of vehicles with ones of Euro 5 and Euro 6 emission standards was carried out. This study provides a solid framework for developing high spatial-temporal resolution emission inventories for other densely populated cities of small area.

Characterisation of peripheral and central components of the rat monoiodoacetate model of Osteoarthritis.

OBJECTIVE: Pain is the main reason patients report Osteoarthritis (OA), yet current analgesics remain relatively ineffective. This study investigated both peripheral and central mechanisms that lead to the development of OA associated chronic pain. DESIGN: The monoiodoacetate (MIA) model of OA was investigated at early (2-6 days post injection) and late (>14 days post injection) time points. Pain-like behaviour and knee histology were assessed to understand the extent of pain due to cartilage degradation. Electrophysiological single-unit recordings were taken from spinal wide dynamic range (WDR) neurons to investigate Diffuse Noxious Inhibitory Controls (DNIC) as a marker of potential changes in descending controls. Immunohistochemistry was performed on dorsal root ganglion (DRG) neurons to assess any MIA induced neuronal damage. Furthermore, qPCR was used to measure levels of glia cells and cytokines in the dorsal horn. RESULTS: Both MIA groups develop pain-like behaviour but only late phase (LP) animals display extensive cartilage degradation. Early phase animals have a normally functioning DNIC system but there is a loss of DNIC in LP animals. We found no evidence for neuronal damage caused by MIA in either group, yet an increase in IL-1ß mRNA in the dorsal horn of LP animals. CONCLUSION: The loss of DNIC in LP MIA animals suggests an imbalance in inhibitory and facilitatory descending controls, and a rise in the mRNA expression of IL-1ß mRNA suggest the development of central sensitisation. Therefore, the pain associated with OA in LP animals may not be attributed to purely peripheral mechanisms.

Cri du Chat syndrome: Characteristics of 73 Brazilian patients.

BACKGROUND: Cri du Chat syndrome (CdCS) is a genetic syndrome caused by deletions in the short arm of chromosome 5. Although the main clinical features of CdCS are well known, the neurocognitive and behavioural characteristics of the phenotype are rarely described in detail in the literature. In this study, we analysed the main phenotypic features of CdCS from a parental perspective. METHOD: A questionnaire was sent to 700 Brazilian families that were registered in the Brazilian Association of CdCS. The questions involved specific domains of CdCS, such as pregnancy and birth conditions, recurrence of the disease in the family, current major health problems, and aspects of cognitive development. RESULTS: In total, 73 questionnaires were completed: 44 females and 29 males, ranging from 9.5 months old to 40 years old (mean = 13.8 years; median = 12 years). Most of the parents noticed the typical cat-like cry at birth (94.4%). The age at diagnosis of CdCS ranged from the time of birth to 180 months (mean = 14 months; median = 6 months), while one case was diagnosed during pregnancy. In all of the cases, the diagnosis of CdCS was made by G-banding karyotype analysis. In 66.2% of the cases, the parents underwent cytogenetic investigation. A total of 52.1% of the parents answered that they did not remember what the recurrence risk of CdCS was in their family. The main health problems that were reported were as follows: swallowing problems (80.3%), feeding problems (80.3%), congenital heart disease (31.5%), spine abnormalities (28.8%), and neurological symptoms (20.5%), including seizures (11%). The behavioural problems that were reported were as follows: aggressive behaviour, stereotypies, anxiety, phobias, and genital manipulation/masturbation. Neurodevelopmental delay was reported in all of the cases. Independent walking was achieved in 72.2% of the patients. Approximately 50% of the patients never presented expressive language, and most of the patients are dependent on others for their daily activities. CONCLUSIONS: The questionnaire was a pioneer initiative in the CdCS support group, and the answers used in this study can improve the health care assistance to these patients because they focus attention on the demands from a parental perspective. In addition, nearly half of the families stated that they did not remember information regarding recurrence risk, which reinforces the importance of genetic counselling follow-up and the need for the expansion of genetic services in Brazil.

Equimolar mixture of nitroux oxyde and oxygen during post-operative physiotherapy in patients with cerebral palsy: A randomized, double-blind, placebo-controlled study.

BACKGROUND: The administration of an equimolar mixture of nitrous oxide and oxygen (N2O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N2O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy. METHOD: It was a randomized 1:1, double-blind, placebo-controlled study. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N2O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within six or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity and the analgesics consumption for managing post-operative pain. RESULTS: Sixty-four patients were enrolled. Targeted angles were achieved more often in the N2O group (23 of 32, 72%, vs. Placebo: 13/ of 32, 41%; p = 0.01). CONCLUSION: The administration of N2O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N2O in various settings are warranted. SIGNIFICANCE: During this randomized placebo-controlled double-blind study, children receiving nitrous oxide and oxygen (N2O) achieved more often the targeted range of motion during physiotherapy sessions after multilevel surgery. Compared to placebo, nitrous oxide and oxygen (N2O) enabled a better management of acute pain related to physiotherapy procedures.