Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044). Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF

Soil preparation and NPK fertilization in the planting of five Atlantic Rainforest species in a clay extraction area

The occurrence of degraded areas worldwide grows each year and measures must be taken to mitigate degradation and to recover these areas. The aim of this study was to assess the effect of soil preparation and NPK levels on the growth of five native species of the Atlantic Rainforest in clay extraction area. The experimental design was randomized block in a split-split plot arrangement with four replications. Subsoiling and scarification soil preparation represented main plots.  Doses of NPK 04-14-08: 0; 40; 80;160; and 320 g pit-1 represented subplots and Atlantic Rainforest native species represented sub-subplots. Absolute growth rate, stem diameter and number of leaves were evaluated, 210 days after planting. The type of soil preparation did not influence the development of the species. The best dose for Dalbergia ecastaphyllum, Inga laurina, Protium heptaphyllum and Psidium cattleyanum were 176.49, 150.18, 199.25 and 166.48 g pit-1 of NPK, respectively. Schinus terebinthifolius was highly responsive to planting fertilization, being recommended 320 g pit-1 of NPK. All species are indicated for area recovery.The occurrence of degraded areas worldwide grows each year and measures must be taken to mitigate degradation and to recover these areas. The aim of this study was to assess the effect of soil preparation and NPK levels on the growth of five native species of the Atlantic Rainforest in clay extraction area. The experimental design was randomized block in a split-split plot arrangement with four replications. Subsoiling and scarification soil preparation represented main plots.  Doses of NPK 04-14-08: 0; 40; 80;160; and 320 g pit-1 represented subplots and Atlantic Rainforest native species represented sub-subplots. Absolute growth rate, stem diameter and number of leaves were evaluated, 210 days after planting. The type of soil preparation did not influence the development of the species. The best dose for Dalbergia ecastaphyllum, Inga laurina, Protium heptaphyllum and Psidium cattleyanum were 176.49, 150.18, 199.25 and 166.48 g pit-1 of NPK, respectively. Schinus terebinthifolius was highly responsive to planting fertilization, being recommended 320 g pit-1 of NPK. All species are indicated for area recovery

30 ANOS DO SERVIÇO DE ORIENTAÇÃO AO EXERCÍCIO EM VITÓRIA/ES: PIONEIRISMO NAS PRÁTICAS CORPORAIS E ATIVIDADES FÍSICAS NO SISTEMA ÚNICO DE SAÚDE

This work analyses the pioneering role played by the Exercise Guidance Service (EGS) in Vitoria, ES, based on its promotion of bodily practices and physical activities (BPPA) in Brazil’s Unified Health System (SUS). It is a collective strategy of reflection and writing built by the program’s professionals and managers, and partner researchers linked to the field of Physical Education and Public Health. It evaluates and discusses the main changes faced by the EGS over 30 years. It presents how the program has dialogued with health policies and the literature on physical activity and BPPA over three decades. It identifies EGS’s potential and challenges as a public health program and highlights BPPA’s core role in the SUS. It asserts the importance of coordination and dialogue with other health institutions, policies, programs and practices to improve the services that EGS offers to the population.  El texto analiza el pionerismo del Servicio de Orientación al Ejercicio de Vitória/ES a partir de la promoción de las prácticas corporales y actividades físicas (PCAF) en el Sistema Único de Salud. Se trata de una estrategia colectiva de reflexión tejida por los profesionales, gestores del programa e investigadores colaboradores vinculados a la Educación Física y a la Salud Colectiva. Hace un “balance” y discute las principales transformaciones ocurridas en el Servicio a lo largo de sus 30 años. Presenta como el Servicio viene dialogando, en tres décadas, con las políticas de salud y con la literatura acerca de las PCAF. Identifica potencialidades y desafíos del Servicio como programa de salud pública, destacando su protagonismo en el campo de las PCAF en el SUS. Afirma la importancia de la articulación y diálogo con otras instituciones, políticas, programas y prácticas de salud para la cualificación del servicio ofertado a la población.  O texto analisa o pioneirismo do Serviço de Orientação ao Exercício (SOE) de Vitória/ES a partir da promoção das práticas corporais e atividades físicas (PCAF) no Sistema Único de Saúde (SUS). Trata-se de uma estratégia coletiva de reflexão e escrita tecida pelos profissionais, gestores do programa e pesquisadores parceiros vinculados à Educação Física e à Saúde Coletiva. Faz um balanço e discute as principais transformações ocorridas no SOE ao longo de seus 30 anos. Apresenta como o Serviço vem dialogando, ao longo dessas três décadas, com as políticas de saúde e com a literatura acerca da atividade física e das PCAF. Identifica potencialidades e desafios do SOE como programa de saúde pública, bem como destaca seu protagonismo no campo das PCAF no SUS. Afirma a importância da articulação e diálogo com outras instituições, políticas, programas e práticas de saúde para a qualificação do serviço que o SOE oferta à população.

My Fair Trade: a introdução e algumas das notas de uma nova tradução do Pigmalião, de G. B. Shaw

This article presents the introduction, translation notes and general notes of  a new Portuguese translation of George Bernard Shaw’s Pygmalion. Besides the usual presentation and discussion of translation problems and their solutions, historical data on the play and its role in Shaw´s life and within his work is briefly considered. We further point to the practical application in this translation work of some concepts developed by theorists of the translation of theatre texts, such as Bassnett (1985) and Betti (2003). We also point out that Pygmalion’s unique condition — a play where language figures with the prominence of a main character, with lines that frequently require for their construction an effort akin to the drawing of an illustration — allows one to recognize in the translation work situations “between the verbal and the visual” as noted, in a different translation condition, by Oittinen (1995). Also, Pygmalion highlights the “cooperative strategy” of  Bassnett (1985) as, by far, the most convenient strategy for the translation of theatre texts.O artigo apresenta a introdução e as notas para uma nova tradução do Pigmalião, de George Bernard Shaw. Além da usual apresentação e discussão de dificuldades e soluções de tradução, o texto busca apresentar um breve histórico da peça e algumas considerações acerca de sua inserção na vida e na obra de Shaw. Ademais, a aplicação prática, no trabalho em pauta, de alguns conceitos de teóricos da tradução teatral,  como em Bassnett (1985) e Betti (2003), é apontada e explicitada. Buscamos também fazer ver que a condição específica de Pigmalião — o tratar-se de uma peça em que a própria língua tem o destaque de um personagem principal, com falas que precisam ser freqüentemente “desenhadas” — permite que se reconheçam nessa peça teatral situações tradutórias que ficam “entre o verbal e o visual”, como o apontado, em outra situação tradutória, por Oittinen (1995). Pigmalião faz também ressaltar a “estratégia cooperativa” de Bassnett (1985) como, de longe, a mais conveniente para a tradução teatral

ASSOCIAÇÃO FAUNÍSTICA E EFEITOS DE VARIÁVEIS AMBIENTAIS NA DISTRIBUIÇÃO ESPAÇO-TEMPORAL NA ESTRUTURA DA COMUNIDADE DA PESCA DE PEIXES DIVERSOS DA COSTA NORTE DO BRASIL

The North Coast, has high biological productivity and áreas with a muddy substrate, suitable for trawling. This modality, there is trawling for various fishes. This fishery despite the denomination, acts on a target specie. Pescada gó, but it captures various species. This study aimed to characterize the faunistic associations in the structure of the main community of this fishry, and to determine the environmental facotrs, which may be related to temporal and spatial variations of this community. The data were acquired through the monitoring of 227 trawls, in six distinct periods, between 2013 and 2014, by on board observers in a detained vessel. The species caught were identified on board. Twenty six species were captured, but for the subsequente analyzes, only eleven species were used, which represented 95% of the caught production. For the associations between species, the grouping analysis was applied, using CPUE data standardizing in ranging and the Ward algorithm to the formation of theses faunistic groups, to the grouping of trawls, gross CPUE data were used in order to group the trawls in relation to their composition and catch periods. For the factors that correlate with the community distribution, redundancy analysis was usedm using environmmental, temporal and spatial variables. Three distinct groups with faunal associations were found, in relation to the trawls, two large grupos with differentss behavior. Regarding correlation facotrs, the set of temporal variables was more influential to this community, followed by environmental varaibles and a few influence by spatial variables.Keywords: Trawling; estuary; shelf; variation; ecology.A Costa Norte, possui alta produtividade biológica e áreas com substrato lamoso, propício a pesca de arrasto. Nesta modalidade, encontra-se a pesca de arrasto para peixes diversos. Essa pescaria, apesar da denominação, atua sobre uma espécie alvo, a pescada gó, porém captura várias espécies. Esse trabalho objetivou caracterizar as associações faunísticas na estrutura da comunidade principal dessa pescaria, e determinar os fatores ambientais, que podem estar relacionados com variações temporais e espaciais desta comunidade. Os dados foram adquiridos através do acompanhamento de 227 arrastos, em seis períodos distintos, entre 2013 e 2014, por observadores de bordo em uma embarcação permissionada. As espécies capturadas foram identificadas à bordo. Foram capturadas vinte e seis espécies, porém para as análises posteriores, utilizou-se apenas onze espécies, as quais representaram 95% da produção capturada. Para as associações entre espécies, aplicou-se a análise de agrupamento, utilizando os dados de CPUE padronizados em ranging e o algorítimo de Ward para formação desses grupos faunísticos, para agrupamento dos arrastos, utilizou-se dados brutos de CPUE, no intuito de agrupar os arrastos em relação a sua composição e períodos da captura. Para os fatores que se correlacionam com a distribuição da comunidade empregou-se a análise de redundância, utilizando variáveis ambientais, temporais e espaciais. Foram encontrados três grupos distintos com associações faunísticas, em relação aos arrastos, dois grandes grupos com comportamento diferente. Em relação aos fatores de correlação, o conjunto de variáveis temporais se mostrou mais influenciador para esta comunidade, seguido pelas variáveis ambientais e pouco influenciado pelas variáveis espaciais.Palavras-chave: Arrasto, estuário, plataforma, variação, ecologia

GENDER DIFFERENCES IN CHRONIC LOWER LIMB ISCHEMIA PRESENTATION AND REVASCULARIZATION OUTCOMES

Introduction: Sex-specific data on outcomes after lower limb revascularization associate the female gender with worse surgical outcomes, particularly after open procedures. Women were found to be more likely to suffer from procedure complications, limb loss, and mortality than their male counterparts. This study aims to identify differences in demographic characteristics, clinical presentation and all major outcomes after lower limb revascularization between female and male patients. Methods: This retrospective, single-center study comprises all never-revascularized lower limbs in patients with clinically diagnosed PAD who underwent a lower limb therapeutic vascular intervention in a tertiary hospital between January 2017 and December 2018. Women's limbs Group (F) was compared against men's limbs Group (M). The primary endpoint was major amputation, and the secondary endpoints were restenosis/occlusion, vascular reintervention and overall survival. Subgroup analysis was undertaken considering open, endovascular or hybrid procedures. Results: Group M included 324 male lower limbs; patients had a mean age of 67,5 years. Group F included 96 female lower limbs; patients had a mean age of 71,7 years (p<0,001). There were no significant differences in cardiovascular risk factors between groups, aside from a higher prevalence of smoking in Group M and hypertension in Group F (p<0.001). 83% of Group F procedures and 79% of procedures in Group M were performed due to CLTI (p=0,321). We found no statistically significant difference between groups regarding wound or infection grading (WIfI) and femoropopliteal or BTA anatomic disease staging (GLASS). Group M was more likely to have aortoiliac (p=0,014) and common femoral artery disease (p=0.001), and Group F to have more severe BTK disease (p=0,012). Group F had a higher proportion of endovascular procedures (p<0.001). Amputation rates in Group M and Group F were 8±2% and 7±3% at 1 month, 14±2% and 16±4% at 1 year, 15±2% and 19±4% at 2 years, respectively (p=0,564). There were no significant differences in rates of procedure restenosis/occlusion between groups (p=0,395). Reintervention rates in Group M and Group F were 13±2% and 13±3% at 1 month, 21±2% and 20±4% at 1 year, 25±3% and 24±5% at 2 years, respectively (p=0,74). Overall survival in Group M and Group F was 97±1% and 93±3% at 1 month, 84±2% and 84±4% at 1 year, 77±3% and 72±5% at 2 years, respectively (p=0,443). Stratifying according to the type of vascular procedure (open, endovascular or hybrid), we found no significant difference between groups in the outcomes mentioned above. Conclusion: Overall, women were more likely to be older, to have more severe BTK disease, and to undergo endovascular procedures. However, this study suggests no major differences in limb outcomes for women who undergo lower limb revascularization procedures

LEFT HEART DYSFUNCTION AND HEART VALVE DISEASE DO NOT INFLUENCE OUTCOMES AFTER LOWER LIMB REVASCULARIZATION

Introduction: Inadequate systemic perfusion as a consequence of heart disease may compromise inflow to lower limb revascularization procedures, decreasing short and mid-term patency. It may be theorized that patients suffering from heart valve disease or reduction of left ventricular ejection fraction (LVEF) have worse limb outcomes after lower limb revascularization. Method: This retrospective study included all first lower limb revascularization procedures performed in a tertiary hospital, between January 2017 and December 2018, in patients with diagnosed PAD and an available preoperative transthoracic echocardiogram (TTE). The group with moderate to severe heart disease in TTE (Group 1, defined as LVEF<40% or moderate to severe valvular heart disease) was compared against the group with no or mild heart disease in TTE (Group 2, defined as LVEF≥40% and no or mild valvular heart disease). Subgroup analysis was undertaken considering the presence and severity of the individual heart change on TTE. Primary endpoint was major amputation, and secondary endpoints were diagnosed restenosis/occlusion, vascular reintervention and overall survival. Results: The study included 268 lower limb revascularization procedures. Group 1 and 2 included 70 and 198 procedures, respectively. In both groups, the prevalence of CLTI was 89%. There were no significant differences in wound and infection grading (in WIfI), and anatomic disease staging (in GLASS), between Groups 1 and 2. In Group 1, 73% were endovascular procedures (65% in Group 2; p=0,34). Amputation rates in Group 1 and 2 were 9% and 13% at 1 month, 19% and 20% at 1 year and 19% and 22% at 2 years, respectively (p=0,758). Diagnosed restenosis/occlusion rates in Group 1 and 2 were 5% and 15% at 1 month, 18% and 26% at 1 year and 24% and 31% at 2 years, respectively (p=0,119). Reintervention rates in Group 1 and 2 were 13% and 18% at 1 month, 25% and 27% at 1 year and 30% and 32% at 2 years, respectively (p=0,614). After subgroup analysis according to the presence and severity of individual heart change, the difference remained non-significant for the above-mentioned outcomes. Overall survival in Group 1 and 2 was 92% and 96% at 1 month, 61% and 86% at 1 year and 52% and 80% at 2 years, respectively (p<0,001). LVEF<40% was associated with worse overall survival (p<0,001), as was moderate to severe valvular heart disease (p=0,004). Conclusion: Our study suggests that moderate to severe heart disease, detected in TTE, does not influence limb-related outcomes after revascularization procedures. However, patients with valvular heart disease or LVEF reduction have worse overall survival. We should not expect worse limb outcomes in patients with heart disease, but aggressive tertiary prevention should be provided to improve vital prognosis

ISQUEMIA AGUDA RENAL, UMA EMERGÊNCIA CIRÚRGICA VASCULAR COM EVOLUÇÃO AINDA DESCONHECIDA

Introdução: A incidência de isquemia aguda renal é baixa. A experiência publicada do seu tratamento cirúrgico resume-se a séries de casos e não há indicações bem definidas para a revascularização renal em caso de isquemia aguda. Métodos: Estudo observacional retrospetivo realizado com base na consulta de processos clínicos de doentes submetidos a revascularização de artéria renal por isquemia aguda renal, num hospital universitário terciário, de Janeiro de 2011 a Junho de 2020. O endpoint primário foi a taxa de diálise aos 30 dias e os endpoints secundários foram a taxa de doença renal crónica de novo aos 30 dias e a sobrevida aos 30 dias. Resultados:    Foram incluídos 11 doentes com isquemia aguda renal. As causas da oclusão arterial renal foram: disseção aórtica (N=3), trombose de artéria renal nativa (N=3), trombose de revascularização renal prévia (N=3), embolia (N=1) e trauma fechado (N=1). Dois dos casos corresponderam a doentes com rim único. A mediana de tempo desde o início do quadro até à revascularização cirúrgica foi de 24 horas. Dois doentes apresentavam doença renal crónica prévia conhecida. A apresentação clínica foi de dor lombar ou abdominal (n=8), HTA não controlada (N=5) e/ou oligoanúria (N=5). O diagnóstico foi realizado em todos com recurso a angio-TC. Em todos os doentes, a artéria renal principal estava afetada (N=9 desde o seu óstio) e havia algum grau de captação de contraste pelo rim afetado. Em todos os casos, foi realizada a revascularização unilateral de uma artéria renal com sucesso angiográfico, com exceção de um dos três casos em que a isquemia renal era bilateral, em que ambas as artérias renais ocluídas foram revascularizadas. Com exceção de um doente com oclusão de stent (submetido a angioplastia com DCB), todos foram submetidos a angioplastia com stent (6 com stents cobertos). Dois doentes apresentaram oligoanúria no pós-operatório e quatro necessitaram de pelo menos uma sessão dialítica. Aos 30 dias, a taxa de diálise foi de 11% (doente com isquemia aguda renal bilateral de etiologia traumática com 13 horas de evolução) e a taxa de doença renal crónica de novo de 22%. A sobrevida aos 30 dias foi de 90%.  Conclusão: Nesta população de doentes, pode-se verificar a reversão da isquemia aguda renal mesmo após oclusões prolongadas das artérias renais. No entanto, com os dados disponíveis, não é possível anteceder quais os doentes que recuperarão a função renal prévia após revascularização urgente com sucesso angiográfico. Por ser rápido e pouco invasivo, o tratamento endovascular é a primeira linha no tratamento cirúrgico da isquemia aguda renal na nossa instituição.

Simbióticos e monensina sódica no desempenho e na qualidade da carne de novilhas mestiças Angus confinadas

The objective of this work was to evaluate the effect of inclusion of synbiotics and sodic monensin on the performance, carcass characteristics, and meat quality of Angus crossbred heifers on feedlot. A completely randomized block design was carried out with 64 animals distributed in four treatments: control, a diet without supplementation; a diet supplemented with synbiotics; a diet with sodic monensin; and a diet with synbiotics and sodic monensin. The diet with sodic monensin and the diet with synbiotics and sodic monensin increased the average daily gain and total live weight gain, besides improving the feed and biological efficiency of animals compared to control treatment. The diet with synbiotics, with sodic monensin, and with synbiotics and sodic monensin decreased dry matter intake, and increased the rib fillet weight (noix) and the total lipid concentration in the meat. The diet with synbiotics facilitated the reduction of meat shear force compared to control treatment. The inclusion of synbiotics, with or without sodic monensin, in diet of Angus crossbred heifers, improves animal performance on feedlot and some physicochemical characteristics of meat.O objetivo deste trabalho foi avaliar o efeito da inclusão de simbióticos e de monensina sódica em dietas sobre o desempenho, as características de carcaça e a qualidade da carne de novilhas mestiças Angus em confinamento. Utilizou-se um delineamento inteiramente casualizado, com 64 animais distribuídos em quatro tratamentos: controle, dieta sem suplementação; dieta suplementada com simbióticos; dieta com monensina sódica; e dieta com simbióticos e monensina sódica. A dieta com monensina sódica e a dieta com simbióticos e monensina sódica proporcionaram maior ganho de peso médio diário e ganho de peso vivo total, além de melhorar a eficiência alimentar e biológica dos animais em comparação ao controle. A dieta de simbióticos, a de monensina e a de simbióticos com monensina sódica ocasionaram a redução da ingestão de matéria seca, elevaram o peso do filé da costela e os teores de lipídeos totais na carne. A dieta com simbióticos proporcionou a redução da força de cisalhamento da carne em relação ao controle. A inclusão de simbióticos, com ou sem monensina sódica, na dieta de novilhas mestiças Angus confinadas, beneficia o desempenho animal e algumas características físico‑químicas da carne