Portuguese Recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.

OBJECTIVE: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud's phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other immune-mediated connective tissue diseases (CTDs). METHODS: A task force comprising 21 rheumatologists, two surgeons (vascular and plastic), two nurses, and one patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined. RESULTS: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean ± standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8±2.1 to 9.8±0.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisciplinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and/or DUs. Sildenafil, tadalafil, and/or iloprost IV are second-line options for severe and/or refractory patients with RP and/or DUs. Sildenafil, tadalafil and/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use. CONCLUSIONS: These recommendations will inform rheumatologists, specialist nurses, other healthcare professionals, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.

Contributions for the Validation of the European Portuguese Version of the Vascular Quality of Life-6 Questionnaire for Peripheral Artery Disease.

INTRODUCTION: Peripheral arterial disease (PAD) is an occlusive atherosclerotic disease of the arteries of the extremities of the body that affects more than 230 million people worldwide. The most common symptom is intermittent claudication, described as leg pain which occurs mainly while walking. The symptoms impair the ambulation and functional capacity of patients, leading to loss of mobility, disease deterioration, increased risk of other cardiovascular diseases, and lower quality of life (QoL). Therefore, the aim of this study was to perform a cross-cultural adaptation and validation of the VascuQol-6 questionnaire for the Portuguese population to obtain a quick, sensitive, and easy-to-use way to assess the QoL of Portuguese patients diagnosed with PAD. METHODS: The Vascular Quality of Life-6 Questionnaire (VascuQoL-6) was adapted and translated into European Portuguese using standard validation methodology, including 115 patients with a mean age of 64.67 (7.23) years, with PAD with IC stable for more than three months; and ABI < 0.9 at rest. VascuQoL-6, SF-36, International Physical Activity Questionnaire (IPAQ), and the PAD Knowledge Questionnaire (PADKQ) were used. Reliability, construct validity analysis through convergent and discriminant validity, known-group validity, and responsiveness analysis were tested. RESULTS: The Cronbach's alpha was 0.64 and the average inter-item correlation was 0.27, indicating acceptable internal consistency. VascuQoL-6 was positively associated with SF-36 Physical Component Summary and Mental Component Summary scores (r = 0.64, p < 0.01 and r = 0.42, p < 0.01, respectively). In turn, there was no significant correlation between VascuQoL-6 scores and the PADKQ or IPAQ. A statistically significant difference between groups according to IC severity [F(2.47) = 8.35, p < 0.001] was found. A paired samples t-test showed differences between VascuQol-6 scores before a walking program (M = 15.65, SD = 3.09), and after a walking program (M = 17.41, SD = 2.71), t(67) = 3.94, p ≤ 0.001. CONCLUSION: The VascuQoL-6 is a six-item instrument to assess the QoL associated with PAD with good psychometric properties, convergent and discriminant validity with SF-36, PADKQ and IPAQ. The instrument proved to have known group validity and responsiveness.

Illness beliefs relation to physical activity and quality of life in patients with peripheral arterial disease.

Intermittent claudication is the most common symptom of Peripheral Arterial Disease (PAD) and is associated with decreased quality of life (QoL) due to walking impairment. The level of threat attributed to the disease affects QoL and physical activity. This study explores beliefs and illness drawings, and their relationship with quality of life and physical activity in patients undergoing conservative treatment for PAD. A cross-sectional study was carried out including 119 patients with PAD and Intermittent Claudication, in which patients were asked to freely draw their disease and 33 agreed to participate. The profile of beliefs about PAD is characterized by a low level of threat. Belief in the emotional impact of the disease, representations about the consequences and concern about the disease were associated with worse quality of life; the belief of having a high personal control over the disease was associated with more physical activity. The analysis of the disease drawings revealed three categories: extension of the disease (category 1), location and representations of the disease (category 2), and level of detail and complexity of the drawings (category 3). Greater disease extent was associated with more disease symptoms (IPQ 6) (rs = 0.399, p = .021). It is necessary to address beliefs and representations about the disease in consultations with patients with PAD. Patient drawings are a useful, practical, and free tool that does not require a lot of time and can facilitate the approach of health professionals to patient training and education.

Effect of a monitored home-based exercise program combined with a behavior change intervention and a smartphone app on walking distances and quality of life in adults with peripheral arterial disease: the WalkingPad randomized clinical trial.

Aims: Investigate whether a Home-based Exercise Therapy (HBET) program for patients with Peripheral Arterial Disease (PAD) and Intermittent Claudication (IC) with a behavior change intervention, supported by a smartphone application, is effective in improving walking distances and performance, and quality of life (QoL) over 6 months. Methods and results: This was a single-center, prospective, two-arm, single-blinded randomized controlled trial including 73 patients with PAD and IC, and three assessment moments: baseline, 3, and 6 months. Participants were randomized to receive a walking exercise prescription, with the support (n = 38) or without the support (n = 35) of the WalkingPad app, between January 2021 and July 2022. Both groups received two face-to-face behavior change sessions and 12 structured and targeted reinforcement phone calls over 6 months. Primary outcomes were between-group differences in pain-free walking distance (PFWD), functional walking distance (FWD), maximal walking distance (MWD), and 6-min walk distance (6 MWD) at 3 and 6 months. Secondary outcomes were QoL and walking impairment. Seventy-three patients (mean age 64 ± 7.2 years, 88% men) participated in this study, 60 of whom completed the three assessment moments. The whole sample significantly improved all primary outcomes in the first 3 months; that is, the average PFWD (151.1 m), FWD (175.2 m), MWD (171.1 m), and 6 MWD (30.8 m) increased from T1 to T2. Only MWD exhibited a significant average increase (35.0 m). Secondary outcomes also increased from baseline to 3 and 6 months. There were no between-group differences, except for MWD, which showed a greater increase at 6 months in the group that used the app, excluding patients with weak walking ability and extreme anxiety symptoms at baseline. Conclusion: The intervention improved distances and walking skills as well as the physical, mental, and disease-related quality of life among adults with PAD and IC. The group that used the WalkingPad app improved their MWD in 6 months compared to the control group, except for patients with poor walking ability and extreme anxiety symptoms, which suggests the effectiveness of the WalkingPad app for patients with high walking ability and no severe anxiety symptoms. More research is needed to determine the durability of these findings and to explore what app functionality might promote the other outcomes. Clinical Trial Registration: https://clinicaltrials.gov (NCT04749732).

Effective VTE prophylaxis with enoxaparin after elective THR or TKR: a retrospective observational study.

Background: Orthopedic patients are at the highest risk for venous thromboembolism (VTE). Nowadays, with VTE prophylaxis as a routine in patients undergoing total hip replacement (THR) and total knee replacement (TKR), fatal pulmonary embolism (PE) is rare and the rates of symptomatic VTE within 3 months dropped to 1.3%-10%, compared with the rates of 50%-70% before VTE prophylaxis implementation. In this study, we aim to evaluate the VTE prophylaxis and incidence in patients who underwent THR and TKR in Centro Hospitalar Universitário de Santo António (CHUdSA). Methods: We included 483 patients who underwent elective THR or TKR in CHUdSA from March 2019 to February 2020 and who were under enoxaparin as a VTE prophylaxis drug. All data related to prescribed enoxaparin were collected from the nationwide common electronic drug prescription system (PEM). Results: Of the 483 eligible patients, 192 (39.75%) underwent elective THR and 291 (60.25%) underwent TKR. Enoxaparin was prescribed for 31.86 ± 5.98 and 30.28 ± 5.97 days, on average, for the THR and TKR groups, respectively (P = .005). Patients completed, on average, 29.38 ± 8.12 days and 28.20 ± 7.32 days of VTE prophylaxis with enoxaparin in the THR and TKR groups, respectively (P = .098). The incidence of VTE was approximately 3.13% and 0.69% in the THR and TKR groups, respectively (P = .064). Conclusion: In CHUdSA, we usually prescribe enoxaparin 40 mg once daily for up to 35 days for VTE prophylaxis after THR or TKR. High therapeutic compliance rates resulted in very few events.

Anatomical traits related to leaf and branch hydraulic functioning on Amazonian savanna plants.

Amazonian savannas are isolated patches of open habitats found within the extensive matrix of Amazonian tropical forests. There remains limited evidence on how Amazonian plants from savannas differ in the traits related to drought resistance and water loss control. Previous studies have reported several xeromorphic characteristics of Amazonian savanna plants at the leaf and branch levels that are linked to soil, solar radiation, rainfall and seasonality. How anatomical features relate to plant hydraulic functioning in this ecosystem is less known and instrumental if we want to accurately model transitions in trait states between alternative vegetation in Amazonia. In this context, we combined studies of anatomical and hydraulic traits to understand the structure-function relationships of leaf and wood xylem in plants of Amazonian savannas. We measured 22 leaf, wood and hydraulic traits, including embolism resistance (as P50), Hydraulic Safety Margin (HSM) and isotope-based water use efficiency (WUE), for the seven woody species that account for 75% of the biomass of a typical Amazonian savanna on rocky outcrops in the state of Mato Grosso, Brazil. Few anatomical traits are related to hydraulic traits. Our findings showed wide variation exists among the seven species studied here in resistance to embolism, water use efficiency and structural anatomy, suggesting no unique dominant functional plant strategy to occupy an Amazonian savanna. We found wide variation in resistance to embolism (-1.6 ± 0.1 MPa and -5.0 ± 0.5 MPa) with species that are less efficient in water use (e.g. Kielmeyera rubriflora, Macairea radula, Simarouba versicolor, Parkia cachimboensis and Maprounea guianensis) showing higher stomatal conductance potential, supporting xylem functioning with leaf succulence and/or safer wood anatomical structures and that species that are more efficient in water use (e.g. Norantea guianensis and Alchornea discolor) can exhibit riskier hydraulic strategies. Our results provide a deeper understanding of how branch and leaf structural traits combine to allow for different hydraulic strategies among coexisting plants. In Amazonian savannas, this may mean investing in buffering water loss (e.g. succulence) at leaf level or safer structures (e.g. thicker pit membranes) and architectures (e.g. vessel grouping) in their branch xylem.

Anatomical functional traits and hydraulic vulnerability of trees in different water conditions in southern Amazonia.

PREMISE: Understanding tree species' responses to drought is critical for predicting the future of tropical forests, especially in regions where the climate is changing rapidly. METHODS: We compared anatomical and functional traits of the dominant tree species of two tropical forests in southern Amazonia, one on deep, well-drained soils (cerradão [CD]) and one in a riparian environment (gallery forest [GF]), to examine potential anatomical indicators of resistance or vulnerability to drought. RESULTS: Leaves of CD species generally had a thicker cuticle, upper epidermis, and mesophyll than those of GF species, traits that are indicative of adaptation to water deficit. In the GF, the theoretical hydraulic conductivity of the stems was significantly higher, indicating lower investment in drought resistance. The anatomical functional traits of CD species indicate a greater potential for surviving water restriction compared to the GF. Even so, it is possible that CD species could also be affected by extreme climate changes due to the more water-limited environment. CONCLUSIONS: In addition to the marked anatomical and functional differences between these phytophysiognomies, tree diversity within each is associated with a large range of hydraulic morphofunctional niches. Our results suggest the strong potential for floristic and functional compositional shifts under continued climate change, especially in the GF.

Detection of Intermittent Claudication from Smartphone Inertial Data in Community Walks Using Machine Learning Classifiers.

Peripheral arterial disease (PAD) causes blockage of the arteries, altering the blood flow to the lower limbs. This blockage can cause the individual with PAD to feel severe pain in the lower limbs. The main contribution of this research is the discovery of a solution that allows the automatic detection of the onset of claudication based on data analysis from patients' smartphones. For the data-collection procedure, 40 patients were asked to walk with a smartphone on a thirty-meter path, back and forth, for six minutes. Each patient conducted the test twice on two different days. Several machine learning models were compared to detect the onset of claudication on two different datasets. The results suggest that we can identify the onset of claudication using inertial sensors with a best case accuracy of 92.25% for the Extreme Gradient Boosting model.

What Do Patients Know About Peripheral Arterial Disease? A Knowledge Questionnaire.

INTRODUCTION: The lack of knowledge about Peripheral Arterial Disease (PAD) is worryingly high as it triggers and main- tains behaviors of denial, indifference, and non-adherence to therapeutics. Therefore, the aim of this study was to build and assess the reliability and validity of a knowledge questionnaire about PAD (Peripheral Arterial Disease Knowledge Questionnaire - PADKQ). MATERIALS AND METHODS: A longitudinal study was carried out with two evaluations that included a sample of patients with PAD and Intermittent Claudication, with no history of surgical interventions, in follow-up at the vascular surgery consulta- tion. The PADKQ was applied to 114 patients (85% men, with a mean age of 65 years, SD=7.2). Sociodemographic and clinical data were collected from clinical records, and physical activity level (International Physical Activity Questionnaire - IPAQ) and walking impairment (Walking Impairment Questionnaire - WIQ) were evaluated through questionnaires. A 2nd evaluation session took place two weeks after the 1st evaluation session where an educational intervention was performed. Internal consistency, temporal stability, content validity, and convergent validity were performed Results: The sample related results have reflected the good reliability (kr-20=0.775) and validity properties of the PADKQ. This sample showed a high level of knowledge about PAD (10.96 points, SD=3.28, from 0 to 16 possible points), which increased significantly from moment 1 to moment 2 (t= -7.457, p<.001). Only half of the sample considered the disease to be serious and identified smoking habits as one of the risk factors. Patients with higher education were the most physically active. CONCLUSION: The PADKQ proved to be a useful, brief, and easy-to-use instrument in health contexts to identify patients' level of knowledge about PAD. Education about PAD increases patients' knowledge about the disease and the greater the knowl- edge about PAD, the greater the practice of physical activity.

O olhar das residentes de Ortopedia e Traumatologia sobre o Serviço Social na equipe de saúde em um hospital público no oeste do Pará

Resumo Objetivo: Averiguar a concepção das residentes do Programa de Atenção Integral em Ortopedia e Traumatologia, da Universidade do Estado do Pará, sobre a atuação do Serviço Social na equipe de saúde do Hospital Regional do Baixo Amazonas do Pará Dr. Waldemar Penna, em Santarém/PA. Métodos: A pesquisa teve o caráter descritivo e explicativo; utilizou-se a pesquisa de campo; os instrumentos como a entrevista semiestruturada com formulários de perguntas abertas e fechadas e o gravador de voz; os dados foram analisados a partir da abordagem qualitativa e da análise de conteúdo de Bardin; a base teórica norteadora foi o materialismo histórico-dialético; e a amostra consistiu em nove participantes residentes. Resultados: O estudo evidenciou duas categorias centrais para a discussão, a primeira "O Serviço Social na equipe do HRBA na ótica das participantes" e a segunda "Demandas pertinentes ao Serviço Social na concepção das participantes". Considerações Finais: identificou-se a necessidade de criar espaços de debates acerca da temática com vista a questionar as práticas verticalizadas em saúde e persistir em intervenções em equipes pautadas na interdisciplinaridade, construindo relações horizontais entre os profissionais com intuito de promover um atendimento integral e de qualidade aos usuários de saúde.

A systematic review on smartphone use for activity monitoring during exercise therapy in intermittent claudication.

OBJECTIVE: Supervised exercise therapy is recommended as first line in the management of intermittent claudication. Its use is often limited by accessibility, compliance and cost. Home-based exercise therapy (HBET) programs emerged as an alternative solution, but have shown inferior results. The use of structured monitoring with the use of external wearable activity monitors (WAM) has been shown to improve outcomes. Mobile applications (apps) can make use of built-in accelerometers of modern smartphones and become an alternative solution for monitoring patients during HBET, potentially providing wider accessibility. This review aims to assess current use of smartphone technology (ie, mobile apps) for monitoring or tracking patients' activity in exercise therapy for peripheral arterial disease (PAD). METHODS: The PubMed database was searched from January 2011 to September 2021. Eligible articles had to include a population of patients with PAD, conduct a mobile-health exercise intervention and use smartphone technology for monitoring or tracking patients' activity. Randomized controlled trials, prospective studies, and study protocols were included. RESULTS: A total of seven articles met the selection criteria. These articles described six different studies and five different mobile apps. Three were fitness apps (FitBit, Nike+ FuelBand, and Garmin Connect) that synchronized with commercially available WAMs to provide users with feedback. Two were PAD-specific apps (TrackPAD and Movn) developed specifically to assess patients' activity during exercise therapy. PAD-specific apps also incorporated coaching and educational elements such as weekly goal setting, claudication reminders, messaging, gamification, training advice, and PAD education. CONCLUSIONS: Current HBET programs use smartphone apps mainly via commercially available fitness apps that synchronize with WAM devices to register and access data. PAD-specific apps are scarce, but show promising features that can be used to monitor, train, coach, and educate patients during HBET programs. Larger studies combining these elements into HBET programs should provide future direction.

WalkingPad protocol: a randomized clinical trial of behavioral and motivational intervention added to smartphone-enabled supervised home-based exercise in patients with peripheral arterial disease and intermittent claudication.

BACKGROUND: Physical exercise is a first-line treatment for peripheral arterial disease (PAD) and intermittent claudication (IC) reducing pain and increasing the distances walked. Home-based exercise therapy (HBET) has the advantage of reaching a higher number of patients and increasing adherence to physical exercise as it is performed in the patient's residential area and does not have the time, cost, and access restrictions of supervised exercise therapy (SET) implemented in a clinical setting. Even so, rates of adherence to physical exercise are relatively low, and therefore, m-health tools are promising in increasing motivation to behavior change and adherence to physical exercise. A built-in virtual assistant is a patient-focused tool available in a mobile interface, providing a variety of functions including health education, motivation, and implementation of behavior change techniques. METHODS: This is a single-center, prospective, three-arm, single-blind, randomized, controlled, superior clinical trial with stratified and blocked random allocation. Three hundred participants with PAD and IC will be recruited from an Angiology and Vascular Surgery Department, Centro Hospitalar Universitário Porto (CHUPorto), Porto, Portugal. All patients will receive the same medical care recommended by  current guidelines. Participants in all three groups will receive a personalized prescription for an HBET program and a behavioral change and motivational intervention. Participants in experimental groups 1 and 2 will receive a smartphone with the WalkingPad app to monitor exercise sessions. Experimental group 2 WalkingPad app will have a built-in virtual assistant that will promote behavioral change and provide motivational support. Participants allocated to the active control group will not receive the m-health tool, but a practice diary to encourage monitoring. The  program will last for 6 months with three evaluation moments (baseline, 3, and 6 months). The primary outcome will be the change in distances walked (maximal and pain-free) from baseline to 3 and 6 months. Secondary outcomes will be changes in quality of life, patients' perception of resistance, and walking speed. DISCUSSION: This study will allow measuring the effectiveness of an m-health tool in increasing motivation for behavior change and adherence to an HBET program in patients with PAD. The superiority of experimental group 2 in the primary and secondary outcomes will indicate that the virtual assistant is effective for motivating behavioral change and encouraging the practice and adherence to physical exercise. The use of m-health tools and virtual health assistants can potentially fill a gap in the access and quality of health services and information, reducing the burden on the health system and promoting self-management and self-care in chronic illness. TRIAL REGISTRATION: ClinicalTrials.gov NCT04749732 . Registered on 10 February 2021.

Angiosarcoma of a Femoropopliteal Bypass Thrombosed Vein Graft.

BACKGROUND: Angiosarcoma is a rare subtype of malignant vascular tumours which has been only anecdotally described in patients submitted to lower limb revascularization. CASE PRESENTATION: This paper reports a patient previously submitted to a femoropopliteal bypass using autologous great saphenous vein (GSV). Nine years after the initial surgery, a primary angiosarcoma of the thrombosed vein graft was diagnosed, requiring en bloc surgical resection. Rampant metastatic spread was documented despite primary tumour surgical resection with a dismal outcome within months. CONCLUSIONS: Malignant transformation of autologous vein for lower limb revascularization is extremely rare and anecdotally described in the literature. It is a poorly studied complication with an aggressive behaviour. This report further reinforces the need for early recognition of this pathology.

Endovascular Treatment of Renal Artery Thrombosis in Living-Donor Kidney Transplant Recipient With Severe COVID-19 Disease.

PURPOSE: Coronavirus disease 2019 (COVID-19) patients have a higher prevalence of micro-and macrovascular thrombotic events. However, the underlying mechanism for the increased thrombotic risk is not completely understood. Solid organ transplant recipients infected with SARS-CoV-2 may have an exponential increase in thrombotic risk and the best management strategy is unknown. CASE REPORT: A female kidney transplant recipient presented with allograft's renal artery thrombosis after a recent COVID-19 infection. Due to the risk of kidney failure or exclusion, catheter directed thrombolysis was performed. Residual thrombus was excluded using an endoprosthesis with an excellent result. There were no adverse events and kidney function improved. CONCLUSION: This paper reports the endovascular treatment of renal artery thrombosis in a living-donor kidney transplant recipient with severe COVID-19 disease.

Emergency Repair of a Ruptured Para-Renal Abdominal Aortic Aneurysm in a Patient with a Functional Renal Graft: A Case Report and Review of the Literature.

INDRODUCTION: Rupture of and abdominal aortic aneurysm (AAA) in a kidney transplant patient is a rare and rarely reported event. Emergent treatment can be challenging and should achieve effective aortic repair while minimizing ischemic damage to the renal graft during aortic cross-clamping. Several renal protective measures have been proposed such as permanent or temporary shunts, renal cold perfusion and general hypothermia. CASE REPORT: We report the effective treatment of a para-renal AAA in a patient with a functional renal allograft. A temporary extra-corporeal axillofemoral shunt was constructed to maintain graft's perfusion during open surgical repair. EVAR was not an option due to a short aortic neck. The postoperative period was complicated by colon ischemia and aortic graft infection. At 3 years follow-up the patient was well and graft's function was unchanged. CONCLUSION: This case is a reminder that renal graft protection must be accounted for when AAA rupture occurs in kidney transplant patients. We reviewed the literature to find previously reported cases and how they were managed.

As Regionais que queremos / The Regions we want

O pioneirismo em regionalização no Estado de Goiás é demonstrado através da abordagem dos tópicos regionalização, regionais e suas divisões, matriciamento, gestão, planejamento, coordenação, neuroliderança e fortalecimento

Pioneering in regionalization in the State of Goiás is demonstrated through the approach of the topics regionalization, regions and their divisions, matrix support, management, planning, coordination, neuro-leadership and strengthening

Morphogenetic and structural characteristics of gamba grass subjected to nitrogen fertilization and different defoliation intensities / Características morfogênicas e estruturais do capim-andropógon submetido à adubações nitrogenadas e intensidades de desfolha

This study aimed to evaluate the morphogenetic, structural, and productive characteristics of Andropogon gayanus cv. 'Planaltina' subjected to different nitrogen fertilization levels and defoliation intensities. The experiment was done in a completely randomized design with a factorial arrangement of six nitrogen doses (0, 100, 200, 300, 400, and 500 kg N ha-1) and two defoliation intensities (15 and 30 cm). The production and structure data were grouped into rainy and dry periods, while morphogenesis data were compared only among different fertilization and defoliation intensities. The total dry forage biomass (TDFB), dry mass of leaves (DML), dry mass of stems (DMS), and dead forage dry mass (DFDM) were then determined. In addition to these variables, the morphogenetic characteristics of the plants and the numbers of tillers alive and dead were evaluated. There was no interaction (P>0.05) between the effects of nitrogen fertilization doses and the intensity of defoliation on TDFB, DML, DMS, and DFDM in both of the evaluated phases (rainy and dry). It was also observed that the rates of leaf elongation, leaf appearance, and leaf blade elongation increased with nitrogen fertilization. On the other hand, the culm elongation rate and phyllochron decreased as the dose applied increased. The defoliation intensity did not influence (P>0.05) the morphogenetic characteristics examined, nor did it affect the senescence rate of nitrogen in leaves and number of live leaves per tiller. The number of dead tillers increased linearly during the rainy period. Based on these results, to improve the efficiency of production of gamba grass it is recommended that it be managed with a defoliation intensity of 30 cm and nitrogen fertilization of 286.52 kg N ha-1 year-1.

Objetivou-se avaliar as características morfogênicas, produtivas e estruturais do Andropogon gayanus cv. Planaltina submetido a níveis de adubação nitrogenada e intensidades de desfolha. O delineamento experimental foi o inteiramente casualizado com arranjo fatorial 6x2, doses de nitrogênio (0, 100, 200, 300, 400 e 500 kg de nitrogênio ha-1) e intensidades de desfolhas (15 e 30 cm). Os dados de produção e estrutura foram agrupados em períodos chuvoso e seco e os de morfogênese analisados somente em função da adubação e intensidade de desfolha. Foi determinada a produção de biomassa de forragem seca total (BFST), massa seca de folhas (MSF), massa seca de colmos (MSC) e massa seca de forragem morta (MSFM). Além dessas variáveis foram avaliadas as características morfogênicas e de perfilhos vivos e mortos. Houve interação (P<0,05) entre as doses e intensidade de desfolhas para a MSFT, MSF, MSC e MSFM em ambas as fases de avaliação. Observou-se que as taxas de alongamento foliar, aparecimento foliar e comprimento da lâmina foliar aumentaram com a adubação nitrogenada. Por outro lado, a taxa de alongamento do colmo e Filocrono diminuíram com a aplicação das doses crescentes. As intensidades de desfolha não influenciaram (P>0,05) nas características morfogênicas, assim como a adubação na taxa de senescência foliar e número de folhas vivas por perfilho. O número de perfilhos mortos aumentou de forma linear durante o período chuvoso. Recomenda-se manejar o capim-andropógon com intensidade de desfolha de 30 cm e adubação nitrogenada de 286,52 kg de N ha-1 ano-1, visando a maior produção.

Effect of racial crossing on the seminal parameters of rams submitted to heat stress / Efeito do cruzamento racial nos parâmetros seminais de carneiros submetidos ao estresse de calor

The aim of this study was to evaluate the effect of racial crossing on seminal parameters of eight Santa Inês and crossbred (Santa Inês x Dorper) rams submitted to heat stress, and to monitor the return of these parameters to previously reported. Before to place the insulation bags, two collects of semen through electroejaculation were performed. The insulation pouches were made with double-layer plastic, internally lined with cotton, and fixed around the spermatic funiculus and scrotum with adhesive tape and bandage remaining on the testes of the animals for seven days. The first collect was performed on the day that the pouches were taken (day 0) and thereafter, every seven days, totalizing 15 measurements. Data were submitted to analysis of variance (ANOVA). The analyzed variables were subjected to Dunnett test at 5% probability to compare the values obtained before treatment with those obtained in the following days. In this study it was found that the animals restored normal seminal parameter after the insulation effects, however, the return rate differed slightly among the studied breeds. The crossbred animals restored the seminal patterns, on average, a week before Santa Inês. It is concluded that the racial crossing influences the semen parameters of rams submitted to heat stress.

O objetivo deste estudo foi avaliar o efeito do cruzamento racial sobre parâmetros seminais de oito carneiros Santa Inês e mestiços, submetidos ao estresse térmico e monitorar o retorno desses parâmetros aos relatos anteriormente. Antes de colocar as bolsas de insulação, foram realizadas duas coletas de sêmen por meio de eletroejaculação. As bolsas de insulação foram confeccionadas com plástico de camada dupla, revestidas internamente com algodão, fixadas ao redor do funículo espermático e escroto com fita adesiva e bandagem, permanecendo nos testículos dos animais por sete dias. A primeira coleta foi realizada no dia em que as bolsas foram retiradas (dia 0) e a partir daí, a cada sete dias, totalizando 15 coletas. Os dados foram submetidos à análise de variância (ANOVA). As variáveis analisadas foram submetidas ao teste de Dunnett a 5% de probabilidade para comparar os valores obtidos antes do tratamento com aqueles obtidos nos dias seguintes. Neste estudo verificou-se que os animais restauraram os parâmetros seminais normais após os efeitos da insulação, porém, a taxa de retorno diferiu ligeiramente entre as raças estudadas. Os animais mestiços restauraram os padrões seminais, em média, uma semana antes da Santa Inês. Conclui-se que o cruzamento racial influencia os parâmetros seminais de carneiros submetidos ao estresse térmico.

Supervised exercise therapy in intermittent claudication: a systematic review of clinical impact and limitations.

INTRODUCTION: The global prevalence of Peripheral Arterial Disease is growing. This condition is associated with serious hallmarks, such as impaired functional capacity and decreased quality of life. Reduced blood flow and oxygen delivery are its dominant mechanisms, although additional ones contribute to it. Exercise therapy is a cornerstone in the management of intermittent claudication and current guidelines recommend supervised exercise therapy as first-line treatment. EVIDENCE ACQUISITION: A search was conducted on PubMed database to identify studies which included supervised exercise therapy as treatment of claudicant patients. Primary aim was to analyze the impact of therapy on three levels: physiological, walking distances and quality of life. Secondary objectives were to review its limitations and the feasibility of other programs. EVIDENCE SYNTHESIS: Physiological changes associated with supervised exercise therapy are not fully understood. Repetitive ischemia-induced phenomena by exercise can lead to an increase of inflammatory levels and oxidative stress. However, the participation in these programs demonstrates benefits in walking distances and quality of life, associated with changes in endothelial function, inflammatory state, muscle composition and angiogenesis. In contrast, ankle-brachial index does not change. Despite the good outcomes, supervised exercise is poorly widespread due to its limitations and emerging alternatives such as structured community-based or home-based therapies are surging with promising results. CONCLUSIONS: Supervised exercise therapy is associated with local and systemic physiological changes. However, it remains an underutilized tool and alternative programs for claudicant patients are emerging.

Já me acostumei: interfaces entre trabalho, corpo e saúde de catadores de materiais recicláveis / I am already used to it: interfaces between work, body and health of recyclable material collectors / Ya me acostumbre: interfaces entre el trabajo, el cuerpo y la salud de los recolectores de materiales reciclables

Resumo O contexto social do sistema capitalista de produção impõe efeitos às relações de trabalho, tais como os cenários de precarização marcados pela instabilidade e insegurança para os trabalhadores. Propõe-se aqui a discussão de dados derivados de um estudo qualitativo realizado no município de Erechim, Rio Grande do Sul, de fevereiro a abril de 2018, o qual investigou a relação entre trabalho, corporeidade e saúde com base na análise de narrativas produzidas por catadores de materiais recicláveis e incursões etnográficas em seu contexto laboral. Buscou-se problematizar a incidência de entrega do corpo ao trabalho e suas repercussões no caso dos catadores participantes da pesquisa, considerando a dinâmica da saúde que integra as dimensões física, psicológica e social desses sujeitos. Os resultados indicam as circunstâncias de vulnerabilidade a que são expostos. Como se depreende de suas narrativas, o trabalho se vincula à necessidade, levando-os a desconsiderar as condições adversas implicadas em sua realização ou se adaptar a elas, ainda que os custos desse processo sejam altos. Tal realidade indica a premência de análises sobre as relações entre trabalho, saúde e desigualdade social no contexto brasileiro, considerando-se que saúde é um direito humano fundamental e seu usufruto deve estar ao alcance de todos.

Abstract The social context of the capitalist production system impacts labor relations, including precarious scenarios marked by instability and insecurity for workers. Here we discuss data derived from a qualitative study carried out in the municipality of Erechim, Brazil, from February to April 2018, which investigated the relationship between work, corporeality and health based on the analysis of narratives produced by recyclable material collectors and ethnographic incursions in their work context. We sought to problematize the incidence of delivery of the body to work and its repercussions in the case of the collectors participating in the research, considering the health dynamics that integrate the physical, psychological and social dimensions of these subjects. The results indicate the circumstances of vulnerability to which they are exposed. As can be seen from their narratives, the work is linked to the need, leading them to disregard the adverse conditions involved in its realization or to adapt to them, even though the costs of this process are high. This reality indicates the urgency of analysis of the relationships between work, health and social inequality in the Brazilian context, considering that health is a fundamental human right and its enjoyment must be available to everyone.

Resumen El contexto social del sistema de producción capitalista impone efectos sobre las relaciones laborales, como los escenarios precarios que se denotan en la inestabilidad e inseguridad de los trabajadores. Se propone aquí discutir los datos derivados de un estudio cualitativo realizado en el municipio de Erechim, Brasil, de febrero a abril de 2018, el que investigó la relación entre trabajo, corporeidad y salud basada en el análisis de narraciones hechas por recolectores de material reciclable e incursiones etnográficas en su contexto laboral. Se buscó problematizar la incidencia de entrega del cuerpo al trabajo y sus repercusiones en el caso de los recolectores participantes de la investigación, considerando las dinámicas de salud que integran las dimensiones físicas, psicológicas y sociales de estos sujetos. Los resultados indican las circunstancias de vulnerabilidad a las que están expuestos. De a cuerdo a sus narraciones, el trabajo está vinculado a la necesidad, llevándolos a ignorar las condiciones adversas involucradas en la realización del mismo o a adaptarse a ellas, a pesar de que los costos de este proceso sean altos. Esta realidad indica la urgencia de análisis sobre las relaciones entre trabajo, salud y desigualdad social en el contexto brasileño, considerando que la salud es un derecho humano fundamental y su disfrute debe estar disponible para todos.