National emission ceilings in Portugal—trends,compliance and projections

The national emission ceilings (NEC) Directive was implemented to contribute to the reduction of transboundary air pollutions impacts, limiting emissions of acidifying and eutrophication pollutants as well as ozone precursors. It was first adopted by the European Commission (EC) in 2001 (Directive 2001/81/EC) covering four pollutants (NO_x, SO₂, NH₃ and NMVOC). Under the scope of the clean air programme for Europe, which established the air policy objectives for 2020 and 2030, a new NEC was adopted (Directive 2016/2284/EU) establishing more strict ceilings for those pollutants and adding as well PM_2.5. The objective of this paper is to analyse the evolution of the Portuguese national emissions and the compliance of NEC Directive in 2010 and to foresee if the new ceilings for 2030 will be fulfilled. The emission inventories reported to the EC show that emissions in Portugal presented a consistent decreasing trend for all pollutants from 2000 to 2014, and a slight increase in 2015. The 2010 targets were achieved with measures implemented at the time (particularly on the energy, industrial combustion and transport sectors) which allowed Portugal to even surpass the defined goals. The emission projections for 2030, however, reveal that necessary emission reductions for all pollutants could be attained only if measures of the most demanding scenarios are implemented. Therefore, an integrated strategy should be designed and implemented aiming to not only fulfil the NEC in 2030 but also guarantee a better air quality with the highest cost-benefit for the environment and health.     

Effects of Birth Spacing on Maternal,Perinatal, Infant,and Child Health: A Systematic Review of Causal Mechanisms

This systematic review of 58 observational studies identified hypothetical causal mechanisms explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health, and critically examined the scientific evidence for each causal mechanism hypothesized. The following hypothetical causal mechanisms for explaining the association between short intervals and adverse outcomes were identified: maternal nutritional depletion, folate depletion, cervical insufficiency, vertical transmission of infections, suboptimal lactation related to breastfeeding–pregnancy overlap, sibling competition, transmission of infectious diseases among siblings, incomplete healing of uterine scar from previous cesarean delivery, and abnormal remodeling of endometrial blood vessels. Women's physiological regression is the only hypothetical causal mechanism that has been proposed to explain the association between long intervals and adverse outcomes. We found growing evidence supporting most of these hypotheses.     

A clinical trial of neoadjuvant hyperthermic intravesical chemotherapy (HIVEC) for treating intermediate and high-risk non-muscle invasive bladder cancer

Purpose: Ths paper reports a pilot/feasibility trial of neoadjuvant hyperthermic intravesical chemotherapy (HIVEC) prior to transurethral resection of bladder tumour (TURBT) for non-muscle invasive bladder cancer (NMIBC). Materials and methods: A pilot/feasibility clinical trial was performed and 15 patients with intermediate to high-risk NMIBC received HIVEC prior to TURBT. HIVEC consisting of eight weekly instillations of intravesical MMC (80?mg in 50?mL) delivered with the novel Combat BRS® system at a temperature of 43?°C for 60?min. Treatment-related adverse effects were measured and patients were followed for 2 years for disease recurrence. Results: A total of 119 HIVEC treatments occurred. Grade 1 adverse events consisted of irritative bladder symptoms (33%), bladder spasms (27%), pain (27%), haematuria (20%) and urinary tract infection (UTI; 14%). Grade 2 adverse events were bladder calcification (7%) and reduced bladder capacity (7%). No grade 3 or higher toxicity was observed. At TURBT, eight patients (53%) were complete responders (pT0) while seven (47%) were partial responders. With a median follow-up of 29 months, the 3-year cumulative incidence of recurrence was 15%. Conclusions: The Combat BRS® system achieved target bladder temperatures and delivered HIVEC with a favourable side-effect profile. Our pilot trial also provides preliminary evidence of treatment efficacy.     

Indications and pitfalls of immunohistochemistry in head and neck cancer

Immunohistochemistry (IHC) has been employed in the differential diagnosis of tumors.ObjectiveTo assess the use of IHC in cases of head and neck tumor.MethodThis is a retrospective study of the cases included in the Cancer Registry of the institution.ResultsIHC was used in 76 (11%) of 704 pathology tests. Most cases were carcinomas (85.80%), and 83.66% of them were squamous cell carcinomas. All tests were done with diagnostic purposes. The most frequently used antibodies were 34BE12 (37.18%), AE1/AE3 (35.9%), 35BH11 (28.21%), CD45 (25.64%), CD20 (24.36%), CD30 (24.36%), CK7 (23.08%) and CD3 (23.08%).ConclusionsIHC was used in 10.67% of the head and neck tumor cases submitted to pathology testing, mostly for carcinoma (5.26%). In the determination of squamous cell carcinoma, IHC accounted for 18.42% of all tumors.