ABSTRACT Economic development based on cleaner industrial technologies has been increasingly studied in recent years. Cementitious composites reinforced with lignocellulosic fibers can be a sustainable alternative for use in engineering. The study aimed to evaluate the technological properties of cementitious composites produced from natural and industrial coconut fiber to compare the reinforcement with wood particles. Physical tests (density, water absorption, and thickness swelling) and mechanical tests (static bending) were carried out in four treatments, which varied the fiber and cement contents. It was found that treatment with natural coconut fiber had the lowest density value, 0.59 g/cm3, and treatment with industrial coconut fiber had the lowest water absorption value for the times and times of 2 and 24 h, 0.19, and 0.38%, respectively, and the treatment with wood particles, the highest values of modulus of elasticity and rupture, 1,897 MPa and 2.44 MPa. The study of the use of lignocellulosic materials as protection in cementitious composites is essential for applications in building constructions to reduce the environmental impacts generated by the generation of waste and use of non-renewable materials and to promote sustainable development.

Abstract Tracheary elements can be classified as tracheids or vessel elements. In ferns, both cell types and even cells with intermediate characteristics can be observed. For a long time, the methods employed in the study of these cells were questioned and consequently their classification as well. In the present work, we analyze the stem tracheal elements of 13 Aspleniaceae species, occurring in different habitats and belonging to different clades. The samples were cut, dried on a hotplate, metallized, and analyzed in SEM. In general, the Asplenium species analyzed contain elongated conducting cells with oblique end walls, with scalariform thickening on all faces of the cell. The presence of pit membranes, however, varies greatly among species, it being possible to observe species with tracheids, with intermittent perforation plates, and with vessel elements.

Resumo Os elementos traqueais podem ser classificados como traqueídeos ou elementos de vaso. Nas samambaias podem ser observados ambos os tipos de células e até mesmo células com características intermediárias. Durante muito tempo os métodos empregados no estudo dessas células foram questionados e consequentemente a sua classificação também. No presente trabalho analisamos os elementos traqueais do caule de 13 espécies de Aspleniaceae, ocorrendo em diferentes habitats e pertencentes a diferentes clados. As amostras foram cortadas, secas em placa quente, metalizadas e analisadas em MEV. Em geral, as espécies de Asplenium analisadas contêm células condutoras alongadas com paredes terminais oblíquas, com espessamento escalariforme em todas as faces da célula. A presença de membranas de pontoações, entretanto, varia muito entre as espécies, sendo possível observar espécies com traqueídeos, com placas de perfuração intermitentes e com elementos de vasos.

ABSTRACT Were characterized microstructurally and mechanically the Ti-6Aℓ-4V alloy obtained through powder metallurgy in an uncontrolled atmosphere, varying the sintering parameters, arose. The samples were compacted in a uniaxial press at 874 MPa, 999 MPa, and 1124 MPa, and sintered without a protective atmosphere or vacuum, at 675 °C, 750 °C, and 850 °C. When sintering the material, the oxides influenced the results due to titanium’s high affinity for interstitial elements, promoting increased density and high hardness values. Based on the results, the treatment carried out at a pressure of 1124 MPa and a temperature of 750 °C showed the highest hardness in the beta phase (β), with a value of 1165.1 HV. In the alpha phase (α), the highest value was 1321.3 HV, presented by the treatment performed at a pressure of 999 MPa and a temperature of 850 °C. The high hardness values observed in the alloy are associated with the reinforcement promoted by the dissolution of Fe atoms. Materials with high hardness values use in the aerospace and biomedical industries, which always look for better mechanical resistance results, thus increasing their products’ useful life and applicability.

RESUMO Foram caracterizadas micro estruturalmente e mecanicamente a liga Ti-6Aℓ-4V obtida através da metalurgia do pó em atmosfera não controlada variando os parâmetros de sinterização. As amostras foram compactadas em uma prensa uniaxial à 874 MPa, 999 MPa e 1124 MPa, e sinterizadas sem atmosfera protetora ou vácuo, nas temperaturas de 675 °C, 750 °C e 850 °C. Ao sinterizar o material, houve influência dos óxidos nos resultados devido à alta afinidade que o titânio tem por elementos intersticiais, promovendo um aumento na densidade e elevados valores de dureza. A partir dos resultados verificou-se que o tratamento realizado na pressão de 1124 MPa e temperatura de 750 °C foi o que apontou a maior dureza na fase beta (β), sendo o valor de 1165,1 HV. Na fase alfa (α), o maior valor foi de 1321,3 HV, apresentado pelo tratamento realizado na pressão de 999 MPa e temperatura de 850 °C. Os elevados valores na dureza observados na liga estão associados ao reforço promovido pela dissolução átomos de Fe. Materiais com elevada dureza possuem uma vasta aplicação nas indústrias aeroespaciais e biomédicas, que buscam sempre por melhores resultados de resistência mecânica, aumentando assim a vida útil e a aplicabilidades de seus produtos.

Abstract Background: Melanoma thickness is a relevant prognostic marker that is crucial for staging and its calculation relies on the histopathological examination. There is a risk of thickness underestimation with an incisional biopsy if the latter is not performed on a tumor area where the thickness is maximal. This occurrence may have an impact on a therapeutic decision, particularly regarding the excision margins and the need for sentinel lymph node biopsy. Objective: To assess the association between melanoma thickness and dermoscopic, demographic, epidemiological and clinical variables, aiming to identify predictive factors of thickness >1 mm. Methods: This was an observational and cross-sectional study, carried out on patients diagnosed with melanoma, from a single center over a time span of four years. Anatomopathological (thickness), dermoscopic, demographic, epidemiological, and clinical variables were collected. The associations between the variables with melanoma thickness were assessed. Results: A total of 119 patients were included. The presence of atypical vessels on the dermoscopic examination was an independent predictive factor of thickness >1 mm. Conversely, an atypical reticular pattern predicted melanoma thickness <1 mm. The presence of ephelides and a previous history of sunburn were also associated with melanomas thinner than 1 mm in the univariate analysis. Study limitations: The lack of data related to some variables and the absence of an optimal correlation between the dermoscopic and the anatomopathological examination constituted study limitations. Conclusion: An atypical vascular pattern on dermoscopy is associated with thickness >1 mm, helping with the choice of the optimal site to perform an incisional biopsy when an excisional biopsy is not feasible.

Resumo A onicocriptose é uma doença inflamatória da prega ungueal lateral que resulta do encravamento do bordo lateral da placa ungueal no sulco lateral, associando-se a infeções secundárias que culminam na formação de tecido de granulação e hipertrofia da prega ungueal lateral. As opções terapêuticas englobam estratégias conservadoras e cirúrgicas, não existindo consenso quanto à estratégia a adotar em cada estadio de gravidade. A pesquisa bibliográfica para a elaboração deste trabalho foi obtida através das plataformas PubMed e ClinicalKey. Foram selecionados artigos de revisão, artigos científicos e descrições de casos clínicos. Após análise dos artigos selecionados, realizou-se a presente revisão da literatura. A terapêutica da onicocriptose é complexa e dependente do estadio. O tratamento conservador é seguro, cómodo e barato, contudo apenas apresenta eficácia comprovada no estadio I. A matricectomia com fenol ou outros agentes após avulsão ungueal parcial revela-se segura, barata e eficaz, sendo a primeira linha no tratamento de onicocriptose de estadio II ou III. Técnicas de resseção de tecidos moles periungueais nos casos com hipertrofia acentuada das pregas ungueais são eficazes, embora sejam mais invasivas e levem a uma maior e mais dolorosa recuperação. Nestes casos em que está indicada a resseção de tecidos moles, as técnicas de Howard-Dubois, de Vandenbos e do Super U são as que se apresentam mais eficazes e são escolhidas consoante a localização e severidade da hipertrofia das pregas ungueais. No tratamento da onicocriptose, a abordagem conservadora está indicada para o estadio I, enquanto o tratamento cirúrgico está indicado para os estadios II e III. A primeira linha nos estadios II e III deve ser a matricectomia com solução de fenol 88%. Novos estudos com níveis de evidência superiores são necessários para que se possa implementar um algoritmo para o tratamento da onicocriptose.

Abstract Onychocryptosis is an inflammatory disease of the lateral nail fold resulting from the embedding of the lateral border of the nail plate in the periungual soft tissues with consequential formation of granulation tissue and hypertrophy of the lateral nail fold. Therapeutic options include conservative and surgical strategies. There is no consensus regarding the strategy to be adopted at each stage of severity. The bibliographic research for the elaboration of this paper was obtained through PubMed and ClinicalKey platforms. Review articles, scientific articles and descriptions of clinical cases were selected. After careful and critical analysis of the selected articles, the present literature review was carried out. The therapeutic choice for each stage of onychocryptosis is complex. Conservative treatment is safe, convenient, and inexpensive, yet it only has proven efficacy in stage I. Matricectomy with phenol or other agents after partial nail avulsion proved to be safe, inexpensive, and effective, thus being the first line in the treatment of stages II or III. Soft tissue resection techniques proved to be effective in cases of marked hypertrophy of the nail folds but are more invasive and lead to a longer recovery period. In such cases, it is recommendable to perform a resection of the periungual soft tissues, with Howard-Dubois, Vandenbos and Super U techniques being the most effective and chosen according to the location and severity of the hypertrophy of the nail folds. When treating onychocryptosis, the conservative approach is indicated for stage I, while surgical treatment is indicated for stages II and III. The first line in stages II and III should be 88% phenol solution matricectomy. New prospective comparative studies and randomized trials are necessary to implement a standardized clinical approach.

Resumo O carcinoma espinhocelular é o segundo cancro de pele não melanoma mais comum, com incidência crescente. A radioterapia apresenta um papel importante no tratamento destes doentes, seja com intuito curativo, adjuvante ou paliativo. Apresentamos o caso clínico de uma doente de 88 anos com extenso carcinoma espinhocelular periorbitário, que não reunia condições para realização de tratamento de radioterapia externa com adequado posicionamento. Por esse motivo, foi efetuada uma abordagem atípica, tendo efetuado tratamento na maca hospitalar com um feixe direto de eletrões de 6 MeV com dose de 30 Gy/5 fr. A doente obteve resposta clínica completa em 4 meses. Este caso clínico pretende relembrar que embora estejamos perante uma evolução contínua de aceleradores lineares, técnicas especiais de radioterapia e sistemas de imobilização mais eficazes, existem alguns casos em que necessitamos de repensar a nossa estratégia e utilizar técnicas de tratamento clássicas para permitir o tratamento de doentes particulares.

Abstract Cutaneous squamous cell carcinoma represents the second most common nonmelanoma skin cancer, with increasing incidence. Radiation therapy has an important role in the management of these patients either in a curative, adjuvant or palliative setting. We present the case of an 88-year-old woman with an extensive periorbital squamous cell carcinoma who did not have physical conditions to make an appropriate radiation therapy treatment with adequate positioning. For that reason, an unusual approach was taken, treating the patient in the hospital stretcher with a direct electron beam of 6 MeV and a dose of 30 Gy/5 Fr. The patient achieved a complete clinical response within 4 months. This case shows that although we are facing a continuous evolution of linear accelerators, special radiotherapy techniques and increasingly effective immobilization systems, in some cases we need to rethink our strategy and use older techniques to be able to treat the patient.

Resumo Objetivo Analisar as temáticas editoriais publicadas na Revista Acta Paulista de Enfermagem ao longo de seus primeiros trinta anos de existência. Métodos Pesquisa bibliométrica dos editoriais publicados entre 1988 e 2017, com o uso dos Descritores em Saúde, com análise quanti-qualitativa de termos específicos e categorias, discutidas sob a ótica da genealogia do saber de Michel Foucault. Resultados Foram coletados 129 editoriais, 389 termos padronizados e 706 categorias. Os termos específicos mais frequentes resultaram na tríade de tendência temática em (1) Editoração / Publicação Periódica, (2) Pesquisa e (3) Capacitação / Especialidade. Por sua vez, as categorias apontaram a tendência temática em Saúde Pública. Conclusão Os termos e categorias transmitiram ideias de base política de valorização da Enfermagem, evento que coincidiu com a trajetória de luta pelo desenvolvimento do sistema de saúde universal. Essa interligação social demonstra que a visão panóptica dos editoriais foi além de suas funções acadêmicas e científicas.

Abstract Objective To analyze the editorial themes published in the Acta Paulista de Enfermagem journal throughout its first thirty years of existence. Methods Bibliometric study of editorials published between 1988 and 2017 using Health Descriptors and quantitative and qualitative analysis of specific terms and categories discussed from the perspective of Michel Foucault’s genealogy of knowledge. Results In total, 129 editorials, 389 standardized terms and 706 categories were collected. The most frequent specific terms resulted in the triad of thematic trend in (1) Editing/Periodic publication, (2) Research and (3) Training/Specialty. In turn, the categories indicated the thematic trend in Public Health. Conclusion The terms and categories conveyed politically based ideas of valuing Nursing, an event that coincided with the struggle for the development of the National Health Service. This social interconnection demonstrates that the panoptic vision of editorials went beyond their academic and scientific functions.

Resumen Objetivo Analizar las temáticas editoriales publicadas en la Revista Acta Paulista de Enfermería a lo largo de sus primeros treinta años de existencia. Métodos Investigación bibliométrica de los editoriales publicados entre 1988 y 2017, con el uso de los Descriptores en Salud, con un análisis cuali-cuantitativo de términos específicos y de categorías, discutidas bajo la óptica de la genealogía del saber de Michel Foucault. Resultados Se recopilaron 129 editoriales, 389 términos estandarizados y 706 categorías para términos específicos más frecuentes resultaron en la tríada de tendencia temática en (1) Edición / Publicación Periódica, (2) Investigación y (3) Capacitación / Especialidad. Por su lado las categorías señalaron la tendencia temática en Salud Pública. Conclusión Los términos y categorías transmitieron ideas de base política de valoración de la Enfermería, evento que coincidió con la trayectoria de lucha por el desarrollo del sistema de salud universal. Esa interconexión social demuestra que la visión panóptica de los editoriales fue más allá de sus funciones académicas y científicas.

Abstract Background Mohs Micrographic Surgery (MMS) is commonly used to treat high-risk basal cell carcinoma (BCC). Objectives Correlate clinicopathologic preoperative features with the number of MMS stages (primary endpoint) and margins (secondary endpoint) required for BCC complete excision. Methods We retrospectively analyzed BCCs treated by MMS in a 2-year period at the study’s institution. Variables studied included the patient gender, age, immune status, lesion size, location, if it was a primary, recurrent, or persistent tumor, histopathologic characteristics, number of surgical stages, and amount of tissue excised. Results 116 BCCs were included. The majority (61.2%, n = 71) required a single-stage surgery for complete clearance, requiring a final margins of 3.11 ± 2.35 mm. Statistically significant differences between locations in different high-risk areas (periocular, perioral, nose, ear) and the number of MMS stages required for complete excision (p = 0.025) were found, with periocular tumours requiring the highest mean of stages (2.29 ± 0.95). An aggressive histopathology significantly influenced the number of MMS stages (p = 0.012). Any significant relation between clinicopathological features and variation in the final surgical margins was found, just certain tendencies (male patients, persistent tumor, periocular location, and high-risk histopathological tumors required larger margins). Neither patient age or tumor dimension correlated significantly with both number of MMS stages and final surgical margins. Study limitations Limitations of this study include its single-center nature with a small sample size, which limits the value of conclusions. Conclusion Main factors related to a greater number of MMS stages were periocular location and high-risk histopathological subtype of the tumor.

Abstract Background: There are conflicting data regarding the prognostic value of the lymphatic basin drainage pattern in melanoma patients and the evidence is scant in the setting of negative sentinel lymph node biopsy. Objective: To investigate whether the pattern of lymphatic basin drainage influences the risk of nodal disease in patients with melanoma of the trunk and negative sentinel lymph node biopsy. Methods: A case series of patients with trunk melanoma and negative sentinel lymph node biopsy was retrospectively evaluated. Clinicopathological features, the pattern of lymphatic drainage and nodal, metastatic, and overall recurrence-free survival were reviewed. Results: Of the 135 patients included, multiple lymphatic basin drainage was identified in 61 (45.2%). Ten of the 74 (13.5%) patients with single drainage developed nodal recurrence, compared with 2 of the 61 (3.6%) patients with multiple drainages (p = 0.04). Nodal recurrence-free survival was significantly longer in the group with multiple drainages than in the group with single drainage (175.6 vs. 138.7 months; p = 0.04). In multivariate analysis, single drainage was associated with a higher risk of nodal recurrence (HR = 4.54; p = 0.05). No significant differences in metastatic and overall recurrence-free survival were found between groups. Study limitations: Retrospective analysis, single-center study, small sample, detailed histopathologic information not always present. Conclusions: In patients with trunk melanoma and negative sentinel lymph node biopsy, multiple lymphatic basin drainage may be an independent risk factor for nodal disease recurrence. This factor may help to identify patients with negative sentinel lymph node biopsy with a higher risk of nodal recurrence.

RESUMO O carcinoma basocelular é o cancro de pele mais comum, com uma incidência muito baixa de metástases, associada a alta morbilidade e mortalidade. A variante clínica morfeiforme é incomum, apresentando um padrão de crescimento agressivo. O diagnóstico precoce e as novas terapias-alvo para a doença metastática são importantes para melhorar as taxas de sobrevivência. Apresentamos o caso de um doente de 29 anos, com carcinoma basocelular morfeiforme na região geniana direita. Devido a recorrências locais, foi submetido a cirurgia e a radioterapia adjuvante. Por extenso envolvimento ósseo metastático, o doente iniciou vismodegib e, mais tarde, pembrolizumab, tendo realizado radioterapia paliativa antiálgica. Apesar das várias linhas de terapêutica sistémica, a doença progrediu, e o doente faleceu após 8 anos de seguimento. Este caso mostra como é crucial identificar fatores de risco para o basalioma metastático, e destaca a necessidade de melhorar as terapias-alvo e de adaptá-las ao perfil biológico do doente.

ABSTRACT Basal cell carcinoma is the most common skin cancer, with a very low incidence of metastases, associated with high morbidity and mortality. The morpheaform clinical variant is uncommon, presenting an aggressive growth pattern. Early diagnosis and new targeted therapies for metastatic disease are important to improve survival rates. We present the case of a 29-year-old patient with morpheaform basal cell carcinoma in the right genian region. Due to local recurrences, he underwent surgery and adjuvant radiotherapy. For extensive metastatic bone involvement, the patient started vismodegib and, later, pembrolizumab, and also performed palliative radiotherapy. Despite several lines of systemic therapy, the disease progressed, and the patient died after 8 years of follow-up. This case shows how crucial it is to identify risk factors for metastatic basal cell carcinoma and highlights the need to improve target therapies and tailor them to the patient’s biological profile.

RESUMO O carcinoma espinocelular (CEC) é o segundo cancro cutâneo não-melanoma mais comum e a sua incidência tem aumentado nas últimas décadas. A metastização locoregional é rara e, quando ocorre, associa-se a um pior prognóstico. Apresenta-se o caso de uma doente de 69 anos, com CEC da perna direita, invasivo, moderadamente diferenciado, totalmente excisado cirurgicamente. Após 1 mês, a doente refere o aparecimento de pápulas eritematovioláceas, de consistência dura, que evoluíram para nódulos de 3-4 cm, ulcerados, localizados na perna direita. A invasão ganglionar inguinal e ilíaca homolateral foi documentada através de punção aspirativa de conglomerado adenopático palpável a esse nível e posteriormente documentado por tomografia de emissão de positrões com TC (PET-TC). Dada a irressecabilidade cirúrgica da doença, foi realizada uma perfusão isolada de membro (PIM) com melfalan e fator de necrose tumoral (TNFα) para evitar a amputação. Foi observada resolução completa de todas as metástases em trânsito 12 semanas após a perfusão. No entanto, 4 meses depois, a progressão sistémica da doença culminou num desfecho fatal. A PIM é uma técnica eficaz e bem estabelecida no tratamento de tumores avançados das extremidades. As suas principais indicações são as metástases em trânsito de melanoma maligno e sarcomas de partes moles. No entanto, estudos demonstram a sua eficácia no tratamento de outros tumores, como é o caso do CEC localmente avançado. Apesar de não ter alterado o prognóstico da doença, foi possível, com a abordagem instituída, evitar a amputação do membro, atingindo a remissão completa da doença localizada.

ABSTRACT Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer and its incidence has been increasing over the past decades. SCC in-transit metastases are rare and predict a poor prognosis. We present the case of a 69-year-old patient with a right lower leg SCC, surgically excised with free margins. One month later, erythematous to violaceous, firm papules begin to erupt on the right lower leg, evolving to ulcerated nodules over a period of weeks. Homolateral inguinal and iliac nodal metastases were documented by percutaneous biopsy of an inguinal palpable lymph node and later documented by positron emission tomography - computed tomography (PET-CT). Given the unresectability of the disease, regional chemotherapy involving isolated limb perfusion (ILP) with melphalan and tumor necrosis factor-alpha (TNFα) was performed in order to avoid amputation. Macroscopic regression ensued, with complete resolution of all visible in-transit metastases 12 weeks after perfusion. However, a fatal outcome was observed 4 months later, due to systemic metastases. ILP is an effective and well-established technique in the treatment of advanced tumors of the extremities. Its main indications are in-transit metastases of malignant melanoma and advanced soft tissue sarcomas. However, studies have shown its effectiveness in other tumors such as locally advanced SCC. Despite the unfortunate outcome, it was possible to avoid amputation of the limb, with complete local disease remission.

RESUMO O duplo retalho de deslizamento em ilha do tipo V-Y constitui uma opção viável para a reconstrução de defeitos labiais, com resultado cosmético-funcional favorável. Apresenta-se o caso de uma mulher com um carcinoma basocelular da região labial superior tendo sido reconstruída, após excisão, com recurso a retalho duplo de deslizamento em ilha. Os autores descrevem a técnica cirúrgica bem como as principais vantagens e aplicabilidade da mesma.

ABSTRACT The double V-Y sliding island flap is a viable option for the reconstruction of lip defects, with a favorable cosmetic-functional result. We present the case of a woman with a basal cell carcinoma of the upper labial region, that after excision, has been reconstructed using a double sliding island flap. The authors describe the surgical technique as well as its main advantages and applicability.

Resumo A reconstrução de defeitos cutâneos nasais é um desafio mesmo para um cirurgião dermatológico experiente. Quando o defeito é grande ou demasiado complexo para ser corrigido com retalhos mais simples, os retalhos interpolados são uma boa opção, mas requerem habitualmente dois tempos operatórios. Os retalhos interpolados tunelizados foram desenvolvidos para permitir a reconstrução de defeitos complexos num só tempo cirúrgico. Na reconstrução nasal, os principais retalhos tunelizados são o frontal paramediano e o nasogeniano. Esta revisão incidirá sobre estes dois retalhos: descrição da técnica, aplicações, vantagens e desvantagens.

Abstract The reconstruction of nasal skin defects is a challenge even for an experienced dermatological surgeon. When the defect is too large or complex to be corrected with simpler flaps, interpolated flaps are a good option, but they usually require two surgeries. Tunneled interpolated flaps were developed to allow the reconstruction of complex defects in only one surgical procedure. In nasal reconstruction, the main tunneled flaps are the paramedian forehead and the melolabial flaps. This review will focus on these two flaps: description of the technique, applications, advantages and disadvantages.

RESUMO O artigo fornece uma introdução filosófica à tradição da fenomenologia hermenêutica e um panorama do projeto de uma pedagogia fundada nas questões centrais dessa tradição. A seguir, por meio de um diálogo com Paulo Freire e de relatos de experiência do autor, procura refletir sobre o problema de como orientar-se em meio ao processo de ensino-aprendizagem.

ABSTRACT The article is a philosophical introduction to the tradition of phenomenology and hermeneutics and an outlook of the project of a pedagogy rooted on the main issues of this tradition. It also builds a reflection on the problem of orientation amidst the teaching-learning process through a dialog with Paulo Freire and reports from the author’s own experience.

RESUMEN El artículo proporciona una introducción filosófica a la tradición de la fenomenología hermenéutica y una visión general del proyecto pedagógico fundado en los temas centrales de esta tradición. Luego, a través de un diálogo con Paulo Freire y los informes de la experiencia del autor, busca reflexionar sobre el problema de cómo orientarse en medio del proceso de enseñanza-aprendizaje.