ABSTRACT Agroecological management is considered a model of sustainable agriculture that offers social, environmental and economic benefits. The hypotheses of this study were that agroecological production systems can promote changes in the physical fractions of soil organic matter (SOM) associated with aggregates of different origins, and that the greater diversity of plant species in the production system may favour an increase in the carbon concentration of these aggregates. The aim of this study was to a) determine the mass of the free light fraction (FLF), intra-aggregate light fraction (ILF) and light organic matter fraction (LOM) of biogenic and physiogenic soil aggregates; and b) quantify the organic carbon content of the three light SOM fractions and the residual particulate SOM fraction. Five production systems were evaluated: AgF - Agroforestry system; CSun - Coffee grown in full sun; CSha - Coffee grown in shade; FLE - Flemingia grown in alleys; and NT - No-tillage. The aggregates were separated, identified and classified according to their origin or formation pathway into biogenic (formed by biological processes) or physiogenic aggregates (resulting from chemical and physical actions). From these, the mass and carbon content of the FLF, ILF, LOM and residual particulate fractions were quantified. The greater diversity of plant species found in the AgF system has not yet favoured an increase in the carbon content of the aggregates. The longer set-up time and the management practices of the CSun system has led to an increase in the carbon content of the organic fractions of the aggregates (3.44-1.63 g kg-1 for C-LOM; 1.93-1.13 g kg-1 for C-FLF). The lowest overall mean values for LOM and ILF were found mainly in the aggregates of the NT system (1.22-1.67 and 1.55-2.20 g kg-1, respectively), being associated with the shorter time and greater mobilisation of the arable layer. Biogenic aggregation afforded the highest overall mean values for LOM, and increased the mass of the light fractions (15.5%-27.8% for FLF; 23.4%-8.0% for ILF) and the carbon in the C-LOM, C-FLF and residual particulate fractions (42.3%, 12.9%, and 35.0%, respectively) in the surface layer, suggesting an improvement in soil quality.

ABSTRACT Sandy texture soils have a great expression in agricultural areas worldwide. In the Baixada Fluminense, soils with a sandy texture on the surface horizons are striking, and a good part of these areas is destined for producing vegetables using conventional cultivation methods. The sandy texture is one of the great challenges for agriculture due to the low water retention capacity provided to the soil, the rapid decomposition of organic matter, and the intense loss of nutrients by leaching. In these areas, the action of erosive processes is sometimes observed, whether water or wind erosion. The practices carried out in conventional agriculture can accentuate these processes. This study aimed to evaluate the influence of different soil management systems, with different vegetation covers, on the pathways of aggregate formation, the nutrient contents contained therein, and the organic matter fractions, with the objective of using these properties as indicators of soil quality. The study was carried out in an organic production unit, with no-till system (NT) and conventional system (CT), three vegetal covers were evaluated, namely; seed cocktail 1 (C1) (Crotalaria (Crotalaria juncea) (20 kg ha-1), Jack Bean (Canavalia ensiformis) (150 kg ha-1) and millet (Pennisetum glaucum) (60 kg ha-1)), and seed cocktail 2 (C2) (with 50 % of the amount of seeds used in C1), and spontaneous plants (S. P). Undisturbed samples were collected at the layers of 0.00-0.05 and 0.05-0.10 m, and, from these samples, aggregates with a diameter between 9.7 and 8.0 mm were classified according to the formation route (Biogenic or Physicogenic). From these, the chemical properties were quantified (pH, Ca2+, Mg2+, Al3+, P, Na+, K+), and also the carbon fractions (total organic carbon – TOC, mineral-associated organic carbon – MAOC), particulate organic carbon – POC, and free light fraction carbon – LFC). Based on the results, it was verified that the percentage of biogenic aggregates was higher than the physicogenic one in the layer of 0.00-0.05 m, not being verified influences of the vegetal coverage or the management system. Chemical properties did not differ significantly between training pathways. The CT, for the most part, was the system in which the highest values of chemical properties were observed, and in general, the C2 and S.P coatings were the ones that provided the greatest improvements for chemical properties and carbon content.

ABSTRACT State parks are integral protection units created to protect ecosystems. However, anthropic activities may have been previously performed before their creation, forming transitional areas. Studies that evaluate the modifications of edaphic properties in these environments are scarce. The aim of this study was to evaluate the changes in soil properties and litter stock in areas of eucalyptus-forest ecotones. Litter stock (Stocklitter) and total soil organic carbon content and stock (TOCsoil), weighted mean diameter (MWD), origin of aggregates (biogenic or physicogenic) and respective content of total organic carbon (TOCBio and TOCPhy), total organic carbon (TOCAG), soil organic matter chemical fractions [fulvic acid (FAC), humic (HAC), and humin (HUMC)], and particulate, mineral-associated, free light and intra-aggregate light (POC, MAOC, FLFC, and ILFC) soil organic matter, fertility, and glomalin-related soil protein (GRSP) fractions were evaluated in aggregates (layer 0.00-0.10 m) in areas of eucalyptus-forest ecotone (Eco), preserved forest fragment (For), and eucalyptus plantation (Euc), in Nova Baden State Park, Lambari–MG. In the Euc and Eco areas, the highest Stocklitter content was found. Higher values of TOCsoil, TOCAG, GRSP, and MWD were observed in the Euc area. In the biogenic aggregates, the highest content of TOCBio, HAC, HUMC, POC, MAOC, FLFC, and ILFC was determined in detriment of the physicogenic ones. The dynamics of edaphic properties in the Eco area showed greater similarity with the For area than in the Euc area. In general, all vegetation covers contribute to the maintenance of soil quality.

Nuestro objetivo es describir las diferencias en los diseños muestrales de las dos ediciones de la Encuesta Nacional de Salud (PNS 2013 y 2019) y evaluar cómo sus cambios afectaron el coeficiente de variación (CV) y el efecto de diseño (Deff) de algunos de los indicadores evaluados. Se analizaron variables de diferentes partes del cuestionario para evaluar proporciones con diferentes magnitudes. La prevalencia de obesidad se incluyó en el análisis, ya que la medición de la antropometría en la encuesta de 2019 se realizó en una submuestra. Los valores del estimador puntual, CV y Deff se calcularon para cada indicador considerando la estratificación de las unidades de muestreo primarias, la ponderación de las unidades de muestreo y el efecto de agrupamiento. Para la mayoría de los indicadores, CV y Deff fueron más bajos en las estimaciones de 2019. En cuanto a los indicadores para todos los miembros de la familia, los Deff fueron altos y alcanzaron valores superiores a 18 por tener un plan de salud. En cuanto a los indicadores del cuestionario individual, Deff osciló entre 2,7 y 4,2 en 2013, y entre 2,7 y 10,2 en 2019 para la prevalencia de obesidad. La prevalencia de hipertensión arterial y diabetes por Unidad Federativa tuvo mayor CV y menor Deff. Un mayor tamaño de la muestra para cumplir con los diversos objetivos de salud y un alto valor de Deff son desafíos importantes para el desarrollo de una encuesta nacional domiciliar probabilística. Se deben considerar nuevas estrategias de muestreo probabilístico para reducir los costos y efectos de agrupamiento.

Nosso objetivo é descrever as diferenças nos desenhos amostrais das duas edições da Pesquisa Nacional de Saúde (PNS 2013 e 2019) e avaliar como suas mudanças afetaram o coeficiente de variação (CV) e o efeito do desenho (Deff) de alguns dos indicadores avaliados. Variáveis de diferentes partes do questionário foram analisadas para avaliar proporções com diferentes magnitudes. A prevalência de obesidade foi incluída na análise uma vez que a medição de antropometria na pesquisa de 2019 foi realizada em uma subamostra. Os valores do estimador pontual, CV e Deff foram calculados para cada indicador considerando a estratificação das unidades amostrais primárias, a ponderação das unidades amostrais, e o efeito do agrupamento. Para a maioria dos indicadores, CV e Deff foram menores nas estimativas de 2019. Em relação aos indicadores para todos os membros familiares, Deffs foram elevados e atingiram valores superiores a 18 para a posse de um plano de saúde. Quanto aos indicadores no questionário individual, Deff variou de 2,7 a 4,2 em 2013 e de 2,7 a 10,2 em 2019 para a prevalência de obesidade. A prevalência de hipertensão arterial e diabetes por Unidade Federativa apresentou CV maior e Deff menor. A expansão do tamanho da amostra para atender aos diversos objetivos de saúde e Deff altos são desafios expressivos para o desenvolvimento de uma pesquisa nacional domiciliar probabilística. Novas estratégias de amostragem probabilística devem ser consideradas para reduzir custos e efeitos do agrupamento.

Our objective is to describe the differences in the sampling plans of the two editions of the Brazilian National Health Survey (PNS 2013 and 2019) and to evaluate how the changes affected the coefficient of variation (CV) and the design effect (Deff) of some estimated indicators. Variables from different parts of the questionnaire were analyzed to cover proportions with different magnitudes. The prevalence of obesity was included in the analysis since anthropometry measurement in the 2019 survey was performed in a subsample. The value of the point estimate, CV, and the Deff were calculated for each indicator, considering the stratification of the primary sampling units, the weighting of the sampling units, and the clustering effect. The CV and the Deff were lower in the 2019 estimates for most indicators. Concerning the questionnaire indicators of all household members, the Deffs were high and reached values greater than 18 for having a health insurance plan. Regarding the indicators of the individual questionnaire, for the prevalence of obesity, the Deff ranged from 2.7 to 4.2, in 2013, and from 2.7 to 10.2, in 2019. The prevalence of hypertension and diabetes per Federative Unit had a higher CV and lower Deff. Expanding the sample size to meet the diverse health objectives and the high Deff are significant challenges for developing probabilistic household-based national survey. New probabilistic sampling strategies should be considered to reduce costs and clustering effects.

Nosso objetivo é descrever as diferenças nos desenhos amostrais das duas edições da Pesquisa Nacional de Saúde (PNS 2013 e 2019) e avaliar como suas mudanças afetaram o coeficiente de variação (CV) e o efeito do desenho (Deff) de alguns dos indicadores avaliados. Variáveis de diferentes partes do questionário foram analisadas para avaliar proporções com diferentes magnitudes. A prevalência de obesidade foi incluída na análise uma vez que a medição de antropometria na pesquisa de 2019 foi realizada em uma subamostra. Os valores do estimador pontual, CV e Deff foram calculados para cada indicador considerando a estratificação das unidades amostrais primárias, a ponderação das unidades amostrais, e o efeito do agrupamento. Para a maioria dos indicadores, CV e Deff foram menores nas estimativas de 2019. Em relação aos indicadores para todos os membros familiares, Deffs foram elevados e atingiram valores superiores a 18 para a posse de um plano de saúde. Quanto aos indicadores no questionário individual, Deff variou de 2,7 a 4,2 em 2013 e de 2,7 a 10,2 em 2019 para a prevalência de obesidade. A prevalência de hipertensão arterial e diabetes por Unidade Federativa apresentou CV maior e Deff menor. A expansão do tamanho da amostra para atender aos diversos objetivos de saúde e Deff altos são desafios expressivos para o desenvolvimento de uma pesquisa nacional domiciliar probabilística. Novas estratégias de amostragem probabilística devem ser consideradas para reduzir custos e efeitos do agrupamento.

Our objective is to describe the differences in the sampling plans of the two editions of the Brazilian National Health Survey (PNS 2013 and 2019) and to evaluate how the changes affected the coefficient of variation (CV) and the design effect (Deff) of some estimated indicators. Variables from different parts of the questionnaire were analyzed to cover proportions with different magnitudes. The prevalence of obesity was included in the analysis since anthropometry measurement in the 2019 survey was performed in a subsample. The value of the point estimate, CV, and the Deff were calculated for each indicator, considering the stratification of the primary sampling units, the weighting of the sampling units, and the clustering effect. The CV and the Deff were lower in the 2019 estimates for most indicators. Concerning the questionnaire indicators of all household members, the Deffs were high and reached values greater than 18 for having a health insurance plan. Regarding the indicators of the individual questionnaire, for the prevalence of obesity, the Deff ranged from 2.7 to 4.2, in 2013, and from 2.7 to 10.2, in 2019. The prevalence of hypertension and diabetes per Federative Unit had a higher CV and lower Deff. Expanding the sample size to meet the diverse health objectives and the high Deff are significant challenges for developing probabilistic household-based national survey. New probabilistic sampling strategies should be considered to reduce costs and clustering effects.

Nuestro objetivo es describir las diferencias en los diseños muestrales de las dos ediciones de la Encuesta Nacional de Salud (PNS 2013 y 2019) y evaluar cómo sus cambios afectaron el coeficiente de variación (CV) y el efecto de diseño (Deff) de algunos de los indicadores evaluados. Se analizaron variables de diferentes partes del cuestionario para evaluar proporciones con diferentes magnitudes. La prevalencia de obesidad se incluyó en el análisis, ya que la medición de la antropometría en la encuesta de 2019 se realizó en una submuestra. Los valores del estimador puntual, CV y Deff se calcularon para cada indicador considerando la estratificación de las unidades de muestreo primarias, la ponderación de las unidades de muestreo y el efecto de agrupamiento. Para la mayoría de los indicadores, CV y Deff fueron más bajos en las estimaciones de 2019. En cuanto a los indicadores para todos los miembros de la familia, los Deff fueron altos y alcanzaron valores superiores a 18 por tener un plan de salud. En cuanto a los indicadores del cuestionario individual, Deff osciló entre 2,7 y 4,2 en 2013, y entre 2,7 y 10,2 en 2019 para la prevalencia de obesidad. La prevalencia de hipertensión arterial y diabetes por Unidad Federativa tuvo mayor CV y menor Deff. Un mayor tamaño de la muestra para cumplir con los diversos objetivos de salud y un alto valor de Deff son desafíos importantes para el desarrollo de una encuesta nacional domiciliar probabilística. Se deben considerar nuevas estrategias de muestreo probabilístico para reducir los costos y efectos de agrupamiento.

ABSTRACT Objective To validate the content and usability of educational hypermedia about embracement and obstetric risk classification. Methods Methodological study, development by the basic instructional design model, conducted in five stages. Twenty-two judges participated to validate the content and usability. For the analysis, the Content Validity Index, the System Usability Scale, and the binomial test were used. Results In the content it was obtained a Content Validity Index of 0.96 and for and usability it was obtained 91.9. In the overall evaluation, all requirements obtained an index of 0.98. Conclusion The educational hypermedia developed presents evidence of validity and constitutes an innovative resource for the teaching and learning process in Nursing.

RESUMEN Objetivo Validar el contenido y la utilidad de la hipermedia educativa sobre el acolchado y la clasificación del riesgo obstétrico. Métodos Estudio metodológico, desarrollo del modelo de diseño instruccional básico, realizado en cinco etapas. Participaron 22 jueces para validar el contenido y la usabilidad. Para el análisis se utilizó el Índice de Validez de Contenido, la Escala de Usabilidad del Sistema y la prueba binomial. Resultados En el contenido se obtuvo un Índice de Validez de Contenido de 0,96 y para la usabilidad se obtuvo un 91,9. En la evaluación global, todos los requisitos obtuvieron un 0,98 de índice. Conclusión La hipermedia educativa desarrollada presenta evidencia de validez y se constituye como recurso innovador para el proceso de enseñanza y aprendizaje en Enfermería.

RESUMO Objetivo Validar o conteúdo e usabilidade de hipermídia educativa sobre acolhimento e classificação de risco obstétrico. Métodos Estudo metodológico, desenvolvimento pelo modelo de design instrucional básico, realizado em cinco etapas. Participaram 22 juízes para validar conteúdo e usabilidade. Para a análise, foram utilizados o Índice de Validade de Conteúdo a System Usability Scale e o teste binomial. Resultados No conteúdo obtiveram um Índice de Validade de Conteúdo de 0,96 e para e usabilidade obteve-se 91,9. Na avaliação global, todos os requisitos obtiveram 0,98 de índice. Conclusão: A hipermídia educativa desenvolvida apresenta evidência de validade e se constitui como recurso inovador para o processo de ensino e aprendizagem em Enfermagem.

RESUMO Introdução: O câncer de mama é a segunda neoplasia maligna mais comum em mulheres no Brasil. O grande desafio para os profissionais de saúde é conciliar a fila de espera tanto para as cirurgias oncológicas quanto para as reconstrutivas. O objetivo é avaliar o cenário dos últimos 5 anos das cirurgias de câncer de mama em comparação ao número de cirurgias reconstrutivas realizadas no mesmo período. Métodos: Trata-se de um estudo descritivo com abordagem transversal e retrospectiva sobre mastectomias, segmentectomias e reconstruções mamárias realizadas no SUS, entre os anos de 2015 e 2020. Os dados foram coletados no serviço de transferência de dados do SUS, segundo os procedimentos e códigos escolhidos e tabulados no software Microsoft Excel 365. Resultados: Foram realizadas 204.569 cirurgias de câncer de mama, sendo 57% segmentectomias/quadrantectomias e 43% mastectomias. No mesmo período, foram realizadas 17.927 cirurgias plásticas reconstrutivas de mama com implantes após mastectomia, sendo que apenas 20,52% das mulheres mastectomizadas foram submetidas à reconstrução imediata com implantes. Conclusão: O número de cirurgias reconstrutivas de mama no Brasil está bem abaixo do ideal, deixando a maioria das mulheres mastectomizadas com sequelas por um longo período de tempo.

ABSTRACT Introduction: Breast cancer is the second most common malignant neoplasm in women in Brazil. A great challenge for health professionals and to reconcile the waiting line for both oncological and reconstructive surgeries. The objective is to evaluate the last 5 years of breast cancer surgeries compared to the number of reconstructive surgeries performed in the same period. Methods: This is a descriptive study with a transversal and retrospective approach on mastectomies, segmentectomies and breast reconstructions performed at SUS, between the years 2015 and 2020. According to the procedures and codes chosen and tabulated in the Microsoft Excel 365 software, the data were collected in the SUS data transfer service. Results: 204,569 breast cancer surgeries were performed, with 57% segmentectomies/quadrantectomies and 43% mastectomies. In the same period, 17,927 reconstructive plastic breast surgeries were performed with implants after mastectomy, with only 20.52% of mastectomized women undergoing immediate reconstruction with implants. Conclusion: The number of reconstructive breast surgeries in Brazil is below the ideal level, leaving most women mastectomized with sequelae for a long time.

SUMMARY OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman’s test and Friedman’s test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

ABSTRACT An important strategy for the sustainable management of Cerrado soils is no-till (NT) systems, which may improve soil properties, particularly aggregation. Soil aggregates can be categorized according to their formation pathways into physicogenic (Phy) and biogenic (Bio). This study aimed (i) to quantify the relative proportion of physicogenic and biogenic aggregates and (ii) evaluate the levels of total organic carbon and their respective humic and physical fractions in the aggregates’ formation pathways. The following managed and unmanaged sites were evaluated: a 6-year no-till site (6NT), an 18-year no-till site (18NT), a conventional tillage site (CT), and a reference Cerrado site (RS). Retained aggregates were analyzed morphologically, separated into Phy and Bio, and quantified. Subsequently, aggregates were subjected to total organic carbon (TOC) determination, fulvic acid carbon, humic acid carbon, humin carbon, particulate organic carbon (POC), mineral-associated organic carbon, and free light fraction carbon (FLFC). The proportion of Bio aggregates increased with decreasing management intensity. When TOC and humic acid carbon levels were compared between sites, it was found that Bio aggregates from 18NT and 6NT contained higher carbon content than Bio aggregates from CT. Particulate organic carbon and FLFC differed between aggregate types, with higher POC values observed in Bio aggregates from CT and 18NT and higher FLFC values in Bio aggregates from CT, 6NT, and 18NT. The practices adopted in the conservation management system favored biogenic aggregation in the Cerrado region, which can be proven through the study of the fractions of soil organic matter contained in these aggregates. The biogenic aggregation changed the SOM dynamics. Principal component analysis showed a clear distinction between conventional and conservationist management systems.

Abstract Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.

ABSTRACT Introduction: Periorbital changes are some of the first detectable signs of aging. The most outstanding currently, refers to the rejuvenation of this region, involving the treatment from the eyebrows to the transition orbital-malar, where are festoons, edemas, and malar bags. However, this management is complex, involving several approaches: invasive or noninvasive techniques. Thus, this review aims to describe the scientific evidence of the most current techniques used in the treatment of festoons, edema, and malar bags and to evaluate the complications related to each modality. Methods: The research was carried out in three databases, PubMed, Cochrane, and LILACS - using the descriptors “bolsa malar,” “malar mounds,” “festoons” and “malar bags” in the period from 2014 to 2019, in English and Portuguese. Results: We selected 13 articles; most of the studies were retrospective reviews (76.9%), seven dealt with noninvasive techniques, three about invasive, and three on the association of techniques. Regarding the procedures described, the noninvasive ones were represented by the use of Kinesio tape, tetracycline injection, doxycycline and hyaluronic acid, and the use of microneedling with radiofrequency. The invasive ones were represented by microaspiration, myocutaneous flap, subperiosteal lift of the middle face, and direct excision. Conclusion: There are numerous techniques for treating festoon and malar bags, but it is up to the plastic surgeon to know its advantages and disadvantages to decide the most appropriate in each situation. Thus, there is no consensus, but it is vital to diagnose correctly to indicate the best treatment.

RESUMO Introdução: As alterações periorbitais são alguns dos primeiros sinais detectáveis do envelhecimento. O destaque, atualmente, refere-se ao rejuvenescimento dessa região, envolvendo o tratamento desde as sobrancelhas até a transição órbito-malar, onde se encontram festoons, edemas e bolsas malares. Entretanto, este manejo é complexo, envolvendo várias abordagens: técnicas invasivas ou não invasivas. Assim, esta revisão objetiva descrever as evidências científicas relacionadas às técnicas mais atuais utilizadas no tratamento de festoons, edemas e bolsas malares e avaliar as complicações relacionadas à cada modalidade. Métodos: A pesquisa foi realizada em três bases de dados - PubMed, Cochrane e LILACS - utilizando os descritores “bolsa malar”, “malar mounds”, “festoons” e “malar bags” no período de 2014 a 2019, na língua inglesa e portuguesa. Resultados: Foram selecionados 13 artigos, a maioria dos estudos eram revisões retrospectivas (76,9%), sete versavam sobre técnicas não invasivas, 3 sobre invasivas e 3 sobre associação das técnicas. Em relação aos procedimentos descritos, os não invasivos foram representados pelo uso de Kinesio tape, injeção de tetraciclina, doxiciclina e de ácido hialurônico, e o uso de microagulhamento com radiofrequência. Já os invasivos foram representados por microaspiração, retalho miocutâneo, lift subperiosteal da face média e excisão direta. Conclusão: Existem inúmeras técnicas para tratamento de festoon e bolsas malares, mas cabe ao cirurgião plástico conhecer suas vantagens e desvantagens para decidir a mais adequada em cada situação. Assim, não há consenso, mas é vital diagnosticar corretamente para indicar o melhor tratamento.

Abstract An unresolved question about the use of animal waste in agriculture is its effect on the physical and chemical attributes of soil, especially in commercial grain producing areas that have adopted direct seeding system (DSS). Aiming at contributing to the clarification of this question, we conducted a study in the mid-north region of the Mato Grosso state, Brazil, in a soybean and maize commercial area consolidated in DSS. Different doses of liquid swine manure (LSM) were applied and compared with NPK mineral fertilization. The aim of this study was to evaluate the physical and chemical quality of the soil and the productive potential of the soybean and maize crops under LSM doses and NPK fertilizer. Results indicated an increase in levels of K, P, Zn and Cu exchangeable with LSM fertilization of 80 m3.ha-1. Fertilizers with mineral NPK and LSM at 80 and 60 m3.ha-1, respectively, show soil porosity improvements and decreased soil penetration resistance. Moreover, the use of LSM also provided the highest increases in soybean and maize grain yield.

Resumo Uma das questões pouco esclarecidas sobre o uso de resíduos animais na agricultura, é seu efeito sobre os atributos físicos e químicos do solo, principalmente em áreas comerciais produtoras de grãos que adotam o sistema de semeadura direta (DSS). Visando contribuir com o esclarecimento desta questão, realizamos um estudo na região médio-norte do estado de Mato Grosso, Brasil, em uma área comercial de soja e milho consolidada em DSS. Aplicou-se diferentes doses de dejetos líquidos de suínos (LSM) e as comparou com adubação mineral NPK. O objetivo foi avaliar a qualidade física e química do solo e o potencial produtivo das culturas soja e milho sob as doses de LSM e NPK como fertilizantes. Os resultados indicaram aumento nos teores de K, P, Zn e Cu trocáveis com adubação de 80 m3 ha-1 de LSM. As adubações com fertilizante mineral NPK e LSM nas doses de 80 e 60 m3 ha-1 proporcionam melhorias na porosidade do solo e diminuíram a resistência do solo à penetração. O uso de LSM também proporcionou os maiores incrementos na produtividade de grãos de soja e de milho.

CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6%) próteses bifurcadas e 10 (24,5%) monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8%) pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8%) pacientes apresentaram oclusão de ramo da prótese. Oito (19,5%) vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.

BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze perioperative mortality, late survival, reoperations, patency rates and the aneurysmal sac behavior in patients with favorable anatomy for this procedure. METHODS: A longitudinal, observational and retrospective study was conducted from October 2004 to January 2009, involving 41 patients with favorable anatomy for endovascular repair of infrarenal aortic aneurysm. The findings of diagnostic exams, the treatment and follow-up results were analyzed. RESULTS: Thirty-one (75.6%) bifurcated and 10 (24.5%) mono-iliac prosthesis of five different brands were successfully implanted. The average diameter of the fusiform aneurysms was 62 mm. Perioperative mortality rate was 4.8% and late survival was 90.2%. During the mean follow-up period of 30 months, two (4.8%) patients needed re-intervention, one for migration of the endoprosthesis and the other for type II endoleak. Two (4.8%) patients presented occlusion of an endograft branch. Eight (19.5%) endoleaks were diagnosed and there was no aneurysm rupture. CONCLUSION: Despite the small number of patients, the results seem to justify the performance of endovascular therapy in patients with favorable anatomy.

Os anticoagulantes orais que atuam através do antagonismo à vitamina K são utilizados na prática clínica há muito tempo, porém ainda há dificuldades no seu manejo e na condução das complicações. Entre as complicações, as mais conhecidas são os transtornos hemorrágicos, mas outras também devem ser reconhecidas, tais como a necrose induzida por varfarina. Esta é uma grave, porém rara complicação, cuja fisiopatologia é ainda obscura e cujas causas são indefinidas. Dentre as possíveis causas, as mais prováveis são a deficiência de proteína C e de proteína S, reações de hipersensibilidade e deficiência de fator VII. Há maior incidência desta complicação entre mulheres de meia-idade, acometendo preferencialmente mamas e glúteos. As medidas mais importantes para o tratamento são: suspensão imediata da droga, uso de heparina não fracionada ou de baixo peso molecular em doses terapêuticas, emprego da vitamina K e, eventualmente, infusão de plasma fresco congelado ou de proteína C ativada recombinante.

Oral anticoagulants acting via vitamin K antagonists have long been employed in the clinical practice. However, difficulties related to the management of treatment regimens and complications still persist. Among the complications, bleeding disorders are widely known, but others should also be taken into consideration, such as warfarin-induced skin necrosis. The pathophysiology of this rare but severe complication is still obscure, and its causes remain to be defined. Among possible causes, protein C and protein S deficiency, hypersensitivity reactions and VII factor deficiency are the most probable ones. There is an increased incidence of warfarin-induced skin necrosis among middle-aged women, usually affecting breasts and buttocks. The most important treatment measures are immediate discontinuation of the drug, use of unfractionated or low-molecular-weight heparin at therapeutic doses, use of vitamin K and, eventually, infusion of fresh-frozen plasma or recombinant activated protein C.

CONTEXTO: Pacientes tratados por revascularização arterial (enxertos e angioplastias) nos membros inferiores acometidos por doença arterial oclusiva periférica foram seguidos por até 2 anos pós-tratamento usando ultrassom vascular (análise espectral segmentar, AES). OBJETIVO: Demonstrar que a AES pode ser utilizada no seguimento dos pacientes tratados por doença arterial oclusiva periférica. MÉTODOS: As medidas de AES realizadas foram: velocidade sistólica de pico, índice de pulsatilidade e forma da onda de velocidade de fluxo. Essas foram comparadas em cada paciente no pré e pós-tratamento (com intervalos de 3 meses) para diagnóstico de perviedade. RESULTADOS: Medidas realizadas no pós-operatório nas artérias imediatamente distais aos segmentos tratados mostraram aumento consistente de velocidade sistólica de pico e índice de pulsatilidade com mudanças na forma da onda de velocidade de fluxo de unifásica para bi ou trifásica. A velocidade sistólica de pico e o índice de pulsatilidade aumentaram respectivamente em 92,26 e 98,2% (tratamentos no segmento aorto-ilíaco), em 112,83 e 62,39% (tratamentos no segmento fêmoro-poplíteo) e em 149,08 e 28,8% (tratamentos no segmento poplíteo-tibial). Tais mudanças nos padrões de velocidade de fluxo ocorreram em todos os pacientes e permaneceram quase inalteradas enquanto os tratamentos estivessem pérvios. Quando ocorria falência nos tratamentos (oclusões ou estenoses hemodinamicamente significantes), os parâmetros caíam a níveis similares aos de antes do tratamento. Se a falência do tratamento era corrigida por nova revascularização (enxerto ou angioplastia), os parâmetros de AES voltavam a se comportar como após o tratamento inicial. CONCLUSÃO: A AES pode ser usada no seguimento dos pacientes com revascularização dos membros devido a doença arterial oclusiva periférica, demonstrando tanto a perviedade quanto a falência do tratamento.

BACKGROUND: Patients treated for peripheral arterial occlusive disease with lower limb revascularization (angioplasty or grafts) were followed up for a 2-year period after treatment with vascular ultrasound (segmental spectrum analysis, SSA). OBJECTIVE: To demonstrate that SSA can be used in the follow-up of patients treated for peripheral arterial occlusive disease. METHODS: The following SSA measurements were performed: peak systolic velocity (PSV), pulsatility index (PI), and flow velocity waveform (FVW). These measurements were performed and compared for each patient during the pre- and post-treatment periods (with 3-month intervals) for diagnosis of vascular patency. RESULTS: Measurements performed postoperatively in the arteries immediately distal to the treated segments showed a significant increase in PSV and PI, with a change of the FVW from a monophasic to a biphasic or triphasic configuration. PSV and PI increased, respectively, 92.26 and 98.2% (intervention in the aortoiliac segment), 112.83 and 62.39% (intervention in the femoral-popliteal segment), and 149.08 and 28.8% (in the popliteal-tibial segment). Such changes in flow velocity patterns occurred in all patients and remained almost unaltered during the period of patient follow up. When treatment failed (hemodynamically significant occlusion or stenosis), parameters fell to levels similar to those observed prior to treatment. If treatment failure was corrected by new revascularization (angioplasty or grafts), SSA parameters returned to patterns observed after initial treatment. CONCLUSION: SSA can be used in the follow-up of patients with lower limb revascularization due to peripheral arterial occlusive disease, demonstrating treatment patency and failure.