Resumen: Las indagaciones sobre los paisajes culturales no antropogénicos, como son los entornos marinos, revelan dinámicas insospechadas por el resurgimiento de ecosofías ajenas a la economía globalizada y a la territorialización como base de la apropiación y posterior explotación indiscriminada. Perturbadas por las errancias de la geoingeniería, varias regiones del mundo se asoman recientemente a claves argumentales con puntos comunes que podrían revitalizar biosferas no humanas y, en ellas, las humanas. La atención a las dinámicas marítimas exige considerar el océano como una entidad. Siguiendo las aún inspiradores lecturas históricas de Fernand Braudel, al ampliar la “mediterraneidad” que él formuló, estaríamos poniendo a prueba otro concepto de cambio de mentalidad por gubernamentalidad: los maritorios, una conceptualización desde la arquitectura en Chile en la década de 1970. A partir de estudios de caso tratamos ejemplos significativos en el Mediterráneo, en el Caribe y en océanos y ríos asiáticos que aportan al actual debate sobre los mares como espacios habitados, como ecosistemas acuáticos frágiles al tiempo que reveladores

Abstract: Enquiries into non-anthropogenic cultural landscapes, such as marine environments, reveal unsuspected dynamics due to the resurgence of ecosophies that are alien to the globalised economy and territorialisation as a basis for appropriation and subsequent indiscriminate exploitation. Disturbed by the wanderings of geo-engineering, several regions of the world have recently touched on key arguments with points in common that could revitalise nonhuman biospheres and, in them, human ones. When considering maritime dynamics, the ocean must be seen as an entity. Following the ever-inspiring historical literatures of Fernand Braudel and expanding on the “mediterraneity” he formulated, we would be testing another concept involving a change in mentality of governmentality: “maritoriums”, a conceptualisation from 1970s Chilean architecture. Based on case studies, we will discuss significant examples in the Mediterranean, the Caribbean and Asian oceans and rivers that contribute to the current debate on the seas as inhabited spaces, as fragile and revealing aquatic ecosystems.

ABSTRACT Objectives: Analyze wrist wrap influence on the values of maximum handgrip strength and dynamic resistance. Methods: A controlled randomized cross-over trial including 54 Crossfit participants randomly assigned to two groups. Group 1 began the series of tests with control wrapping, and Group 2 started with functional wrapping. Alternate series of four dynamic grip strength resistance tests were performed, and the resistance and fatigue values were calculated. Results: The values obtained from the grip tests did not indicate any effect from the wrist wrap for an increase in maximum grip strength (35.7 vs. 35.6 kg; p=0.737) or greater endurance (78.2 vs. 77.8%; p=0.549). Fatigue was also equal in both groups (mean differences between the groups: 0.1 kg, CI= -0.7–0.8; p=0.779). Conclusion: The hypothesis that using a wrist wrap increases maximum strength and dynamic handgrip endurance was rejected in this study. Evidence Level I; Randomized control trial .

RESUMO Objetivos: Analisar a influência do uso da munhequeira no valor máximo de força e na resistência dinâmica de preensão palmar. Métodos: Foi feito um ensaio controlado randomizado cruzado (cross-over) incluindo 54 praticantes de Crossfit. Os participantes foram alocados em dois grupos de forma aleatorizada. O grupo 1 iniciou a bateria de testes com enfaixamento placebo e o grupo 2 iniciou com enfaixamento funcional. Séries alternadas de quatro testes dinâmicos de resistência foram realizadas e os valores de resistência e fadiga foram calculados. Resultados: Os resultados apontaram para uma ausência de efeito do enfaixamento do punho tanto para um suposto aumento da força máxima de preensão (35,7 vs 35,6 kg; p=0,737) quanto para uma maior resistência (78,2 vs 77,8%; p=0,549). A fadiga também foi igual entre os dois grupos (média das diferenças entre os grupos: 0,1kg, CI: -0,7 – 0,8; p=0,779). Conclusão: A hipótese de que o uso da munhequeira aumenta o valor máximo de força e a resistência dinâmica de preensão palmar foram rejeitadas neste estudo. Nível de evidência I; Estudo clínico randomizado .

Resumen: Antecedentes y Objetivos: Diversos estudios han destacado el importante papel de los monos aulladores (Alouatta palliata mexicana) en la dispersión de semillas y, con ello, en la regeneración de las poblaciones de plantas con frutos carnosos de los bosques tropicales. Sin embargo, poca es la evidencia empírica sobre cuáles podrían ser los mecanismos que les permitiría a los monos aulladores favorecer la germinación de las semillas de muchas especies de plantas, incluyendo la escarificación de su cubierta externa. En este trabajo se evaluó si los endocarpos de Spondias mombin (Anacardiaceae), una especie importante en la dieta de los monos aulladores, podrían ser escarificados al pasar por el tracto digestivo de estos primates. Métodos: Se colectaron endocarpos de las heces de monos aulladores, así como frutos maduros del suelo, en la región de Los Tuxtlas, municipio Catemaco, Veracruz, México. Mediante cortes transversales de los endocarpos y su análisis en el microscopio electrónico de barrido, se tomaron medidas del grosor de la cubierta externa y probaron las diferencias entre ambos tipos de muestras (i.e., endocarpos de frutos y endocarpos que pasaron por el tracto digestivo). Resultados clave: Se observó que el grosor de la cubierta de los endocarpos en frutos fue mayor ( X ~=47.05±9.69 µm) que el de endocarpos en heces ( X ~=1.51±3.60 µm) (W=0.48, p<0.001). Conclusiones: Los resultados evidencian que la ingesta de endocarpos de S. mombin por A. p. mexicana puede tener un efecto de escarificación de los tejidos que conforman su cubierta externa. Esto apoya la versión sobre la función de los frugívoros, como los monos aulladores, reduciendo la cubierta externa de las semillas y aumentando así su capacidad para germinar; siendo, por lo tanto, organismos clave en la dinámica de regeneración de bosques tropicales.

Abstract: Background and Aims: Several studies have emphasized the important role of howler monkeys (Alouatta palliata mexicana) in seed dispersal and, as a result, in the regeneration of fleshy-fruited plant populations in tropical forests. However, there is little empirical evidence regarding the possible mechanisms that would allow howler monkeys to promote seed germination of many plant species, including seed coat scarification. In this study, we evaluated whether endocarps of Spondias mombin (Anacardiaceae), an important species in howler monkey diet, could be scarified by passage through the digestive tract of these primates. Methods: We collected endocarps from howler monkey feces as well as ripe fruits fallen on the ground, in the region of Los Tuxtlas, Catemaco municipality, Veracruz, Mexico. By analyzing endocarp transverse sections using a scanning electron microscope, we measured the thickness of the outer layer and tested differences between both types of samples (i.e., fruit endocarps and endocarps that had passed through the digestive tract). Key results: We observed that the outer layer thickness of endocarps in fruits was greater ( X ~=47.05±9.69 µm) than that of endocarps found in feces ( X ~=1.51±3.60 µm) (W=0.48, p<0.001). Conclusions: Our results highlight that consumption of S. mombin endocarps by A. p. mexicana may have a scarification effect on the tissues that constitute the outer layer. This supports the hypothesis of the role of frugivores, such as howler monkeys, in reducing the seed coat and thus increasing germination ability; therefore, being key organisms in regeneration dynamics of tropical forests.

ABSTRACT. Organic agriculture systems have the nutrients supplied by plant or animal by-products, bioinoculants, and compost-based products as earthworm composts and green manures. However, the quantitative and qualitative parameters of soil amendments depend on their sources, and soil amendments are generally not sufficient to supply the nutritional requirements of maize crops. Moreover, specialty maize requires high levels of N. Thus, the aim of this study was to investigate specialty maize varieties supplied with two microbial inoculants applied in two inoculation methods. These factorial treatments were compared with their checks (varieties without inoculation), and the interaction among these factors was also investigated. The trials were carried out during the growing season in 2017-2018 in the State University of Maringá. The popcorn trial followed the randomized complete block design where the factorial 3 × 2 × 2 + 3 had five replications. The trial with white grits maize followed the same experimental design but the factorial scheme was 2 × 2 × 2 + 2 with three replications. Both trials had maize varieties and two species of microbial inoculants (Azospirillum brasilense and Methylobacterium sp.) applied in two inoculation methods, in the seeds and the foliar spray at V4 stage of plant development. The response traits were grain yield and the components of crop production. In both trials, we verified that the majority of the interactions among the factors was non-significant (p > 0.05), indicating the independence of these factors. Furthermore, the microbial inoculants had no beneficial effects on the traits. The possibility of a higher crop yield did not confirm the application of the inoculant in the stage V4. The organic compost may be the key point in mitigating the treatments with microbial inoculants due to the availability of N in the first stages of plant development. The traits also suggest the necessity of more trials about the influence of microbial inoculants on specialty maize production.

RESUMO A efetividade de um programa de pagamento por serviços ambientais (PSA) na Amazônia brasileira foi analisada através de um mapeamento detalhado de áreas desmatadas. O Programa Bolsa Floresta (PBF), no estado do Amazonas (Brasil), foi escolhido como um exemplo de PSA que visa compensar agricultores por aderirem ao desmatamento zero da floresta primária ao abrir roças somente em áreas de capoeira. Porém, a medição oficial das roças não é efetiva, visto que apenas áreas desmatadas maiores que 6,25 ha estão sendo mapeadas, enquanto a maioria das áreas abertas para cultivo de mandioca possuem áreas de aproximadamente 1 ha. A eficácia do PBF foi avaliada na Reserva de Desenvolvimento Sustentável (RDS) do Uatumã. Testamos uma metodologia de mapeamento de áreas a partir de 0,45 ha abertas para roças de mandioca. Foram analisados os anos de 2006 (antes da implantação do PBF), 2011, 2015 e 2019. Os resultados indicam que 88% das áreas abertas para roças tinham entre 0,45 e 6,25 ha. Após a implantação do PBF, a área total desmatada acumulada diminuiu e houve redução das áreas desmatadas em floresta primária. Também observamos uma intensificação da roça, o que pode ocasionar queda na produtividade. O monitoramento do zoneamento do uso da terra mostrou que a maioria das áreas abertas estão localizadas na zona de uso intensivo, seguindo as regras do plano de manejo da RDS. Os resultados mostraram os esforços das famílias para cumprir as regras do BFP.

ABSTRACT The effectiveness of a program of payment for environmental services (PES) in the Brazilian Amazon was analyzed through an accurate mapping of deforested areas. The Bolsa Floresta Program (BFP) in Amazonas state (Brazil) was chosen as an example of a PES program that aims to compensate farmers for their commitment to zero deforestation of primary forests while opening swiddens only in secondary vegetation areas. However, the official measurement of opened swiddens is not effective since only deforested areas larger than 6.25 ha are mapped, whereas most areas opened for cassava crops are approximately 1 ha in size. The effectiveness of the BFP was evaluated in the Uatumã Sustainable Development Reserve (SDR). We tested a methodology for mapping areas from 0.45 ha upwards that have been opened for cassava swiddens. The years 2006 (before the implementation of the BFP), 2011, 2015 and 2019 were analyzed. The results indicated that 88% of the areas opened for swiddens were between 0.45 and 6.25 ha in size. After the implantation of the BFP, the cumulative total deforested area decreased, and there was a reduction in deforested areas in primary forests. An intensification of swidden cultivation was also observed, which could cause a decline in productivity. The monitoring by land-use zoning showed that the majority of opened areas were located in intensive use zones, following the rules of the SDR management plan. The results show the efforts of local families to fulfill the BFP rules.

RESUMO O projeto e a gestão inadequados da camada de cobertura de um aterro sanitário produzem impactos ambientais prejudiciais ao meio ambiente. Uma alternativa disponível é desenvolver cenários baseados na simulação de modelos físicos e computacionais para representar o balanço hídrico que se espera que ocorra em uma camada de cobertura do aterro por meio de um experimento de campo. O presente trabalho investiga o projeto de cobertura final de um aterro sanitário no município de Seropédica, localizado no estado do Rio de Janeiro - Brasil. Mais especificamente, a cobertura compacta do solo, que é amplamente utilizada para a cobertura final de aterro de resíduos sólidos urbanos, é avaliada em contraste com a cobertura vegetal por gramíneas, cobertura vegetal por braquiária e barreira capilar. Para realização dessa tarefa, forçantes hidrometeorológicas, nomeadamente precipitação e temperatura na escala diária, foram obtidas da estação meteorológica de Anchieta, situada nas proximidades da área de estudo. Os códigos computacionais Hydrus 1D e 2/3 D foram empregados para desenvolver um conjunto de cenários para acompanhar a evolução da pluma de contaminação no interior do aterro ao longo do período de 20 anos com algum grau de confiabilidade. Ressalta-se que a avaliação realizada indica a possibilidade de controlar a liberação de chorume e, consequentemente, de evitar a contaminação do meio ambiente, notadamente para prevenir a poluição do solo e dos recursos hídricos. A cobertura vegetal por gramíneas e braquiárias apresentou importantes mecanismos de controle com relação ao movimento da pluma contaminante. Além disso, deve-se notar que os melhores resultados para a cobertura final do aterro foram alcançados para a barreira capilar, enquanto que os resultados de baixo desempenho foram obtidos para o solo compacto comumente empregado.

ABSTRACT Improper design and management of the cover layer of a sanitary landfill has been proven to produce harmful environmental impacts on the environment. One alternative at hand is to develop scenarios based on simulation of physical and computational models to represent the expected field water balance of a landfill coverage layer. This paper investigates the design of a sanitary landfill final cover in the municipality of Seropédica, which is located at the state of Rio de Janeiro - Brazil. More specifically, the compact soil coverage, which is widely used for landfill final cover of municipal solid waste, is evaluated in contrast to vegetation cover by grass, vegetation cover by brachiaria and capillary barrier. To accomplish such task, hydrometeorological forcing conditions, namely daily rainfall and temperature, were retrieved from the Anchieta weather station, which is situated nearby the study area. The Hydrus 1D and 2/3 D computational codes were employed to develop a set of scenarios to follow the contamination plume evolution within the landfill along the time frame of 20 years with some degree of reliability. It should be noted that the performed evaluation indicates the possibility to control the leachate release and consequently to avoid contaminating the environment, notably to prevent soil and water resources pollution. Vegetation cover by grass and brachiaria showed important control mechanisms with respect to the movement of the contaminant plume. In addition, it should be noticed that the best results for the landfill final cover were achieved for the capillary barrier, while poor performance results were obtained for the commonly employed compact soil.

ABSTRACT Among titanium alloys with non-toxic elements, the Ti-25Nb-25Ta alloy has good elastic behavior for applications in osseous implants, biocompatibility, and excellent corrosion resistance. The present study aimed to better the biocompatibility characteristics of Ti-25Nb-25Ta alloy modifying its surface through Plasma Electrolytic Oxidation (PEO) treatment. The formed oxide coating is amorphous and composed of two distinct porous formations: smaller hole-shaped pores and larger volcano-like pores. The regions with the formation of smaller pores and in the hole shaped presented the highest atomic percentage of the chemical element phosphorus. Nanoindentation tests have shown that the hardness of the Ti-25Nb-25Ta alloy is slightly lower than the commercially pure grade 2 titanium (a material used as reference), while elastic modulus measurements of Ti-25Nb-25Ta presented more suitable values for implant application (lower values when compared with titanium reference). After PEO treatment there were significant mechanical surface improvements (increased fairly surface hardness and decreased elastic modulus) for application in osseous tissue. Despite the Ti-25Nb-25Ta alloy presented excellent characteristics for applications in hard biological tissues, the PEO treatment better its features.

The present study produced binary titanium-niobium alloys Ti-xNb with high niobium percentage (x = 50, 80 e 90 wt.%) aiming to apply it as a base material in osseous implant devices. The produced TiNb alloys presented a cubic crystalline phase, lower corrosion rate than titanium, lower elastic modulus values, and superior cellular viability than titanium and niobium. The Ti50Nb alloy among all analyzed metallic substrates showed the best values of elastic modulus, corrosion properties, wettability, and cellular viability. Thus, this work suggests a Ti/Nb ratio close to 1 (Ti50Nb) displays optimum characteristics to apply in orthopedic devices.

RESUMO Objetivo: Descrever os resultados parciais de estudo em pacientes com câncer de reto submetidos a tratamento neoadjuvante com quimioterapia e radioterapia quanto à taxa resposta clínica completa, sobrevida livre de doença, função anorretal e qualidade de vida. Material e métodos: Estudo prospectivo desde junho 2015 até junho de 2018, em paciente com adenocarcinoma de reto baixo ou médio e estadio clínico II ou III tratados com RT/QT (IMRT 54 Gy em 6 semanas) concomitante a 5-Fuorouracil (5-FU) 380 mg/m2 e ácido folínico (LV) 20 mg/m2 por 5 dias nas primeira e quinta semanas e dois ciclos após RT (5-FU 400 mg/m2 e LV 20 mg/m2) a cada 28 dias. Após o tratamento, realizou-se exame clínico, retossigmoidoscopia, RNM de pelve, TC de tórax e abdômen superior e dosagem de CEA. Naqueles com Resposta Clínica Incompleta (iRC) procedeu-se à cirurgia de ressecção. Aqueles com Resposta Completa (cRC) estão em observação (wait and see policy). Manometria e escalas de função esfincteriana e qualidade de vida foram obtidas antes e após 30 e 90 dias do término do tratamento. Resultados: Até junho de 2018, recrutaram-se 11 pacientes. Um foi excluído da análise, pois apresentou toxicidade severa sugestiva de deficiência de DPD após o primeiro ciclo de QT. Todos os demais concluíram o tratamento. Toxicidades graus 3/4 relacionadas à QT ocorreram dois pacientes, reduzindo-se sua dose. Sete (70%) apresentaram iRC, submetendo três à retossigmoidectomia cuja avaliação anatomopatológica evidenciou Resposta Completa (pRC) em dois casos (28,5%). Três (30%) apresentaram cRC e estão sem evidência de doença com seguimento médio de 19 meses. Houve melhora da função anorretal e da qualidade de vida. Conclusões: Avanços no tratamento neoadjuvante dos tumores de reto contribuíram para melhores taxas de pRC. Novos paradigmas promovem crescentes índices de cRC, o que possibilitaria a preservação do órgão e consequente redução da morbidade cirúrgica.

ABSTRACT Objective: To describe the partial results of a study in patients with rectal cancer who underwent neoadjuvant treatment with chemotherapy and radiotherapy regarding the rate of complete clinical response, disease-free survival, anorectal function, and quality of life. Material and methods: This was a prospective study from June 2015 to June 2018, in patients with low- or mid-rectum adenocarcinoma and clinical stage II or III, treated with radiotherapy and chemotherapy (IMRT 54 Gy for six weeks) concomitant with 5-fluorouracil (5-FU) 380 mg/m2 and folinic acid (LV) 20 mg/m2 for five days in the first and fifth weeks and two cycles after radiotherapy (5-FU 400 mg/m2 and LV 20 mg/m2) every 28 days. After the treatment, clinical examination, rectosigmoidoscopy, pelvic magnetic resonance imaging, chest and upper abdomen computed tomography, and CEA testing were performed. Resection surgery was performed in those with incomplete clinical response (iCR). Those with complete clinical response (cCR) are under observation (wait-and-see policy). Manometry and scintigraphic function and quality of life scales were collected before treatment and at 30 and 90 days after the end of treatment. Results: As of June 2018, 11 patients were recruited. One was excluded from the analysis for presenting severe toxicity, suggestive of dihydropyrimidine dehydrogenase (DPD) deficiency, after the first chemotherapy cycle. All others completed the treatment. Two patients presented toxicity grade 3/4 related to chemotherapy and had their doses reduced. Seven patients (70%) presented iRC; three underwent rectosigmoidectomy, and the anatomopathological evaluation indicated complete pathological response in two cases (28.5%). Three (30%) presented cCR and did not present evidence of disease after a mean follow-up of 19 months. Patients presented improvement of anorectal function and quality of life. Conclusions: Advances in the neoadjuvant treatment of rectal tumors contributed to better rates of complete pathological responses. New paradigms promote an increase in the complete clinical response rates, which would allow organ preservation and consequent reduction of surgical morbidity.

This article reports a novel virtual screening algorithm seeking the rational identification of novel lead anticoagulants. Seven 5-(3-methyl-1-aryl-1H-pyrazol-4-yl)-1H-tetrazoles and seven novel 1-aryl-4-(4,5-dihydro-1H-imidazol-2-yl)-3-methyl-1H-pyrazoles were obtained in three steps starting from arylhydrazine hydrochlorides as raw materials in good yields: 50-72% and 50-85%, respectively. All compounds were submitted to an in silico target-base pipeline named integrated multiplex analysis virtual screening (IMA-VS), which comprises the evaluation of their (i) fitting physicochemical properties to the chemical environment of the target enzyme; (ii) active-site homing electrostatic potential to the target enzyme; (iii) structural fitting to the target active site through molecular docking; and (iv) overall absorption, distribution, metabolism, excretion and toxicity (ADMET) profile. After the virtual selection of potential anticoagulant hits, all molecules were synthesized and candidates were evaluated in vitro for their anticoagulant and hemolytic profile. The most promising candidate pointed out by IMA-VS was compound 1-(3',4'-dichlorophenyl)-4-(4,5-dihydro-1H-imidazol-2-yl)-3-methyl-1H-pyrazole that shown to display factor Xa (FXa)-specific inhibitory activity in vitro, acting as an uncompetitive inhibitor with an inhibition constant (Ki) = 61.16 ± 12.96 µM, in addition to the lowest hemolytic activity of the series. Further experiments revealed the antithrombotic activity of this compound in an in vivo model of arterial thrombosis induced by FeCl3.

Abstract The objective of this study was to determine how to support actions to increase the resilience and adaptation of socio-ecological systems in the semiarid region of Bahia State, focusing on the Fundo de Pasto Communities (FPCs) of the Uauá municipality. Primary (semistructured interviews with decision-makers and community leaders) and secondary data sources were used. Five dimensions of analysis were selected to organize the primary data within a framework of adaptive capacity for climate change: territorial, socio-cultural, environmental, economic and politico-institutional. For approximately 200 years, FPCs have been communally occupying and using the Caatinga biome based on agrosilvopastoral systems. The results showed the communities’ resilience in dealing with climate stresses in both the territorial and socio-cultural dimensions. This includes processes of self-organization in associations and in networks, which facilitate the flow of knowledge and collective decision-making processes. The results also identified the environmental, economic and politico-institutional dimensions of the climate risks to FPCs, which could potentially limit their adaptive capacity.

Resumo A pesquisa realizada entre 2017 e 2018 buscou produzir conhecimentos que subsidiem ações voltadas à resiliência e à adaptação de sistemas socioecológicos na região semiárida do estado da Bahia - Semiárido Baiano, com foco nas Comunidades de Fundo de Pasto (CFP) localizadas no município de Uauá. Utilizaram-se dados secundários e primários (entrevistas semiestruturadas com tomadores de decisão e lideranças comunitárias). Para a sistematização dos dados primários no marco de capacidades adaptativas para mudanças climáticas foram selecionadas cinco dimensões de análise: territorial, sociocultural, ambiental, econômica e político-institucional. As CFP ocupam e usam o bioma Caatinga há cerca de 200 anos de forma comunal, com base em sistemas agrossilvopastoris. Os resultados indicaram o caráter resiliente das comunidades para lidar com os estresses climáticos nas dimensões territorial e sociocultural, a partir de processos de auto-organização em associações e na organização em redes, por meio das quais fluem conhecimentos e são tomadas decisões coletivas. Os resultados também indicaram os riscos climáticos aos quais as CFP estão expostas nas dimensões ambiental, econômica e político-institucional, com potencial para limitar capacidades adaptativas.

RESUMO Objetivo: Artrite reumatoide é uma doença prevalente na população (0,5% a 1%), envolvendo tratamento tanto ortopédico, quanto reumatológico. A técnica do “Time Trade Off”, que determina a quantidade de anos que o paciente ou o profissional daria para ter sucesso absoluto em determinado procedimento, vem ganhando espaço nos protocolos modernos. Diante disto, comparamos a avaliação dada pelo paciente, pelo ortopedista e pelo reumatologista usando “Time Trade Off” e correlacionamos com repercussão clínica e escores já estabelecidos: Brief Michigan Questionnaire (Anexo I) e Disease Activity Score-28 (DAS-28) (Anexo II). Métodos: Estudo prospectivo com 37 pacientes diagnosticados com artrite reumatoide, que foram submetidos ao questionário “Time Trade Off” pelo ortopedista, pelo reumatologista e por um avaliador independente, e avaliação através do DAS-28 e do Brief Michigan. Resultados: Através da análise descritiva, notou-se medianas semelhantes entre ortopedista, reumatologista e paciente. Entretanto, evidenciou-se correlação fraca entre paciente e reumatologista, paciente e o Brief Michigan; e ortopedista e o DAS-28. Conclusão: Valores de mediana semelhantes demonstram “Time Trade Off” equivalentes entre ortopedista, reumatologista e paciente. Mas, diante das correlações fracas entre os escores, não foi possível substituí-los por uma escala única de avaliação. Nível de Evidência II, Estudo Prognóstico.

ABSTRACT Objective: Rheumatoid arthritis is a prevalent disease in the population (range 0.5% to 1%) and involves both orthopedic and rheumatologic treatment. The Time Trade-Off (TTO) technique, which determines the number of years the patient or the professional would be allowed before a successful procedure in terms of life expectancy and value of the procedure, has been gaining ground in clinical protocols. From this standpoint, we sought to compare evaluations provided by the patients, orthopedists, and rheumatologists in determining the TTO and to correlate their responses with the clinical repercussions using previously established scores such as the Brief Michigan Hand Questionnaire and the Disease Activity Score-28 (DAS-28). Methods: A prospective study was conducted that involved 37 patients with rheumatoid arthritis, orthopedists, and rheumatologists. The TTO questionnaire was administered by an independent evaluator for evaluation using the DAS-28 and the Brief Michigan Hand Questionnaire. Results: The descriptive analysis revealed similar medians between the orthopedists, rheumatologists, and patients for single assessments. However, there was a weak correlation between the results from the patient and rheumatologist, the patient and Brief Michigan Questionnaire, and those of the orthopedic surgeon and the DAS-28. Conclusion: Similar median values demonstrated equivalent TTO among the orthopedist, rheumatologist, and patient. However, given the weak correlations between the scores, it was not possible to substitute results using a single evaluation scale. Level of Evidence II, Prognostic Studies.

Resumo Objetivo: Avaliar a eficácia do exame de ultrassonografia (US) na visualização do plexo braquial e avaliar o método comparativamente à ressonância magnética (RM). Materiais e Métodos: Estudo da anatomia do plexo braquial pela US e RM (40 plexos braquiais) em 20 adultos assintomáticos. No estudo por US foi utilizado transdutor linear de alta frequência e na RM de alto campo magnético foi utilizada bobina neurovascular. O plexo braquial foi dividido em segmentos para estimar a frequência da visualização entre a US e a RM. Resultados: As raízes cervicais e os troncos superior e médio foram as estruturas que apresentaram maior grau de visualização pela US. Na RM, a maioria dos segmentos do plexo apresentou excelente grau de visualização. Na análise da equivalência entre a US e a RM, as raízes de C5, C6, tronco superior e médio apresentaram graus de visualização equivalentes, com alta concordância. Conclusão: O método de US consegue avaliar de forma eficaz o segmento proximal do plexo braquial que compreende as saídas das raízes cervicais de C5, C6 e C7, assim como os troncos superior e médio na região lateral do pescoço. O exame de US mostrou ter alta concordância com a RM nos ramos ventrais cervicais de C6, C7 e o tronco médio bilateral.

Abstract Objective: To assess the accuracy of ultrasound in the visualization of the brachial plexus and to determine the value of the method in comparison with that of magnetic resonance imaging (MRI). Materials and Methods: This was an anatomical study of the brachial plexuses of 20 asymptomatic adults (40 plexuses), comparing ultrasound and MRI in terms of their accuracy. In the ultrasound study, a high-frequency linear transducer was used, and a neurovascular coil was used in the MRI study. To estimate the frequency of visualization, the brachial plexus was divided into segments. Results: The cervical nerve roots, the upper trunk, and the middle trunk were the segments that were best visualized on ultrasound. On MRI, the degree of visualization was excellent for most of the segments. In the comparison between ultrasound and MRI, the C6, C7, upper trunk, and middle trunk segments showed equivalent degrees of visualization, with a high level of agreement between the two methods. Conclusion: In the brachial plexus, ultrasound can be used in the assessment of the cervical nerve roots, as well as of the upper and middle trunks, although it provides limited visualization of the remaining segments. Ultrasound and MRI showed a high level of agreement for the visualization of the C6, C7, and middle trunk segments.

ABSTRACT Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell lymphoproliferative disorder that has recently been recognized as an independent entity in the World Health Organization (WHO) classification of lymphomas. Despite the small number of reports to date, the number of cases is rapidly increasing. Of the few hundred cases that have been reported so far, very few came from Brazil and none have been reported to the local authorities. We encountered a case of BIA-ALCL and believe that its report to the local plastic surgery community could raise awareness of this emerging pathology. The prognosis is very good in most of the diagnosed cases. However, little is known about how and why silicone implants could trigger a lymphoid response that results in ALCL.

RESUMO O linfoma anaplásico de células grandes (ALCL) associado a implantes mamários é um distúrbio linfoproliferativo das células T que foi recentemente reconhecido como uma entidade independente na classificação de linfomas da Organização Mundial de Saúde (OMS). Apesar do pequeno número de descrições, o número de casos está crescendo rapidamente. Das poucas centenas de casos que foram publicados até agora, muito poucos vieram do Brasil e nenhum foi relatado às autoridades locais. Encontramos um caso recentemente, e acreditamos que seu relato à comunidade local de cirurgia plástica poderá chamar a sua atenção para essa patologia emergente. O prognóstico é muito bom na maior parte dos casos diagnosticados. Contudo, ainda se sabe pouco sobre como e por que os implantes de silicone poderiam desencadear uma resposta linfoide, culminando num ALCL.

ABSTRACT Introduction: The objective of this study was to report our findings with a collagen and alginate dressing (Fibracol®) used to cover donor areas of partial-thickness skin grafts. Method: We retrospectively evaluated the medical records of 35 patients in whom Fibracol® was used on donor areas. The routine used to manage the donor area is as follows: The area is covered with one or more units of Fibracol®, followed by application of a waterproof film. After three or four days, the dressing is removed and the area cleaned gently with saline and gauze; the area is dressed again if necessary. The mean patient age was 25.52 years (range, 1-65 years). Results: The thigh was used as the donor area in 29 patients, the arm in 2, the leg in 4, and the trunk in 3. Two patients had more than one donor area. The mean time needed for epithelization was 4.51 days (range, 3-8 days). The Pearson correlation coefficient value correlating age and time of epithelization was -0.0755; p = 0.6685. None of the patients experienced an infection in the donor area. The ideal dressing for the donor area of split-thickness skin grafts would have multiple characteristics including low price, good patient comfort, low infection rate, and a short epithelization period. Conclusion: The authors report a positive experience with the use of Fibracol® in 35 patients over a period of 22 months. The mean epithelization period was 4.51 days, shorter than that in the majority of published studies, and had no correlation with the age of the patient.

RESUMO Introdução: O objetivo deste estudo é relatar a nossa experiência com curativo de colágeno e alginato (Fibracol®) para cobrir áreas doadoras de enxerto de pele de espessura parcial. Método: Estudamos, retrospectivamente, 35 prontuários de pacientes que utilizaram o Fibracol® em áreas doadoras. Nossa rotina para cobrir a área doadora é a seguinte: cobertura da área com uma ou mais unidades de Fibracol® e, em seguida, com uma película à prova de água. Depois de três ou quatro dias, remover o curativo, limpar delicadamente com soro fisiológico e gaze e, quando julgava-se necessário, cobria-se novamente. A idade média foi de 25,52 anos (1-65). Resultados: A coxa foi usada como área doadora em 29 pacientes, o braço em 2, a perna em 4 e tronco em 3 (2 pacientes tiveram mais de uma área doadora). O tempo médio necessário para epitelização foi de 4,51 dias (3-8). O valor de R do coeficiente de correlação de Pearson correlacionando a idade e tempo de epitelização foi -0,0755, com p = 0,6685. Nenhum dos pacientes teve infecção na área doadora. O curativo ideal para a área doadora do enxerto de pele de espessura parcial teria muitas características, incluindo: preço baixo, bom conforto do paciente, baixa taxa de infecção, período curto de tempo para epitelização, etc. Conclusão: Os autores relatam uma boa experiência usando Fibracol® em 35 pacientes, durante um período de 22 meses. O tempo para epitelização foi de 4,51 dias, mais curta do que a maioria dos trabalhos publicados, e não tinha correlação com a idade do paciente.