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Category: Ankle Arthritis; Ankle Introduction/ Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Ankle/ Hindfoot, Midfoot and 1st MTPJ arthritis. The aim of this study is to compare foot specific patient reported disability and quality of life satisfaction scores between patients presenting with arthritis of either the ankle/hindfoot, midfoot or 1st MTPJ. Methods: Patients who presented between 2020 and 2021 with a diagnosis of primary Osteoarthritis (OA) in either the ankle/hindfoot (AHA), midfoot (MA) or first MTPJ (MTPJA) were included in this study. Patients with associated foot problems, bilateral presentations, previous reconstructive surgery, or underlying neurological conditions were excluded. Differences in preoperative Patient Reported Outcome Measures (PROMs) including, MOX-FQ (Domains: Pain, Walking/Standing, Social activities), EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, sport, Recreation, Quality of Life) were analysed. Results: 94 patients (2020-2021) were included in this study (mean age 58.50). There were 45 patients with AHA, 21 with MA and 28 with MTPJA. The AHA group reported worse pain compared to the MTPJA group (p=0.03), and the MA group (p=0.004). AHA patients had more difficulty with Sports & Recreational Activities (p=0.029). Quality of Life scores was not significantly different between the groups. MTPJA patients had more difficulty with engaging in social activities compared the AHA patients (p=0.049). Conclusion: AHA patients suffer more pain that patients with arthritis in other areas of the foot. They appear to struggle with walking and standing and have difficulty participating in sports and recreational activities. Interestingly, MTPJA patients experience the most difficulty taking part in social activities. Patients with any type of foot or ankle arthritis experience similar difficulties with their mental health and their ability to carry out activities of daily living.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining popularity as a treatment option for end stage arthritis. We analysed whether the underlying pathology leading to the arthritis has any bearing on patient reported or clinical outcomes. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2010 by a single surgeon were reviewed. This included WOMAC score, SF-36 and patient satisfaction scores. Data was collected preoperatively and post- operatively at 1, 2, 5 and 10 year. The indications for TAR were obtained by review of clinical notes and radiographs and these included osteoarthritis (OA), inflammatory arthritis (IA), pilon fracture (PF), ankle fracture (AF), and post-traumatic arthritis without previous fracture (PTOA).PROMs were available for 156 TARs: 81 (51.9%, mean age 65.29) for OA, 28 (17.9%, mean age 65.29) for AF, 23 (14.7%, mean age 64.28) for IA, 11 (7%, mean age 55.01) for PF, and 13 (8.3%, mean age 51.08) for PTOA. Results: At 1 year WOMAC score showed significant worsening pain and stiffness on PTOA group (p=0.023, p=0.001) and worse general health and vitality for the IA group (p=0.0025, p=0.005). At 5 years The PTOA group showed significant worsening stiffness (p=0.048), social and emotional domains (p=0.004, P=0.029) and worsening pain, return recreational activities and surgery dissatisfaction (p < 0.05, p=0.032, p=0.023). At 10 years 50% of IA patients were unhappy with return to ADLs but no other difference were found between groups. There was a higher revision rate at 10 years in the PTOA group with 30.7% of patients being revised (4/13) compared to other groups (OA-6.17%, AF-3.57%, IA-4.35%, PF-9%) Conclusion: Similar outcomes in all groups were seen at 10 years but higher revision rates were present in PTOA group. In patients with PTOA careful consideration and counselling is needed prior to proceed with TAR.

Category: Other Introduction/Purpose: Steroid injection is a common treatment for Plantar fasciitis (PF) but has high recurrence rates. Platelet- rich plasma (PRP) injections have been used as an alternative treatment. Our aim was to review the effectiveness of PRP injection. Methods: All patients who underwent PRP injection for PF between 2015 and 2021 were included in this study. Clinical results and patient reported outcomes (MOX-FQ scores, EQ-5D and FAOS scores) were collected pre and post-operatively. Results: A total of 34 patients underwent PRP injection between 2015 and 2021 (mean age 34 years). There was a 71% PROMs response rate (80% female with, mean age 53). The mean duration of symptoms was 4 years and the median follow up time was 4.2 years. 77.1% were satisfied with overall outcomes of treatment with PRP injections (p < 0.05). 68.1% of patients reported satisfaction with pain relief. 74.6% were satisfied with return to activities of daily living. 72.6% were satisfied with return to recreational activities. 59% reported improvement in quality-of-life post treatment. 64% were happy to receive the same treatment again; 13.6% would not have the procedure again. 2 patients had severe pain within 2 weeks following the injection but symptoms settled. No other complications. Conclusion: PF is considered to be a self-limiting condition but can be debilitating whilst awaiting resolution of symptoms which can take upwards of 12 months to fully resolve. PRP injection provides effective pain relief for PF at 4 years follow up.

A pesquisa apresenta o itinerário de construção das principais perspectivas de avaliação de políticas públicas, enfatizando suas especificidades no processo de incorporação do debate político no Brasil, trazendo, por fim, a avaliação construtivista de 4ª geração como uma alternativa aos métodos hegemônicos, que se apresenta como uma ferramenta apta para investigar a realidade, tendo na participação social seu elemento fundante de investigação. Justifica-se na necessidade de se apresentar novos formatos do fazer avaliativo, a partir de um paradigma voltado à realidade do sujeito inserido dentro da política. A metodologia utilizada foi a indutiva, tendo como ênfase o método histórico descritivo e a pesquisa bibliográfica. Nas considerações finais, são apresentadas impressões acerca desse fazer avaliativo, relacionando sua relevância para a compreensão das realidades avaliadas.

There is a strong link between humans and the coastal zone, as it provides important services and resources. This paper aims to determine the existing environmental coastal research status in the Azores and Cabo Verde since research is essential for any decision support system. Some tools are fundamental to ensure the viability of the marine environments, such as Integrated Coastal Zone Management (ICZM), Marine Protected Areas (MPAs), and Marine Spatial Planning (MSP), which rely on existing knowledge. Effective implementation of marine plans can increase by developing a multi-perspective knowledge approach. This paper presents a systematic review of the archipelagos of the Azores and Cabo Verde through a comparative meta-analysis of the literature based on the PRISMA report to better understand the focus and status of research related to coastal zones, within and outside MPAs, along with marine spatial planning and management in the two socio-economic contexts. This will help to identify common issues, trends over the years, successes, and challenges, highlighting the specific interests of each country, identifying the knowledge gaps, promoting mutual learning, and pointing out possible paths for future convergence toward sustainable use of the ecosystems and conservation goals. Differences were found between the research made in both archipelagos, lacking research on important disciplines (reproduction, behavior, population dynamics, climate change, etc.), in Cabo Verde, compared to the Azores. This study also reveals that some research fields still need to be pushed forward to have broader knowledge in both areas.

Sharks are regularly considered to be an indicator of the ocean ecosystem’s health and are generally difficult to study in their natural environment. Citizen science has been increasing, being a cost-effective method for particularly important species that have low encounter rates or are logistically challenging to sample. Madeira Island has a considerable gap in terms of its coastal shark species data and studies, which this work aims to complement. To achieve this goal, online questionnaires to citizens and specific interviews of spearfishers were conducted, with questions related to species size, distribution, and behaviour. Exactly 129 reports of shark sightings were obtained, including seven different species exhibiting four different types of behaviour around the coastal areas of the different municipalities of Madeira Island. Individuals seem to aggregate around the east and west edges of the island due to localised upwelling phenomena. Also, a relation was found between size and distance to coast and depth, as smaller sharks tend to stay close to the shore, probably reflecting the role of Madeira as a nursery area, but further studies are necessary to confirm the reliability of this hypothesis.

RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.

Grapple skidder is a machine designed for the extraction of tree bunches after felling. Several factors influence its technical performance and costs such as terrain slope, operator experience time, machine type, and the size of tree bunches for each operating cycle, among others. Thus, it becomes necessary to weigh the variables that most influence the productivity and costs of the grapple skidder. So, the main objective was evaluated according to the influence of bunch size using two feller bunchers with distinct technical characteristics, two slope classes and two skidding areas on the productivity and machine production cost in a Eucalyptus plantation. For the analysis of the productivity, the study of time and method was applied and the scheduled machine cost per hour was based on the Food and Agriculture Organization of the United Nations methods. When analyzing the results, it was found that the operational elements moving without load (MWoL) and moving with load (MWL) were the ones that spend the most time in the operational cycle of the grapple skidder. Among the cost components, monetary expenditure on fuel and operator labor were the most influential in the scheduled machine cost per hour. In conclusion, the tree bunches and slope class influenced the productivity and, consequently, the cost of the skidding operation.

The processing of Eucalyptus logs is a stage that follows the full tree system in mechanized forest harvesting, commonly performed by grapple saw. Therefore, this activity presents some associated uncertainties, especially regarding technical and silvicultural factors that can affect productivity and production costs. To get around this problem, Monte Carlo simulation can be applied, or rather a technique that allows to measure the probabilities of values from factors that are under conditions of uncertainties, to which probability distributions are attributed. The objective of this study was to apply the Monte Carlo method for determining the probabilistic technical-economical coefficients of log processing using two different grapple saw models. Field data were obtained from an area of forest planted with Eucalyptus, located in the State of São Paulo, Brazil. For the technical analysis, the time study protocol was applied by the method of continuous reading of the operational cycle elements, which resulted in production. As for the estimated cost of programmed hour, the applied methods were recommended by the Food and Agriculture Organization of the United Nations. The incorporation of the uncertainties was carried out by applying the Monte Carlo simulation method, by which 100,000 random values were generated. The results showed that the crane empty movement is the operational element that most impacts the total time for processing the logs; the variables that most influence the productivity are specific to each grapple saw model; the difference of USD 0.04 m3 in production costs was observed between processors with gripping area of 0.58 m2 and 0.85 m2. The Monte Carlo method proved to be an applicable tool for mechanized wood harvesting for presenting a range of probability of occurrences for the operational elements and for the production cost.

Conhecer a tolerância das plantas cultivadas na região semiárida brasileira ao estresse salino, é de fundamental importância para a sustentabilidade da agricultura regional. Este trabalho objetivou avaliar o crescimento e produtividade de palma forrageira ‘Orelha de Elefante Mexicana’ (Opuntia stricta Haw), irrigada com níveis crescentes de salinidade da água (0,75; 3,0; 5,25; e 7,50 dS m-1 a 25 ºC) e cultivada sobre solos representativos da região semiárida brasileira (Luvissolo crômico, Planossolo nátrico e Neossolo flúvico). A massa verde total apresentou efeito linear decrescente havendo uma redução de 21,42 % ao comparar a massa verde média por planta do tratamento de menor nível com o tratamento de maior nível salino. Os solos Luvissolo crômico e Planossolo nátrico apresentaram as melhores produtividades de massa verde e massa seca nas condições deste experimento.

Cadmium (Cd) is a highly toxic heavy metal particularly susceptible to mobilization by anthropogenic and natural processes. The volcanic nature of oceanic islands in the Macaronesia geographical region such as the Azores archipelago, located near the Mid-Atlantic Ridge, is reflected in deep-sea and shallow-water hydrothermal activities that release heavy metals such as Cd to seawater, affecting marine organisms and integrating food webs. In this paper, a thorough systematic review of all studies performed on coastal marine species in Macaronesia focusing on Cd was conducted, specifically considering the Azorean geological setting and socioeconomic context. Present results are compared and discussed with data from the Mediterranean, a region with apparent strong anthropogenic pollution. The Azorean marine species seem to be particularly strong Cd accumulators, displaying high levels that should be closely monitored, reflecting an important local natural source that should not be underestimated; especially considering the high consumption rates of some of these organisms, which may lead to a potential seafood safety issue. In light of these findings, the potential effects, impacts, and future research challenges are discussed, from an ecological and public health perspective.

Machinery traffic and animal trampling can deform the soil and, consequently, impair soil pore functioning. This study aimed to evaluate how soil structure affects the compressibility, physical properties and air permeability of a Typic Paleudalf under forest, pasture and eucalyptus. Soil samples with preserved structure were used to determine soil physical (bulk density, porosity, degree of water saturation at 33 kPa-tension, air permeability) and mechanical properties (soil deformation, precompression stress, compressibility index). After these evaluations, each soil sample was fragmented, sieved, and the metal rings filled with structureless soil, and underwent the same determinations as the samples with preserved structure. For loads greater than the precompression stress (load greater than 200 kPa), soil with non-preserved structure had the largest deformation. An increase in bulk density decreased macropores linearly (R2 = 0.77 and 0.87, respectively, to preserved and non-preserved soil structure) and air flow exponentially. The soil with preserved structure was less susceptible to further compaction. Air flow was greatest in soils with lower bulk density, microporosity and water saturation degree, and a high volume of macropores. Soil structure (preserved and non-preserved) had more significative differences in microporosity, compressibility index, soil deformation, and bulk density at the end of the compression test.

Nocardiosis is a rare opportunistic infection caused by the bacteria Nocardia spp. It may presents as a localized cutaneous infection or as an invasive infection (pulmonary, central nervous system or disseminated). The authors describe a 65-years-old woman, without a known cause of immunosuppression, admitted with fever, respiratory and constitutional symptoms. After an exhaustive etiological study, it was diagnosed a disseminated nocardiosis (pulmonary and central nervous system), in a probable context of immunosuppression secondary to a previously undiagnosed systemic lupus erythematosus. Nocardiosis is a serious infection with a variable and non-specific presentation making its diagnosis a challenge.

A determinação da vida econômica de máquinas empregadas na colheita de madeira, ou o momento em que a máquina executou suas funções com o menor custo operacional, está associada à obtenção do menor custo de produção. Assim, objetivou-se determinar a vida econômica de máquinas autopropelidas que compõem um módulo de colheita mecanizada de madeira com incertezas associadas. Foram considerados os custos operacionais incorridos no período de cinco anos, para o ajuste de modelos matemáticos que associaram os intervalos de incertezas e permitiram atribuir distribuições de probabilidades. Posteriormente, números pseudoaleatórios foram gerados, por meio da simulação de Monte Carlo, para determinação das probabilidades dos valores econômicos estocásticos. Os resultados evidenciaram que o momento ótimo para a substituição do conjunto de máquinas que compõem o módulo de colheita mecanizada de madeira ocorre no ano 4 da vida útil destas máquinas. Outrossim, o custo uniforme equivalente do módulo de colheita aumenta 18,3% no ano subsequente ao momento ótimo de substituição, aditando os custos de colheita e processamento da madeira. Por fim, os elementos de custos que mais influenciam a determinação da vida econômica das máquinas são os custos de reposição de peças e de reparos e manutenções.

A atuação do Estado brasileiro na busca por um desenvolvimento econômico atrelado ao mercado globalizado vem gerando transformações no espaço ambiental e cultural dos territórios ocupados por comunidades tradicionais. Isso ocorre através da implementação de políticas públicas que incentivam o deslocamento de grandes conglomerados industriais da zona urbana para áreas de uso tradicional, remodelando a dinâmica das populações afetadas. Este artigo tem como objetivo discutir como a intervenção do Estado, através de efetivação de políticas públicas desenvolvimentistas, em territórios ocupados por populações tradicionais, pode gerar conflitos entre os propósitos da política e os interesses dessas comunidades. Para tanto, utilizou-se como estudo de caso a Resex da Prainha do Canto Verde/CE, devido à existência de parque eólico próximo ao seu território. Metodologicamente, as informações são provenientes de pesquisa bibliográfica, documental e através de dados coletados por meio de entrevistas, tendo sido utilizado a análise de conteúdo para tratamento desse material. Seu propósito, portanto, conduz a uma reflexão acerca da participação do Estado brasileiro no processo de geração de conflitos nas comunidades tradicionais, motivados por aspectos econômicos e que alteram o significado dos valores e do patrimônio coletivo das comunidades tradicionais.

O coentro (Coriandrum sativum L.) é uma olerícola que necessita de deposição de nutrientes, visto que os pré-existentes no solo são insuficientes para impulsionar o crescimento da mesma. Nesse contexto, objetivou-se, com este trabalho, avaliar a eficiência da adubação orgânica com esterco caprino no cultivo do coentro. O experimento foi realizado em casa de vegetação da Universidade Federal de Alagoas - Campus de Arapiraca. O delineamento experimental foi em cinco blocos ao acaso, com cinco tratamentos, que consistiram na adubação orgânica com esterco caprino associado ao solo em diferentes proporções: T1 = 20%; T2 = 40%; T3 = 60%; T4 = 80%; T5 = 0% da proporção solo/esterco. As variáveis analisadas foram altura de planta, comprimento de raizes, fitomassa fresca total, fitomassa seca da parte aérea, fitomassa seca de raízes, fitomassa seca total, relação raiz/parte aérea, taxa de crescimento absoluto e taxa de crescimento relativo em altura de planta. A adição de 60% de esterco caprino no substrato promove resultados positivos na maioria das variáveis investigadas, tendo prevalecido uma significância da ordem de 78% das variáveis investigadas. A proporção de 60% esterco caprino e 40% de solo é a mais indicada para obtenção de plantas de coentro de melhor qualidade.

O surgimento do vírus da síndrome respiratória aguda grave – coronavírus 2, responsável pela doença COVID-19, conduziu a um rápido desenvolvimento de métodos moleculares e serológicos para o seu diagnóstico. Apesar de o teste molecular de amostras do trato respiratório ser o teste de diagnóstico standard, verifica-se um interesse crescente pelo uso de exames serológicos, mas existe, ainda, evidência limitada sobre os mesmos. Os autores apresentam dois casos clínicos em que traduzem algumas das vantagens da utilização do teste serológico como complementar no diagnóstico da infeção pelo vírus da síndrome respiratória aguda grave – coronavírus 2, nomeadamente nos casos ativos de COVID-19, que apresentam teste molecular inicial negativo.

With the innovations of mechanized harvesting in Brazil, become necessary studies to obtain real data on the new machines that are emerging in the market. The study aimed to the technical evaluation and cost a forest delimber on trees with different times storage in the field, and verify possible correlations among wood moisture, productivity and cost of production. For the technical analysis was conducted a study of time and motion by timing method of continuous time and for the cost analysis, we calculated operating costs through the method proposed by ASABE. Approximately 40 days in the field trees reached the equilibrium moisture content, the moisture has demonstrated no correlation of content with the performance of the machine, which was on average 643.34 m3/h, and not with the cost of production, and, the operating cost of R$ 180.04 / hour, and the production cost average R$ 0.28 / m3.

The operational productivity and costs of tree felling operations can be influenced by several factors, among which, the machine characteristics, slope class, the cutting area and the individual volume of the trees stand out. Thus, the main objective of the present study was to analyze the productivity and production cost for two feller-bunchers with different technical characteristics operating in a eucalyptus forest. The productivity was calculated from a time study and the factors analyzed were two feller-buncher models, two slope classes, and two cutting areas. The machine cost per scheduled hour was based on the methodology of the Food and Agriculture Organization of the United Nations. Analysis of the results showed that the felling and turn operational elements occupied the most time in the operational cycle of feller-bunchers. The machine cost per scheduled hour was USD 69.69 h−1 for feller-buncher 1 and USD 102.03 h−1 for feller-buncher 2. In conclusion, the distinct technical characteristics of feller-bunchers were found to influence the productivity and, consequently, the cost, of the felling operation during the harvesting of whole eucalyptus trees.

Os custos da colheita florestal, de forma abrangente, podem ser definidos como a quantificação econômica dos fatores produtivos, determinados em sua maioria pelo modal utilizado. Todavia, um elemento presente no conhecimento dos custos desses modais é a incerteza nas estimativas, devido ao conjunto de fatores envolvidos ou da insuficiência de informações. À vista disso, objetivou-se neste estudo construir um modelo estocástico, a partir da produtividade operacional de um trator florestal skidder empregado na extração de Eucalyptus sp., para quantificar os riscos técnico-econômicos por meio da simulação de Monte Carlo. A análise técnico-econômica teve como premissa o estudo de tempos e métodos, seguida da estimativa do custo horário do trator florestal skidder e do custo da extração de madeira. Os resultados permitiram quantificar os riscos do custo da extração de madeira, além de determinar que o dispêndio com combustível é o que mais onera essa operação florestal.

Resumo A síndrome de Wunderlich é uma doença rara que se caracteriza por hemorragia espontânea nos espaços subcapsular e perirrenal. Apresentamos dois casos de síndrome de Wunderlich. Uma mulher de 38 anos com esclerose tuberosa que se apresentou com dor abdominal e hipotensão. A tomografia computadorizada (TC) revelou um hematoma peri-renal. Uma mulher de 86 anos, anticoagulada com varfarina por tromboembolismo pulmonar, apresentou-se com dor abdominal nos quadrantes inferiores. A TC abdominal revelou uma massa renal com hemorragia no espaço peri-renal. Foram ambas submetidas a embolização super-seletiva da artéria renal, com boa evolução posterior. Abstract Wunderlich syndrome is a rare disease characterized by spontaneous renal hemorrhage into the subcapsular and perirenal spaces. We report two cases of Wunderlich syndrome. A 38-year-old woman with tuberous sclerosis presented with abdominal pain and hypotension, perinephric hematoma was diagnosed by computerized tomography (CT) scan. A 86-year-old woman, treated with warfarin for pulmonary embolism, presented with abdominal pain in the lower quadrants. Abdominal CT scan revealed a renal mass with recent hemorrhage to perinephric space. Renal artery highly selective embolization was performed with good outcome in both cases.

Using the basic principle of construction between a hydrogen bond acceptor (HBA) and a hydrogen bond donor (HBD), four bio-based deep eutectic solvents (DESs) were prepared in a 1:2 molar ratio of HBA:HBD. 2,3-Dihydroxypropyl-1-triethylammonium chloride ([C9H22N+O2]Cl−) was synthesized from raw glycerol and used as an HBA. Lactic acid, urea, pure glycerol, and ethylene glycol were selected as HBD. Attempts to prepare DESs, using citric acid and benzoic acid as HBDs, were unsuccessful. All these DESs were characterized using FTIR and NMR techniques. Besides, physicochemical parameters such as pH, viscosity, density, and melting point were determined. The behavior of these DES to fractionate olive pomace was studied. Lignin recovery yields spanned between 27% and 39% (w/w) of the available lignin in olive pomace. The best DES, in terms of lignin yield ([C9H22N+O2]Cl− -lactic acid), was selected to perform a scale-up lignin extraction using 40 g of olive pomace. Lignin recovery on the multigram scale was similar to the mg scale (38% w/w). Similarly, for the holocellulose-rich fractions, recovery yields were 34% and 45% for mg and multi-gram scale, respectively. Finally, this DES was used to fractionate four fruit pruning samples. These results show that our novel DESs are alternative approaches to the ionic liquid:triethylammonium hydrogen sulfate and the widely used DES: choline chloride:lactic acid (1:10 molar ratio) for biomass processing.

Category: Basic Sciences/Biologics Introduction/Purpose: Exogen low-intensity pulsed ultrasound therapy is well established in the management of fracture delayed or non-union. Its use in trauma has recently been recommended by the National Institute for Clinical Excellence in England. In comparison the use of Exogen for managing delayed union following elective foot and ankle surgery has not previously been reported in the literature. We aim to review the indications for and outcomes following Exogen therapy for managing delayed union following elective foot and ankle surgery in our English tertiary referral centre. Methods: Case notes and imaging were reviewed for all patients receiving Exogen therapy following elective foot and ankle surgery from July 2012 - July 2017 in our centre. Data were collected on patient demographics, smoking status, comorbidities, indications for and type of surgery performed, duration of Exogen therapy and final outcomes. Union was confirmed radiologically and clinically. Results: 58 patients were included, 18 smokers and 8 diabetic. The mean age was 55 years. 50 underwent an arthrodesis, 8 an osteotomy. Exogen was started a mean of 244-days post-operatively. 24 patients went on to complete union; a further 7 were showing good progress towards union. When grouped together the union rate was 53.4% (n=31). Complete union took a mean of 177-days (range 44–441). The non-union rate was 46.6% (n=27) despite a mean of 330-days treatment (range 72–1112). 1 was complicated by infection. There were no significant differences in age, time to commencing Exogen, number of smokers or diabetics between the groups. The non-union group had significantly longer treatment (p=0.003). Union was more likely following an osteotomy (n=6/8,75%) or surgery to the hindfoot (n=6/7,86%). Conclusion: We have found Exogen can be beneficial in managing delayed union following elective foot and ankle surgery for over half of patients. This can potentially reduce the number of revision surgeries required. We found no correlation between patient age, smoking or diabetes in outcome. Union was more likely following a corrective osteotomy or surgery to the hindfoot. This data can help inform clinicians in their decision-making and in counselling patients.

Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. Early recognition of micro or macronutrient deficiencies is essential, because the use of nutritional supplements reduces the risk of complications. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. Treatment management should aim to maintain an adequate protein and caloric intake and to correct nutrient deficiencies. The large majority of patients with grade I/II hepatic encephalopathy can tolerate a regular diet. Protein restriction can aggravate malnutrition and is not recommended, except in cases of hepatic encephalopathy unresponsive to optimized therapy.

Category: Ankle, Sports, Trauma Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. The aim of this study was to specifically analyse the reliability of MRI reported lateral ligament findings in relation to examination under anaesthesia and stress X-rays in patients with symptomatic ankle instability. Methods: A single centre, single surgeon consecutive series of patients who had undergone examination under anaesthesia and stress X-rays preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and procedure findings were extracted and analysed. Results: Between April 2012 and December 2016, 49 patients who fulfilled the above criteria were included. There were 25 male and 24 female patients, the average age was 43.1. The average time interval between MRI scan and examination under anaesthesia was 9.7 months (2-49 months). There is a significant association between MRI reported lateral ligament findings and status of ankle stability detected on examination under anaesthesia and stress views, p=0.003 (Chi-square analysis for association). In 34 patients who had abnormal lateral ligament findings on MRI, 20 patients (58.8%) had stable findings and 14 (41.2%) had unstable findings on stress views. There was, however, a 100% concordance between MRI reported normal lateral ligament findings and stability on examination under anaesthesia and stress views (N=15). Conclusion: MRI is accurate in diagnosing the status of ankle ligaments and in particular, in predicting true stability.

Category: Lesser Toes, Morton’s neuroma Introduction/Purpose: Background: Morton’s neuromata are a common cause of forefoot pain. Surgical excision of the neuroma is expected to result in loss of sensation, however in the author’s experience post-operative sensation can be incongruent with the expected cutaneous innervation of the excised nerve. There is a lack of literature regarding this observed discrepancy. The purpose of this study was to carry out sensory mapping in post excision patients. Methods: Methods: Data was collated from the consecutive case series of a single surgeon from 2013-2015 resulting in a total of 19 respondents (23 excisions). All patients were a minimum of 7 months post-excision (average=23 months). Each toe was divided into 13 anatomical segments (total 65). Sensation was assessed using a 10 g monofilament and results were recorded on a sensory map. Results: 19 excisions were done from the 3 rd intermetatarsal space (group A) and 4 from the 2nd intermetatarsal space (group B). The range of patients from group A affected by complete sensory loss within any individual segment varied from 5.3%-47.4%. In the lesser toes (2, 3, 4 and 5), at least 10% of patients described decreased or absent sensation in =7/13 segments in each of all the lesser toes. Over 36.9% of patients reported decreased or absent sensation involving =7/13 segments in each the 3 rd and 4th toes. The percentage of patients who reported unaltered sensation ranged from 21.1%-100% across all 65 segments. Group B followed a similar pattern but had a much smaller cohort of patients. Conclusion: The results of the sensory mapping indicate an unexpected pattern of loss and preservation of sensation when considering the perceived knowledge of the cutaneous innervation of the forefoot. Further research is required to evaluate this intriguing pattern of innervation. A greater understanding would be useful in better informing our patients during the consent process.

Category: Ankle, Arthroscopy Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. Musculoskeletal radiologists aim to determine and report both chondral and/or osseous stability/instability of each lesion. The aim of this study was to specifically analyse the reliability of MRI reported findings in predicting the stability of OCL’s in symptomatic patients. Methods: A single centre, single surgeon consecutive series of patients who had undergone an ankle arthroscopy procedure preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and arthroscopic findings were extracted and analysed. Arthroscopy findings were taken as the gold standard. Results: Between April 2012 and July 2016, 48 patients who fulfilled the criteria were included. There were 27 male and 21 female patients, the average age was 43.4. Average time interval between MRI and arthroscopy was 9 months. There was a significant negative relationship between OCL’s reported as stable on MRI to arthroscopic findings, r=-.31, p=0.03. Of the 21 patients who had OCL’s reported as stable on the MRI, all had unstable lesions on arthroscopic evaluation (100%). One patient had an unstable OCL reported on the MRI and it was also unstable arthroscopically. In 27 patients, there was no mention of the stability of the reported OCL on the MRI, 22 patients (81.5%) had unstable lesions and 5 patients (18.5%) had stable lesions on arthroscopic findings. Conclusion: This study demonstrates that MRI has a poor predictive value for the stability of OCL’s of the ankle. Therefore we recommend that in the symptomatic patient an arthroscopy is indicated irrespective of MRI findings.

http://dx.doi.org/10.5902/1980509815742A racionalização da colheita florestal e a minimização dos custos é uma busca constante por parte dos gestores envolvidos nesse processo, competindo a esses deliberar práticas economicamente viáveis para otimizar essa operação. O objetivo deste estudo foi avaliar técnica e economicamente a produtividade do feller-buncher e do processador florestal em povoamento de eucalipto em primeiro corte. A análise técnica englobou um estudo de tempos e movimentos, produtividade, eficiência operacional e disponibilidade mecânica. A análise econômica englobou os parâmetros do custo operacional, custo de colheita florestal e rendimento energético. Visando à otimização do custo de colheita florestal, o sistema composto pelo feller-buncher e processador florestal apresenta-se como uma alternativa viável tecnicamente e economicamente para a colheita em povoamentos de eucalipto de primeiro corte ou para povoamentos que não possuam árvores bifurcadas.

The main interest of this research is to contribute to the development and understanding of supramolecular chemistry and molecular architectures, which are constructed by the self-assembly of supramolecular entities. Therefore, the synthesis and characterization (IR, UV, 1H NMR, 31P, 19F, 1H-1H COSY) of a nickel (II) supramolecular square [7] was performed through the synthesis between nickel chloride [1] and diphenylphosphinoethane (dppe) [2] to form the precursor complex [Ni(dppe)Cl2] [3]. This was followed by the synthesis of the complex of interest, [Ni(dppe)(TOF)2] [5], using the precursor and silver trifluoromethanesulfonate (Ag-TOF). Finally, the self-assembly was performed between the complex [1,2-bis(diphenylphosphinoethane)bistriflatonickel(II)] [Ni(dppe)(OSO2CF3)2] [5] and the organic ligand 4,4'-bipyridine [6], which act as vertex and edge, respectively.According to various analyses, it was found that the self-assembly generated only one supramolecular species; a square is the most probable thermodynamic structure.

A mecanização da colheita de madeira permite maior controle dos custos e pode proporcionar reduções em prazos relativamente curtos. Além disso, tem um lugar de destaque na humanização do trabalho florestal e no aumento do rendimento operacional. O presente trabalho teve por objetivo avaliar o desempenho de operadores de harvester em função do tempo de experiência na atividade. Foram avaliados oito operadores do sexo masculino, com idade entre 23 e 46 anos. O estudo consistiu na análise do volume de madeira colhida pelo harvester. O tempo de experiência afeta significativamente o rendimento operacional dos operadores de harvester. Tal rendimento aumenta expressivamente nos primeiros 18 meses de experiência, mantendo-se em ascensão nos próximos 26 meses. Após os 44 meses de experiência, o rendimento dos operadores tende a reduzir, revelando as possíveis acomodações do cotidiano. Tais resultados permitem concluir que por volta dos 50 meses de experiência na atividade de operação de harvester, se faz necessária a adoção de medidas de reciclagem, motivação, entre outras, a fim de proporcionar aos operadores melhores condições de trabalho que os possibilitem continuar exercendo a atividade de forma eficiente e rentável à empresa.

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature relating to information needs of patients in Orthopaedic Surgery, despite the fact that Orthopaedic Surgeons in the UK welcome the use of patient decision aids for joint replacement surgery. This multi- centre study aimed to study the information needs of patients for surgical treatment of ankle arthritis from 6 different hospitals across the North East region of England. Methods: Ethical permissions were obtained for this multi-centre qualitative research study. The study recruited 18 patients from 6 hospitals across the North East of England. They were invited to take part in patient focus group meetings. 3 focus groups were conducted with 4-8 patients/ group. These groups were facilitated by independent researchers using a semi-structured discussion approach. Patients were asked for their views on information needs for surgical treatment of ankle arthritis. The focus group meetings were digitally recorded and transcribed verbatim. Data was analysed using the nVIVO software with framework analysis. Results: The analysis highlighted 4 main themes: A) Factors influencing surgical decision making B) Information needs of patients C) Information provision and D) Patient expectations. Theme B is discussed in detail for this abstract. Primary information needs requested by over 70% of patients were: 1. Desire to meet with patients who had undergone similar surgical procedure 2. Information on post-operative rehabilitation 3. Information on return to work and driving 4. Experience of consultant team 5. Written information regarding procedures (advantages, disadvantages, survivorship and outcomes) and 6. Personalized decision support based on individual patient’s lifestyle and preferences. These components form the Preoperative/information ‘6 pack’. Conclusion: When developing information materials and decision tools for patients, providing them with the Ankle Arthritis ‘6 pack’ will enable them to make a more informed choice of the surgical options offered by the consultant.

Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Diagnosis, risk stratification and monitoring are usually based on clinical and echocardiographic parameters. Complementary methods are needed to improve management and outcome, particularly in patients with severe asymptomatic AS, whose management remains controversial. Natriuretic peptides (NPs) have established value as biomarkers in heart failure, coronary heart disease and pulmonary hypertension. This review discusses the usefulness and prognostic value of natriuretic peptides in AS. B-type natriuretic peptide (BNP) and its prohormone (NT-proBNP) correlate with disease severity, development of symptoms and prognosis, but before they can be routinely used in clinical practice, additional prospective studies are needed. Resumo: A estenose aórtica (EA) é a doença valvular mais prevalente em países desenvolvidos. O diagnóstico, a estratificação do risco e a monitorização são habitualmente baseados em parâmetros clínicos e ecocardiográficos. São necessários métodos complementares para melhorar a gestão e os resultados, particularmente nos doentes com EA grave assintomática, cuja abordagem permanece controversa. Os peptídeos natriuréticos (PN) demonstraram utilidade como biomarcadores na insuficiência cardíaca, cardiopatia isquémica e hipertensão pulmonar. Esta revisão pretende discutir a utilidade e valor prognóstico dos PN na AS. O Peptídeo natriurético do tipo B (BNP) e a sua prohormona (NT-proBNP) correlacionam-se com a gravidade da doença, desenvolvimento de sintomas e prognóstico, mas antes do seu uso por rotina na prática clínica, são necessários estudos prospetivos adicionais. Keywords: Aortic stenosis, Natriuretic peptides, BNP, NT-proBNP, Palavras-chave: Estenose aortica, Peptideos natriuréticos, BNP, NT-proBNP

O processo constante de avaliação técnica e econômica dos sistemas de colheita de madeira é intrínseco às empresas florestais, devido ao fato de corresponder a uma fase de suma importância que despende elevado investimento financeiro. No experimento deste trabalho, estudaram-se o rendimento operacional e custos operacionais e de produção do processador florestal Hypro. A análise técnica englobou estudos de tempos e movimentos pelo método de tempo contínuo. O rendimento operacional foi determinado através do volume, em metros cúbicos de madeira processada. A análise econômica incorporou os parâmetros do custo operacional, custo de processamento da madeira e rendimento energético. A análise dos dados evidenciou que o rendimento operacional por hora efetiva de trabalho foi de 38 árvores e, em metros cúbicos sem casca por hora efetiva de trabalho, de 11,68 m³ h-1, com custo de processamento de madeira sem casca de US$ 6.85 por metro cúbico.

A salinidade da água e do solo afeta o crescimento, o desenvolvimento e a produção de espécies frutíferas, dentre as quais os citros. O uso de porta-enxertos tolerantes pode garantir a sustentabilidade do agronegócio citrícola em tais condições. Assim, estudou-se a sensibilidade à salinidade durante a fase de formação de portaenxertoscompreendendo variedades e híbridos selecionados. O experimento foirealizado em casa-de-vegetação, considerando cinco níveis de salinidade da água de irrigação [testemunha, irrigação com água de abastecimento local, condutividade elétrica da água (CEa) de 0,41 dS m-1 e água com CEa de 1,0; 2,0; 3,0 e 4,0 dS m-1] e sete genótipos, utilizando delineamento em blocos casualizados, com cinco repetiçõesem esquema fatorial e quatro plantas úteis por parcela, durante o período de 150 dias. Avaliaram-se variáveis de crescimento e fisiológicas. A redução mais expressiva foi observada na fitomassa seca total da parte aérea com aumento unitário da CEa. Observou-se redução linear no crescimento com aumento da salinidade nos híbridosLVK x LVA-009 e TSK x TRENG-256. Dentre os genótipos avaliados, o limoeiro ‘Volkameriano’ foi o menos sensível ao estresse salino.Water and soil salinity affects the growth, development and production of fructiferous species, such as citrus. The use of tolerant rootstocks can guarantee the agribusiness of citrus under such conditions. Thus, the sensibility to salinity during the phase of rootstock formation of varieties and selected hybrids was studied. The experiment was carried out in a greenhouse, with five levels of irrigation water salinity [control, tap water with electrical conductivity (ECw) of 0.41 dS m-1, and water with ECw of 1.0, 2.0, 3.0 and 4.0 dS m-1] and seven genotypes, in a randomized block designand five replications each consisting of four plants, during 150 day period. Growth and physiologic variables were evaluated. Significant effects of genotypes and salinity in the variables were observed. The most expressive reduction was found for total dry matter with unit increase of ECw. A linear reduction was observed in hybrids LVK x LVA-009 and TSK x TRENG-256. Among the evaluated genotypes ‘Volkamer’ lemon was the least sensitive to saline stress.

This study aimed to technically and economically evaluate the Feller-buncher in different conditions of harvest in eucalyptus forests of second cut. The technical analysis included a study of time and movements by the method of continuous time, and operational performance was determined by volume in cubic meters of harvested wood. The economic analysis included the parameters of operational cost, harvest cost and energy consumption. The analysis of the data showed that the composition of main line harvesting and the arrangement of bundles of trees influenced operational performance. The average operational cost was US$ 86.26 per hour of actual work, which resulted in an average cost of forest harvesting of US$ 1.09 m-³.

This study aimed to technically and economically evaluate the Feller-buncher in different conditions of harvest in eucalypt forests of second cut. The technical analysis included a study of time and movements by the method of continuous time, and operational performance was determined by volume in cubic meters of harvested wood. The economic analysis included the parameters of operational cost, harvest cost and energy consumption. The analysis of the data showed that the composition of main line harvesting and the arrangement of bundles of trees influenced operational performance. The average operational cost was US$ 86.26 per hour of actual work, which resulted in an average cost of forest harvesting of US$ 1.09 m-³.

The cashew production is one of the most important agricultural activities from the social-economical viewpoint for the North East of Brazil; besides to produce a great deal of hand labor, it is very important as an exporting commodity. The inadequate use of irrigation in the semi arid regions of the North East of Brazil has induced soil salinization and consequently problems for the irrigated agriculture. In spite of this, few works have been conducted to study the effect of saline stress on the growth and development of the cashew. Because of the lack of information for this crop, an experiment was conducted to study the effect of salinity stress on the phytomass production and nutrient accumulation on the different organs of the precocious dwarf cashew (Anacardium occidentale L.) clone CCP76. The study was conducted under controlled conditions using as statistical scheme a randomized block design factorial with six replicates. Five salinity treatments were considered for the irrigation water (electrical conductivities of 0.8, 1.6, 2.4, 3.2 and 4.0 dS m-1 at 25oC). The increasing in salinity of the irrigation water reduced the phytomass at different organs of the studied plant. The nitrogen, phosphorus, potassium, chloride and sodium in the plant varied with the salinity of the irrigation water according with the part of the plant analyzed; in some parts increased, in others decreased, in others increased initially and decreased afterwards, and finally, in other part of the plant the salinity of the irrigation water did not affect the nutrient concentration.

Este trabalho objetivou avaliar o desempenho de um trator florestal "feller-buncher" Prentice Blount (modelo Hydro AX-611E) na colheita de madeira de um povoamento de Eucalyptus saligna Smith, de seis anos, durante as operações de corte, amontoamento, derrubada direcionada e rebaixamento de tocos. A metodologia baseou-se na determinação de tempos e movimentos de máquina em operação de colheita comercial e a respectiva produção de madeira sob a forma de árvores inteiras, utilizando-se a técnica de amostragem rápida. Os resultados indicam que o ciclo operacional completo de colheita de madeira atingiu a média de 60,02 +/- 13,11 segundos, com a produção respectiva de 4,41 +/- 0,90 fustes. Não houve correspondência funcional entre o tempo operacional efetivo do ciclo de operações de colheita e o número de árvores colhidas. Esse resultado demonstra que vários fatores associados atuaram no processo de colheita, como as condições da área de trabalho, povoamento florestal, máquina florestal e operador.

A disponibilidade hídrica total do Brasil, apesar de confortável, não é homogênea quanto à distribuição, pois existem problemas localizados na região semi-árida do nordeste. Nesse contexto, a região nordeste do Brasil é a que mais sofre com a má distribuição hídrica, tornando-se imprescindível a preservação deste recurso de grande relevância para população. Objetivou-se com o presente estudo avaliar e caracterizar os recursos hídricos através de analises na qualidade de água para fins de irrigação nos perímetros irrigados no município de Arapiraca da região Agreste do Estado de Alagoas. O levantamento foi realizado na Barragem das Bananeiras e nas comunidades que compõem o projeto Cinturão Verde, no município de Arapiraca. Inicialmente foram entrevistados 30 produtores com questionário pré definido, em quatro comunidades para conhecimento das práticas de manejo utilizado pelos produtores locais. Em seguida foram coletadas amostras de água de poços tabulares, cacimbas e barragens para determinação da CE, pH, Dureza total, Cálcio . Os dados foram tabulados por localidade, proporcionando com isto a classificação das águas nos poços e localidades estudadas, o que definirá a recomendação para o correto uso das águas e a tolerância das culturas ao conteúdo total de sais dissolvidos.

Kaposi’s sarcoma (KS) is a malignant vascular tumor, caused by the human herpesvirus 8. It is one of the commonest tumors in human immunodeficiency virus (HIV) patients and not uncommonly the first manifestation of acquired immunodeficiency syndrome (AIDS). Case. We present a case of an isolated bulbar conjunctival KS on a 43-year-old HIV positive male, with no other lesions. Excision and cryotherapy were performed, and the patient remains free of lesions to date. Conclusion. Isolated bulbar conjunctival KP is an unusual site for its initial presentation and must be kept in mind in HIV positive patients.

The uncertainty in road transportation of wood is inherent to its operational costs, to the amount of transported wood, to the traveled distance, to its revenue, and more. Although it is not possible to measure this uncertainty fully, it can be quantified by the investment risk, which is the probability and degree of financial loss. The objective of this study is to quantify the financial risk of the investment in wood transportation through Monte Carlo simulation, which uses realistic situations to estimate the operational cost of vehicles used for road transportation of wood. We quantify these uncertainties by assessing financial risk and building pseudorandom scenarios with the Monte Carlo simulation method, in addition to the Net Present Value techniques, the Modified Internal Rate of Return, and the Profitability Index, all commonly used in financial investment projects. The results show that the estimated operational costs are equivalent to the actual ones, along with the evidence that the cost of fuel, the driver’s manpower, and tires are components that mainly increase the degree of financial risk for an investment project in road transportation of wood. In contrast, optimizing the amount of transported wood and maximizing wood transportation cost have a significant and positive correlation with the volume of transported wood and the average price of wood transportation, leading to a reduction in the degree of financial risk.

O conhecimento do desempenho operacional de uma máquina agrícola tornou-se uma preocupação crescente e de suma importância, pois com o advento da mecanização, os custos de produção foram influenciados diretamente pela eficiência da máquina no campo. Este estudo teve como objetivo avaliar o desempenho operacional e econômico do trator agrícola na operação de subsolagem em função da declividade. A análise técnica englobou um estudo de tempos e movimentos e a análise econômica os parâmetros do custo operacional, custo de produção e rendimento energético. Dentro das classes de declividade avaliadas, foi comprovado que com o aumento do percentual de inclinação do relevo, menor é o desempenho operacional e maior o custo de produção. O item combustível é o principal componente dentre os demais que compõem o custo operacional da maquinaria agrícola durante a operação de subsolagem, impactando diretamente os custos finais de produção.

A salinidade da água e do solo afeta o crescimento, o desenvolvimento e a produção de espécies frutíferas, dentre as quais os citros. O uso de porta-enxertos tolerantes pode garantir a sustentabilidade do agronegócio citrícola em tais condições. Assim, estudou-se a sensibilidade à salinidade durante a fase de formação de porta-enxertos compreendendo variedades e híbridos selecionados. O experimento foi realizado em casa-de-vegetação, considerando cinco níveis de salinidade da água de irrigação [testemunha, irrigação com água de abastecimento local, condutividade elétrica da água (CEa) de 0,41 dS m-1 e água com CEa de 1,0; 2,0; 3,0 e 4,0 dS m-1] e sete genótipos, utilizando delineamento em blocos casualizados, com cinco repetições em esquema fatorial e quatro plantas úteis por parcela, durante o período de 150 dias. Avaliaram-se variáveis de crescimento e fisiológicas. A redução mais expressiva foi observada na fitomassa seca total da parte aérea com aumento unitário da CEa. Observou-se redução linear no crescimento com aumento da salinidade nos híbridos LVK x LVA-009 e TSK x TRENG-256. Dentre os genótipos avaliados, o limoeiro ‘Volkameriano’ foi o menos sensível ao estresse salino.

Os AA. referem um caso de blastoma primitivo do estômago, mostrando a par das estruturas de adenoma destruens e de adenocarcinoma, a de carcinoma epidermoide. O tumor corresponde ao tipo descrito no literatura como adenocancroide e apresenta metástases no figado, gânglios linfáticos regionais, apêndice cecal, colon transverso, peritônio e diafragma. Uma revisão da literatura e discussão sobre a origem de tais tumores são apresentadas.The AA. report a case of adenocancroid of the stomach (aged colored male), with metastasis in the liver, regional lymph nodes, vermiform appendix, transverse colon, peritoneum and diaphragm. The structure was not uniform, and was referred as adenoma destruens, adenocarcinoma and epidermoid carcinoma, according to the field under examination.