ABSTRACT The ideal ventral hernia surgical repair is still in discussion1. The defect closure with a mesh-based repair is the base of surgical repair, in open or minimally invasive techniques2. The open methods lead to a higher surgical site infections incidence, meanwhile, the laparoscopic IPOM (intraperitoneal onlay mesh) increases the risk of intestinal lesions, adhesions, and bowel obstruction, in addition to requiring double mesh and fixation products which increase its costs and could worsen the post-operative pain3-5. The eTEP (extended/enhanced view totally intraperitoneal) technique has also arisen as a good option for this hernia repair. To avoid the disadvantages found in classic open and laparoscopic techniques, the MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair) concept, created by W. Reinpold et al. in 2009, 3 years after eTEP conceptualization, allows the usage of bigger meshes through a small skin incision and laparoscopic retro-rectus space dissection, as the 2016 modification, avoiding an intraperitoneal mesh placement6,7. This new technique has been called E-MILOS (Endoscopic Mini or Less Open Sublay Repair)8. The aim of this paper is to report the E-MILOS techniques primary experience Brazil, in Santa Casa de Misericórdia de São Paulo.

RESUMO O tratamento cirúrgico ideal para correção das hérnias ventrais ainda é motivo de grande discussão1. O fechamento do defeito associado a utilização de telas para reforço da parede abdominal são passos fundamentais da terapia cirúrgica, podendo ser realizados tanto pela via aberta quanto pelas técnicas minimamente invasivas2. A via aberta apresenta maiores taxas de infecção de sítio cirúrgico, enquanto o reparo laparoscópico IPOM (intraperitoneal onlay mesh) acarreta um risco aumentado de lesões intestinais, aderências e obstruções intestinais, além de requerer uso de telas de dupla face e dispositivos de fixação que encarecem o procedimento e não raro aumentam a dor no pós-operatório3-5. A técnica eTEP (extended/enhanced view totally extraperitoneal), tem ganhado importância, mostrando-se uma boa opção para a correção das hérnias ventrais também2. A fim de se evitar as desvantagens das técnicas abertas e laparoscópicas “clássicas” o conceito MILOS (Endoscopically Assisted Mini or Less Open Sublay Repair), desenvolvido por W. Reinpold et al. em 2009, 3 anos antes do advento do eTEP, possibilita ao cirurgião o uso de telas de grandes dimensões no plano retromuscular através de uma pequena incisão na pele e dissecção laparoscópica deste espaço, conforme modificação realizada em 2016, evitando a colocação de uma tela no espaço intraperitoneal6-7. Esta nova técnica passou a se chamar EMILOS (Endoscopic Mini or Less Open Sublay Repair)8 Este artigo tem como objetivo relatar nossa experiência inicial no emprego da técnica E-MILOS no Brasil, na Santa Casa de Misericórdia de São Paulo.

RESUMO Objetivo: descrevemos nossa experiência com uso da plataforma robótica no tratamento das recidivas operadas previamente por laparoscopia, mantendo assim uma proposta minimamente invasiva a esses pacientes, apesar de haver uma predileção pela via anterior e aberta nestes casos. Métodos: foram incluídos pacientes submetidos a hernioplastia inguinal robótica transabdominal pré-peritoneal como tratamento de recidiva e que foram operados previamente por laparoscopia, entre dezembro de 2015 e setembro de 2020 e mantidos em uma base de dados ambulatorial prospectiva. Variáveis de interesse incluíram dados demográficos, características herniárias, detalhes operatórios, ocorrências do sítio cirúrgico em 30 dias (com ou sem necessidade de intervenção), infeção do sítio cirúrgico, tempo de seguimento e taxa de recidiva. Resultados: dezenove pacientes (95% masculino, média de idade de 55 anos, média de índice de massa corporal 28kg/m2) e 27 hérnias operadas (N=8 bilaterais). Média de tempo cirúrgico 168.9±49.3 min (variando 90-240). N=2 complicações intraoperatórias por lesão de vasos epigástricos inferiores. N=2 seromas e N=1 hematoma foram identificados no pós-operatório; N=1 paciente apresentou dor crônica pós operatória. Após um tempo de seguimento médio de 35.7 meses (intervalo entre quartis 13-49), nenhuma recidiva foi diagnosticada. Conclusões: o uso da plataforma robótica parece ser seguro e efetivo no tratamento das recidivas operadas previamente laparoscopia, nesse pequeno grupo de pacientes selecionados, apesar de requerer expertise em cirurgia robótica. Outros estudos com maiores casuísticas são necessários para estabelecer o papel desta técnica no cenário das hérnias inguinais recidivadas.

ABSTRACT Objective: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. Methods: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. Results: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. Conclusions: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.

The development of visible-light active photocatalysts is vital to harvest the solar irradiation and build efficient photoelectrochemical devices. Bismuth oxyhalide (BiOCl, BiOBr and BiOI) materials stand out due to their remarkable properties, e.g., the band gap energy can be tuned from 1.9 to 3.4 eV depends on the halide employed. However, the hydrothermal synthesis of this material class was not properly investigated and compared. Then, we evaluated the effect of the hydrothermal treatment in the BiOX’s structural, electronic, morphological and textural properties and the relationship with their photocatalytic performance. Methylene blue (MB) dye was used as probe for photocatalytic performance evaluation under ultraviolet (UV) and visible (Vis) radiation. BiOCl and BiOBr samples showed a good photoactivity under both UV and visible radiation, on other hand the BiOI samples was not active, likely due to the fast charge recombination. BiOCl and BiOBr samples exhibit a favorably interaction with MB dye, because their surfaces are negatively charged. BiOCl samples were able to promote around 40 and 80% of the MB dye degradation under visible and UV radiation, respectively. The samples were also employed as photoanode for O2 evolution, BiOI sample exhibited the best performance, due to the synergistic effect of photocatalysis and electrocatalysis.

CO2 REDUCTION TO HYDROCARBONS AND OXYGENATES: FUNDAMENTALS, STRATEGIES AND CHALLENGES. The development of renewable energy sources (e.g., solar and wind) moves foward, the tendance for replacing fossil fuels increases. However, these technologies have as primary barriers to industrial processes’ efficiency and especially storage. Thus, CO2 reduction routes using these energy sources could chemically store part of the energy as fuels or chemicals, offering alternatives to current oil and gas industry. This process is inspired by photosynthesis, e.g., photochemical or electrochemical processes, using homogeneous or heterogeneous catalysts. Nevertheless, this reaction is thermodynamically unfavorable and has very slow kinetics, given the high stability of the CO2 molecule and the complexity of the redox reactions involved. Therefore, this review addresses this process’s kinetic and thermodynamic challenges, and the fundamental concepts of the photo(electro)chemical processes for CO2 reduction, besides presenting and discussing the materials with the potential to act as catalysts. The main reaction mechanisms and advances in the understanding of such processes are discussed, as well as future perspectives

RESUMO Em anfíbios a territorialidade, o cortejo elaborado e outras formas de comportamento, parecem estar mais associados a espécies que exibem o padrão de reprodução prolongado. A vocalização é um importante aspecto biológico relacionado à reprodução e ao comportamento social dos anuros. Este é o primeiro estudo com comportamento e vocalização da rã-foguete Allobates olfersioides (Lutz, 1925) e nós registramos em etograma o comportamento de territorialidade e corte, descrevemos e analisamos o seu repertório vocal e avaliamos a influência climática na atividade acústica da espécie. Ao todo 18 machos de A. olfersioides foram observados pelo método de animal focal, registrando todas as atividades individuais durante dez minutos. Adicionalmente, nós utilizamos o playback de um canto de advertência de macho adulto para analisar as respostas territoriais exibidas por indivíduos machos durante o trabalho. Para este anuro, registramos 11 comportamentos distintos e analisamos 14 cantos de anúncio que demonstraram que o canto de A. olfersioides é um canto simples e composto por uma única nota não pulsionada com duração média de 0,02s, intervalo médio entre cantos de 0,35s e frequência dominante média de 5,67kHz. O período de atividade vocal foi registrado durante quase todos os meses do estudo (novembro de 2015 a outubro de 2016), exceto novembro e dezembro, onde os indivíduos ficaram inativos quanto às atividades acústicas. Acreditamos que A. olfersioides apresente uma reprodução contínua (com duração de aproximadamente dez meses), devido à ausência de vocalizações durante os meses mais secos em novembro e dezembro. No que se refere às atividades comportamentais, A. olfersioides apresenta padrões de comportamento semelhantes a outras espécies de Aromobatidae, como também, o padrão territorialista já visto para o grupo, demonstrando a importância dos sinais acústicos e visuais.

ABSTRACT For the amphibians the territoriality, the elaborate courtship and other forms of behaviors, seem to be more associated with species that exhibit the pattern of prolonged reproduction. Vocalization is an important biological aspect related to the reproduction and social behavior of the anurans. This is the first study with behavior and calls for the rocket frog, Allobates olfersioides (Lutz, 1925) and we record the territorial and courtship behavior in ethogram, describe and analyze its vocal repertoire and evaluate the climatic influence on the acoustic activity of the species. We observed 18 males of A. olfersioides by animal focal method, recording all individual activities for ten minutes to calculate the frequency of each action exhibited. Additionally, we played a previously recorded advertisement call to individual male frogs for analyze the territorial responses displayed by individual males during the work. For this anuran, we recorded 11 distinct behaviors and analyzed 14 advertisement calls that demonstrated that the call of A. olfersioides is a simple call composed of a single non-pulsed note, the call duration had a mean of 0.02s, the mean of intercall interval was of 0.35s and the dominant frequency presented a mean of 5.67 kHz. The period of vocal activity was recorded during almost all months of the study (November 2015 to October 2016), except November and December, where the individuals presented acoustic inactivity. We believe that A. olfersioides presents a continuous reproduction (approximately 10 months), due to the absence of vocalizations during the driest months in November and December. Concerning the behavioral activities, A. olfersioides presents territorialist behavior patterns similar to other species of Aromobatidae, demonstrating the importance of the acoustic and visual signals exhibited by this anuran species of the Atlantic Forest.

RESUMO O objetivo deste estudo é discutir os custos financeiros mundiais atribuídos à doença renal crónica (DRC) e suas repercussões sobre os sistemas de saúde em países em desenvolvimento, como o Brasil. Trata-se de uma revisão sistemática realizada na base de dados do PubMed/Medline, utilizando os termos em inglês “costs” e “chronic kidney disease”, em janeiro de 2017. A busca foi ampliada a outros bancos, como o Scielo e o Google Acadêmico, com o objetivo de identificar estudos locais relacionados ao assunto, publicados em revistas não indexadas no PubMed. Foram incluídos apenas artigos publicados a partir de 2012. Priorizaram-se estudos que abordavam os custos da DRC e das modalidades de tratamento. A busca resultou em 392 artigos, dos quais foram excluídos 291 por fugirem da temática principal desta revisão. Dos 101 restantes, foram excluídos revisões, comentários e protocolos. Foram incluídos 37 artigos cujo foco eram os custos globais relacionados à DRC. Apesar de os métodos e análises serem diversos, os resultados dos estudos são unânimes em alertar sobre o forte impacto, financeiro e social, da DRC que atinge os sistemas de saúde, públicos e privados, portadores da doença, familiares e a sociedade. Investir maciçamente em prevenção e nas medidas para retardar a progressão da DRC para os estágios finais e, consequentemente, evitar a necessidade de diálise e transplante, podem representar uma enorme, e ainda não calculada, economia para pacientes e sistemas de saúde do mundo todo.

SUMMARY The aim of this study is to discuss the global costs attributed to chronic kidney disease (CKD) and its impact on healthcare systems of developing countries, such as Brazil. This is a systematic review based on data from PubMed/Medline, using the key words “costs” and “chronic kidney disease”, in January 2017. The search was also done in other databases, such as Scielo and Google Scholar, aiming to identify regional studies related to this subject, published in journal not indexed in PubMed. Only papers published from 2012 on were included. Studies on CKD costs and treatment modalities were prioritized. The search resulted in 392 articles, from which 291 were excluded because they were related to other aspects of CKD. From the 101 remaining articles, we have excluded the reviews, comments and study protocols. A total of 37 articles were included, all focusing on global costs related to CKD. Despite methods and analysis were diverse, the results of these studies were unanimous in alerting for the impact (financial and social) of CKD on health systems (public and private) and also on family and society. To massively invest in prevention and measures to slow CKD progression into its end-stages and, then, avoid the requirement for dialysis and transplant, can represent a huge, and not yet calculated, economy for patients and health systems all over the world.

ABSTRACT The objective of this study was to identify types of production system and their main indicators on bioeconomic efficiency, using qualitative and quantitative methods to evaluate beef cattle farms in the western region of the state of Rio Grande do Sul. A survey was carried out with 43 farmers operating in the western region of that state. All farms operated with complete cycle production systems in areas larger or equal to 900 ha. A qualitative questionnaire with binary answers and a quantitative questionnaire with numerical answers were applied. Technology and Management drivers were used for the calculation of the efficiency index of farmers obtained by both questionnaires. Farmers were divided into three clusters: low-efficiency level (LEL), intermediate-efficiency level (IEM), or high-efficiency level (HEL), as a result of the comparison of the scores obtained for the analyzed parameters. Subfactors resulting from each comparison (LEL × IEL; LEL × HEL, and IEL × HEL) were different as a function of the comparison and of the methods applied. Low-efficiency level farmers need to improve essential production processes, such as technology and management, as well as health management practices together with the financial management of the production system. Intermediate-efficiency level farmers need to improve their routine animal management, pasture management, and calculation of financial indicators to become highly efficient. The quantitative method allowed to identify underestimation (39.3%) or overestimation (24.2%) when farmers were are classified in clusters. Different methods may be used, but those based on quantitative information have stronger discrimination power to identify different types of farmers.

Audiovisual Media Law generates, since 2008, a number of political and media transformations in Argentina. These changes are still in full force, because after six years of its enactment, the law is still a matter of legal disputes and political tensions, in addition to being subject non-neutralized in media coverage. Seeks, first, pass between academic peers located in the native audience of programs the effects of mediatization in the mediatic-communicational circulation and social-mediatical circulation of 6-7-8 and Periodismo Para Todos observed in this work. Secondly, it proposes an external point of view from the polarized argentine situation. The analyzed material consists in the issues of programs displayed from 22 September to 10 November 2013, dates that correspond respectively the beginning of the parliamentary election campaigns in audiovisual media and the impact of the verdict that defines de constitutionality of the Media Law by the Supreme Court on 29 October. It is noticed that the mediatization generates changes both in the political and media fields, emphasizing the conflict between Grupo Clarín and Kirchner government through television programs. The polarization generates responses from other social groups in an attempt to overcome the effect of two truths.

La Ley de Medios Audiovisuales genera, hacia 2008, una serie de transformaciones políticas y mediáticas en Argentina. Estas transformaciones aún están en pleno vigor, pues después de seis años de su promulgación, la ley aún es materia de batallas judiciales y tensiones políticas, y también no está neutralizado en la cobertura mediática. Buscase, en primero lugar, repercutir entre pares académicos ubicados en la audiencia nativa de los programas los efectos de la mediatización en la circulación mediático-comunicacional y mediático-social de los programas 6-7-8 y Periodismo Para Todos percibidos en este trabajo. En según lugar, propone un punto de vista externo a la coyuntura argentina polarizada. El material analisado consiste en las ediciones de los programas exhibidas entre los días 22 de septiembre y 10 de noviembre de 2013, fechas que corresponden, respectivamente, al empiezo de las campañas electorales legislativas en medios audiovisuales y a las repercusiones del fallo de constitucionalidad de la Ley de Medios proferida por la Corte Suprema en 29 de octubre. Percíbese que la mediatización genera transformaciones tanto en el campo político cuanto en el mediático, acentuando el conflicto entre Grupo Clarín y Gobierno Kirchner por medio de programas televisivos. La polarización genera respuestas de otros corpos sociales, en un intento de superar el efecto de dos verdades.

Resumo: Este estudo teve como finalidade a recolha e sistematização de dados etnobotânicos referentes às relações desenvolvidas entre o povo insular Açoriano e a flora nativa. O método de recolha de informação assentou em dois modelos de entrevistas, a entrevista informal e a entrevista estruturada. Algumas das plantas citadas pelos entrevistados já ostentavam utilizações descritas na literatura. Todavia verificou-se que, em 54 utilizações referidas, distribuídas por 4 classes de uso, 25 são citações novas, das quais sete são atuais e 18 pertencentes a um passado recente, abrangendo um total de 13 espécies.

Abstract: The study was aimed at the collection and systematization of ethnobotanical data on relationships developed between the Azorean islands people and the native flora. The information collection method was based on two models of interviews, i.e., informal interview and a structured interview. Some of the plants mentioned, already bore uses described in literature. However, it was found that of the 54 mentioned uses, distributed by 4usage classes, 25 are new quotes, of which, 7 are current and 18 belong to a recent past, covering a total of 13 species.

Resumen: El estudio tuvo como objetivo la recopilación y sistematización de los datos etnobotánicos en las relaciones desarrolladas entre los habitantes de las islas de Azores y la flora nativa. El método de recogida de información se ha basado en dos modelos de entrevistas, es decir, la entrevista informal y una entrevista estructurada. Algunas de las plantas mencionadas, ya llevaban usos descritos en la literatura. Sin embargo, se encontró que, de las 54 utilizaciones mencionadas, distribuidas en 4 clases de uso, 25 son nuevas citas, de las cuales, 7 son actuales y 18 pertenecen a un pasado reciente, que abarca un total de 13 especies.

Résumé: L'étude a visé la collecte et la systématisation des données ethnobotaniques sur les relations développées entre les habitants des 'îles des Açores et la flore indigène. La méthode de collecte de l'information a était basée sur deux modèles d'entretiens, à savoir, entretien informel et l'entrevue structurée. Certaines plantes mentionnées, portaient déjà utilisations décrites dans la littérature. Cependant, il a été constaté que, des 54 utilisations citées, distribués par 4 classes d'utilisation, 25 sont de nouvelles citations, dont 7 sont en cours et 18 appartiennent à un passé récent, couvrant un total de 13 espèces.

RESUMO Objetivo Analisar, a partir do exame de decisões proferidas por tribunais brasileiros, como a Medicina Baseada em Evidências foi aplicada e se conduziu a decisões bem fundamentadas, sob a perspectiva do melhor conhecimento científico. Métodos Analisaram-se decisões de Tribunais Federais selecionadas pela busca, sem limitação temporal, no sítio do Conselho da Justiça Federal, dedicado à pesquisa unificada de jurisprudência, contendo a expressão “Medicina Baseada em Evidências”. Quanto aos acórdãos da Corte Paulista, a busca foi feita em sua página na internet dedicada à pesquisa de jurisprudência, também por meio da expressão “Medicina Baseada em Evidências”, e sem limitação temporal. Efetuou-se, a seguir, uma análise qualitativa da discussão efetuada em cada processo, verificando se nela se apreciaram a situação do paciente/autor da ação, e a eficácia ou ineficácia de tratamentos ou medicamentos constantes em protocolos já existentes, antes de se deferir a medida buscada em juízo. Resultados Verificou-se que em menos de um terço das decisões examinadas houve uma discussão adequada da eficácia do procedimento buscado judicialmente, em comparação com os disponibilizados em protocolos clínicos pelo Sistema Único de Saúde e por planos privados de saúde, à luz da situação individual do autor da ação. A maioria das decisões envolvia planos de saúde (n=13, 68%). Conclusão O número de decisões em que se deu maior consideração à evidência científica e às peculiaridades dos pacientes foi preocupante. É necessário ampliar a discussão da Medicina Baseada em Evidências nos processos envolvendo a saúde pública.

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

The objective of this study was to determine the main causes of failure in bull breeding using a soundness evaluation in Rio Grande do Sul State/Brazil. We evaluated 19,836 bulls from 15 different breeds with ages ranging from two to eight years. The failures of bulls in each step were analyzed by logistic regression. The binary logistic regression was applied because the response variable had only two responses: Success (1) and Failure (0). Older bulls are more likely to be rejected than are younger bulls, regardless of their genetic group. Depending on the step of the assessment, one or another group is rejected. All steps of bull breeding soundness evaluation (BBSE) are important, with special attention to the failures of the behavioral evaluation (libido and physical ability). A BBSE performed before the breeding season reduces the risk of sub-fertile bulls in the herd.

The complexity of the consumers' behavior has taken the food industry to a new level of dynamism. Therefore, understanding the factors that influence this behavior is decisive for the differentiation of products to niche markets and even to adjust the supply according to consumers' expectancy. This article proposes a conceptual model to identify the factors influencing beef consumption in Brazil. The methodological approach was characterized by a systematic review through a synthesis of research related directly to this topic. Therefore, 76 papers published during the 2000-2014 period, including official documents (statistics), full research papers, abstracts, proceedings, and reports, were selected. Four main factors were related to influences in consumer behavior and/or directly in beef consumption: sociocultural, economic, health/food, and environmental. Among these dimensions, there was an emphasis on recent publications related to health/food and the environment. The compilation and analysis of these papers enabled the conception of the proposed model and suggests the consideration of four main dimensions in beef consumption.

O objetivo deste experimento é a identificação das demandas de melhorias para fazendas com diferentes níveis de competitividade no Oeste do RS. Entrevistaram-se 63 produtores grandes (área= +900 ha) por meio de um questionário semi-estruturado, dividido em quatro direcionadores: tecnologia (TEC), gestão (MAN), relações de mercado (MR) e ambiente institucional (IE). Utilizou-se o software SAS 2002, versão 9.0, para realização da análise de cluster, realizando a tipologia dos produtores. Nesta análise, formaram-se aleatoriamente três clusters, sendo denominados de baixo nível de competitividade (LCL), médio nível de competitividade (MCL) e alto nível de competitividade (HCL). Dividiram-se as 29 variáveis (subfatores) avaliadas na análise de cluster de acordo com nível de impacto na competitividade das fazendas de bovinos de corte, sendo classificadas em variáveis de alto, médio ou baixo impacto. Esta estratificação do ranking de demanda de melhorias foi realizada a partir dos pesos atribuídos pelos especialistas aos subfatores. Os pecuaristas com baixo nível de competitividade apresentaram status desfavorável para MAN, enquanto os pecuaristas pertencentes aos clusters MCL e HCL apresentaram, respectivamente, status neutro e favorável para o mesmo direcionador. Portanto, a gestão é determinante para definir o nível de competitividade das fazendas entrevistadas

The aim of this experiment was to identify improvement demands for farms with different levels of competitiveness in the west of Rio Grande do Sul state, Brazil. A total of 63 owners of large farms were interviewed (farms with an area greater than 900ha) by applying a semi-structured questionnaire, guided by four drivers: technology (TEC), management (MAN), market relations (MR) and the institutional environment (IE).It was used the Statistical Analysis System 9.2 software to perform the cluster analysis and identify farmers' characteristics. Three random clusters with different levels of competitiveness were observed: low competitiveness level (LCL), middle competitiveness level (MCL) and high competitiveness level (HCL). The 29 variables (sub factors) were evaluated in the cluster analysis according to level of impact on competitiveness, being classified into variables of high, medium or low impact. Stratification was carried out, ranking demands for improvements from aspects attributed by experts in relation to sub factors. The farmers with low competitiveness level (LTL) had an unfavorable status for MAN, while the farmers belonging to clusters MCL and HCL have, respectively, favorable and neutral status for the same driver. The management characteristics determined the level of competitiveness of the farms surveyed

Enteropatia com formação de tufos epiteliais (ETE), também conhecida como displasia epitelial intestinal (DEI), é uma rara enteropatia congênita relacionada com um início precoce de diarreia intratável grave devido a anormalidades específicas do epitélio intestinal e mutações do gene EpCAM. ETE caracteriza-se por uma heterogeneidade clínica e histológica, como ausência ou leve infiltrado de células mononucleares na lâmina própria e anormalidades de membrana basal. Pode ser associada a malformações, outras doenças epiteliais ou anormalidades no desenvolvimento/na diferenciação dos enterócitos. Os autores relatam um caso de ETE, em uma criança brasileira, associada à mutação c.556-14A> g do gene EPCAM (NM_002354.2).

Tufting enteropathy (TE), also known as intestinal epithelial dysplasia (IED), is a rare congenital enteropathy related to an earlyonset of severe intractable diarrhea due to specific abnormalities of the intestinal epithelium and mutations of the EpCAM gene. TE is characterized by clinical and histological heterogeneity, such as with low or without mononuclear cell infiltration of the lamina propria, and abnormalities of basement membrane. TE can be associated with malformations, other epithelial diseases, or to abnormal enterocytes development and/or differentiation. The authors report a case of a Brazilian child with TE associated with c.556-14A>G mutation in the EpCAM gene (NM_002354.2).