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IntroductionAssessment of neuropsychiatric sequelae of traumatic brain injury (TBI) brings about challenges in the forensic setting, comprising analysis of neurobiological variables, preinjury variables (personality/psychiatric disturbances), postinjury psychosocial, allowing the expert witness to provide clear and appropriate explanations, so the court can decide with justice, particularly in civil law cases.ObjectivesDiscuss the main clinical and neuroimagiologic aspects to consider in civil litigation of TBI cases.MethodsComprehensive literature review.ResultsAlthough accurate predictions are difficult, some generalizations can be made. Recovery from hypoxic and diffuse axonal injury (DAI) takes longer and is less complete than focal contusions. Posttraumatic amnesia is the main predictor of long-term cognitive outcome. In moderate/severe TBI (m/sTBI) occurs chronic lesion expansion (axonal degeneration) and brain atrophy. DAI topography determinates the cognitive disfunction pattern yet underestimated in conventional neuroimaging. Diffusion-Tension-Imaging (DTI) may be valuable to outcome predictions in m/sTBI: structural disconnection within the Default Mode and the Salience Networks are linked to attention and executive impairments; hippocampus and fornix damage correlates with memory/learning impairments. Conversely, DTI findings can be misleading in mild TBI (mTBI), and case-by-case analysis seldomly prove its scientific validity.ConclusionsTo elaborate formulations within reasonable medical certainty, outcome predictions should not be made until at least six months following the TBI, considering that most mTBI symptoms resolve in few months, and up to 1-½ years, when m/sTBI neuropathologic changes stabilize. The neurobiological underpinnings are fundamental for causality formulations, however atypical outcomes in mTBI are frequently predicated upon non–brain-injury psychiatric conditions and psychosocial factors.DisclosureNo significant relationships.

Purpose The main goal of this work was to study the stereotactic anatomy of the human locus coeruleus (LC), important relay of adrenergic and dopaminergic human brainstem (HB) circuitry, to allow its easy localization on MRI and in microsurgical procedures. Methods Forty LC were studied from 20 adult HB of both sexes. The melanin pigmentation of its cells was used to identify and localize them and so to define the 2-D and 3-D LC contours. These HB were cut on a cryomicrotome with 3-D referenciation. The slices were coloured with haematoxyline-eosin. On the slices, digitized images of the cells were referenced to the midline, the fourth ventricle floor plane and the pontomedullary junction plane with an appropriate computer program. Results The LC revealed to be a symmetric, thin and elongated nucleus, divergent caudally except in its superior part, with a sub-ependymal location on the superior dorsal lateral pons. The main LC dimensions are: length 12.0–17.0 mm (m 14.5); width 2.5 mm; height 2.0 mm. The 3-D references of the LC center are: 3.2 ± 0.3 mm to the midline; 1.1 ± 0.2 mm to the IV ventricle floor and 18.5 ± 1.5 mm to the ponto-medullary junction. Conclusions The human LC is a nucleus thinner and longer than previously described (in average 14.5 mm long and 2–2.5 mm thick), localized 1 mm under the IV ventricle, 3 mm apart from the midline and centered 14–21 mm above de ponto-medullary junction. No correlation was found between LC and pons dimensions, the gender or the age.

Postictal psychosis (PIP) is one of the most common types of psychosis in epileptic patients. By virtue of the paucity of research on PIP, its pathophysiology remains not completely understood. Our case report describes a clinical picture of PIP, characterized by pleomorphic features, with neither Schneider’s first-rank symptoms nor negative symptoms of schizophrenia, in a longstanding epileptic female patient with a history of nonadherence to antiepileptic treatment and poorly controlled seizures. Additionally, she had previous cognitive impairment and encephalomalacia in the right parietooccipital region as a sequela of a moderate-to-severe traumatic brain injury known to precede the emergence of the epilepsy. In light of our findings, we critically reviewed the current literature on postictal psychoses providing insight into its neurobiological underpinnings.

Macro and meiobenthic communities of two fishing areas (Vilamoura and Lagos) in the western part of south Portugal (Algarve coast) were analysed. Both locations had been under severe dredge-fishing impact until four years previously. Vilamoura has since continued to be dredged, while fishing activity in Lagos was stopped in 1995 as a response to overfishing. For each location, three replicate areas were analysed at depths of 7–9 m. In each of these areas, 18 quadrats for macrofauna and 12 cores for meiofauna were randomly sampled by SCUBA divers during September 1999. The Shannon–Weiner diversity index was higher for meiofauna in the fished area, whereas macrofauna diversity was higher in the recently non-fished area. Bray–Curtis dissimilarity between the two areas was 87·82%. Major differences were found between Ampeliscidea, Amphiura mediterranea, Spisula solida, Haustoriidae, Nemertinea and Diogenes pugilator populations at the two sites. There was higher abundance but lower biomass of potential macrofaunal scavengers in the fished area, and carnivore biomass was also higher in this area. Deposit-feeders dominated meiofauna abundance in both study areas. The community structure of the continuously fished area was dominated by small, opportunistic, short-lived species while the community structure of the recently non-fished area was dominated by more fragile and long-living sessile organisms.

Little attention has been given to the behavioural and physiological effects of dredging on clams. The response of the clam Spisula solida under stress imposed by dredging activity is analysed in terms of reburial time and two acute indices: AEC (adenylic energetic charge) and ATP per milligram dry weight. Stress on undersized (<25 mm) S. solida, due to habitat disturbance by dredging itself and subsequent aerial exposure was measured with in situ studies during September 1999 at Vilamoura, a bivalve sandy ground, off the southern coast of Portugal. The study showed significant increases in reburial time and a decrease in adenylic-derived indices of stressed bivalves compared with in situ control bivalves monitored by SCUBA divers. It was concluded that the stress caused by dredging affects the behavioural and physiological responses of S. solida. Moreover, the reburial time is an easy and valuable indicator of stress levels in the studied clam.

Patterns in community structure of meiofauna and macrofauna in relation to Portuguese clam dredging were compared during a 2-y-period off Lagos and Vilamoura, south Portugal. SCUBA divers randomly sampled corer and quadrat samples before and immediately after simulating commercial dredge fishery. Univariate measures (abundance, number of taxa, evenness, diversity and biomass) and multivariate analyses (Cluster, MDS and SIMPER) revealed changes in the meio- and macro-benthic community structure caused by dredge disturbance (short-term effects), with a general decrease in all measures. Macrofauna were found to be more sensitive to dredge disturbance, and aggressive predatory behaviour was observed after disturbance in the continuously dredged area. Nevertheless, higher significant natural changes were found between seasonal periods, indicating that dredging may only cause a small-scale and short-term impact.

On the basis of low-quality evidence, international critical care nutrition guidelines recommend a wide range of protein doses. The effect of delivering high-dose protein during critical illness is unknown. We aimed to test the hypothesis that a higher dose of protein provided to critically ill patients would improve their clinical outcomes. This international, investigator-initiated, pragmatic, registry-based, single-blinded, randomised trial was undertaken in 85 intensive care units (ICUs) across 16 countries. We enrolled nutritionally high-risk adults (≥18 years) undergoing mechanical ventilation to compare prescribing high-dose protein (≥2·2 g/kg per day) with usual dose protein (≤1·2 g/kg per day) started within 96 h of ICU admission and continued for up to 28 days or death or transition to oral feeding. Participants were randomly allocated (1:1) to high-dose protein or usual dose protein, stratified by site. As site personnel were involved in both prescribing and delivering protein dose, it was not possible to blind clinicians, but patients were not made aware of the treatment assignment. The primary efficacy outcome was time-to-discharge-alive from hospital up to 60 days after ICU admission and the secondary outcome was 60-day mortality. Patients were analysed in the group to which they were randomly assigned regardless of study compliance, although patients who dropped out of the study before receiving the study intervention were excluded. This study is registered with ClinicalTrials.gov, NCT03160547. Between Jan 17, 2018, and Dec 3, 2021, 1329 patients were randomised and 1301 (97·9%) were included in the analysis (645 in the high-dose protein group and 656 in usual dose group). By 60 days after randomisation, the cumulative incidence of alive hospital discharge was 46·1% (95 CI 42·0%–50·1%) in the high-dose compared with 50·2% (46·0%–54·3%) in the usual dose protein group (hazard ratio 0·91, 95% CI 0·77—1·07; p=0·27). The 60-day mortality rate was 34·6% (222 of 642) in the high dose protein group compared with 32·1% (208 of 648) in the usual dose protein group (relative risk 1·08, 95% CI 0·92–1·26). There appeared to be a subgroup effect with higher protein provision being particularly harmful in patients with acute kidney injury and higher organ failure scores at baseline. Delivery of higher doses of protein to mechanically ventilated critically ill patients did not improve the time-to-discharge-alive from hospital and might have worsened outcomes for patients with acute kidney injury and high organ failure scores. None.

Background Gorongosa National Park in Mozambique hosts a large population of baboons, numbering over 200 troops. Gorongosa baboons have been tentatively identified as part of Papio ursinus on the basis of previous limited morphological analysis and a handful of mitochondrial DNA sequences. However, a recent morphological and morphometric analysis of Gorongosa baboons pinpointed the occurrence of several traits intermediate between  P. ursinus  and  P. cynocephalus , leaving open the possibility of past and/or ongoing gene flow in the baboon population of Gorongosa National Park. In order to investigate the evolutionary history of baboons in Gorongosa, we generated high and low coverage whole genome sequence data of Gorongosa baboons and compared it to available  Papio  genomes. Results We confirmed that  P. ursinus  is the species closest to Gorongosa baboons. However, the Gorongosa baboon genomes share more derived alleles with  P. cynocephalus  than  P. ursinus  does, but no recent gene flow between  P. ursinus  and  P. cynocephalus  was detected when available  Papio  genomes were analyzed. Our results, based on the analysis of autosomal, mitochondrial and Y chromosome data, suggest complex, possibly male-biased, gene flow between Gorongosa baboons and  P. cynocephalus , hinting to direct or indirect contributions from baboons belonging to the “northern”  Papio clade, and signal the presence of population structure within  P. ursinus . Conclusions The analysis of genome data generated from baboon samples collected in central Mozambique highlighted a complex set of evolutionary relationships with other baboons. Our results provided new insights in the population dynamics that have shaped baboon diversity.

Close coupling of Iberian hydroclimate and North Atlantic sea surface temperature (SST) during recent glacial periods has been identified through the analysis of marine sediment and pollen grains co-deposited on the Portuguese continental margin. While offering precisely correlatable records, these time series have lacked a directly dated, site-specific record of continental Iberian climate spanning multiple glacial cycles as a point of comparison. Here we present a high-resolution, multi-proxy (growth dynamics and δ13C, δ18O, and δ234U values) composite stalagmite record of hydroclimate from two caves in western Portugal across the majority of the last two glacial cycles (∼220 ka). At orbital and millennial scales, stalagmite-based proxies for hydroclimate proxies covaried with SST, with elevated δ13C, δ18O, and δ234U values and/or growth hiatuses indicating reduced effective moisture coincident with periods of lowered SST during major ice-rafted debris events, in agreement with changes in palynological reconstructions of continental climate. While in many cases the Portuguese stalagmite record can be scaled to SST, in some intervals the magnitudes of stalagmite isotopic shifts, and possibly hydroclimate, appear to have been somewhat decoupled from SST.