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.

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.

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: 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 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 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 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.

ABSTRACT The goal of our study was to evaluate the nutritional potential of dented corn hybrids for silage production. We performed a two-location trial in which 19 dented corn hybrids and five corn controls grew in four randomized blocks within two experimental areas located in the Northern (Campos dos Goytacazes) and Northwestern (Itaocara) Rio de Janeiro State, Brazil. We recorded yields of fresh and dry forage matter and yields of fresh and dry grain matter, as well as chemical composition variables. We interpreted variables by assuming a Normal distribution for yield variables and a Beta distribution for chemical composition and ratios. The SAS GLIMMIX procedure fitted the linear model under those assumptions. Dual-pool models fitted the gas production profiles generated by in vitro anaerobic fermentations. We used the nlme of R software to fit the dual-pool models and the information-theoretic approach to evaluate their quality of fit. We did a cluster analysis (NbClust of R) to group corn hybrids based on fresh and DM yields and kinetic parameters of in vitro gas production. Three clusters of corn hybrids stood out, their basic differences relied on fresh and DM yields. Nonetheless, the least-squares means for gas production characteristics among groups did not present disjoint confidence intervals. Therefore, we can infer that dented corn hybrids rank by forage yield, but not by forage quality, and recommend the most productive ones that consistently outstand in both locations (hybrids UENF-2203, UENF-2192, UENF-2193, and UENF-506-11).

ABSTRACT Our objective was to evaluate whether the single nucleotide polymorphism (SNP) BIEC2-808543, identified in some horse breeds, also occurs in the Brasileiro de Hipismo (BH) breed. In addition, we verified if this SNP is related to the growth curve profile of these animals for the variables body mass, height at withers, and height at croup, using nonlinear mixed models. For the DNA isolation, we collected blood samples from 167 young BH horses. We obtained the genotypes of these animals using the polymerase chain reaction-restriction fragment length polymorphism technique. For the association studies of this polymorphism with the growth curve in foals, we selected three traits: body mass, height at withers, and height at croup. Polymorphism C/T exists in BH horses and is significantly associated with the evaluated traits. Animals that presented the TT genotype were smaller and lighter when compared with animals of the CT and CC genotypes. By the Akaike information criterion, the model that best described the growth curve for the body mass variable is the Brody model associated with the power of the mean variance function. For the height at withers variable, the best-fit model was von Bertalanffy, adjusted without polymorphism effect in parameter b, associated with the asymptotic variance. For the height at croup trait, the model that best described the growth curve was Brody model, associated with asymptotic variance. This polymorphism represents a good molecular marker. Nonlinear models are promising for describing growth curves in horses, particularly by the possibility of associating SNP effects to model parameters.

RESUMO O objetivo deste artigo é demonstrar o impacto da rivalidade geopolítica regional sul-americana sobre o desenvolvimentismo brasileiro. No começo do século XX, oficiais do Exército formularam um paradigma militar que associava a defesa contra a Argentina com a centralização política e a industrialização. Após a Revolução de 1930 esse pensamento desenvolvimentista geopoliticamente orientado se tornou referência no Alto-Comando do Exército que, utilizando a nova posição do Exército na política nacional, converteu-se em patrocinador político decisivo de iniciativas de desenvolvimento na área da petroquímica, siderurgia e transportes. A geopolítica regional foi assim uma das variáveis-chave do início do desenvolvimentismo brasileiro.

ABSTRACT This paper´s aim is to demonstrate how South American regional rivalry influenced Brazilian developmentalism. During the early years of the XXth century, Army officers created a military paradigm which associated the defense against Argentina with the need for political centralization and industrialization. With the Revolution of 1930 this geopolitically-oriented developmental thought became a tenet for the Army High Command which, using the Army’s new position in national politics, decisively backed development initiatives in the petrochemical, steel and transportation sectors. Regional geopolitics was, therefore, one of the key variables at the onset of Brazilian developmentalism.

ABSTRACT Lactation records from cows of the southwestern Paraná state, Brazil, form the dataset of this study. We applied the information-theoretic approach to evaluate the ability of the nonlinear Wood, Brody, Dijkstra, and Gamma functions to fit to these data by employing a two-step technique based on nonlinear mixed-effects models and generalized linear mixed-effects models. Wood's equation was fitted with the combination of a first-order autoregressive correlation structure and a variance function to account for heteroscedasticity. This version was the best choice to mimic lactation records. Some geometric attributes of Wood's model were deduced, mainly the ascending specific rate from parturition to peak milk yield and the descending specific rate as a measure of the lactation persistence of the milk yield at peak production. Breed and parity order of the cows were assumed as fixed effects to obtain a reliable model fitting process. Regardless of breed, first-order parity cows had greater persistency than their older counterparts, and the greater the ascending rate of milk yield from the parturition to the peak, the sharper the decrease in milk yield post-peak; therefore, the rates (absolute values) of ascending and descending phases correlated positively. Nonetheless, the actual estimated values of the descending phase rates are negative. Wood's equation was flexible enough to mimic either concave- and convex-shaped lactation profiles. The correlations between both peak milk yield and random estimates for β with total milk yield per lactation were positive. However, peak milk yield might not be the only variable used for ranking cows; the total milk yield integrates all information of the lactation profile through the estimated parameters of Wood's equation.