Comparing the Surgical Outcomes of Carotid Endarterectomy: Assessing the Impact of Consultant vs. Trainee Cases on Patient Care and Surgical Training.

OBJECTIVE: This study assesses the impact of having a surgical trainee performing a carotid endarterectomy procedure on the post-operative rates of stroke and death. DESIGN: Observational Retrospective study METHODS: Consecutive patients, who underwent carotid endarterectomy between 01/05/2016 and 31/7/2022, were entered into a retrospectively collected database. Patients were stratified into two categories - consultant-led cases and trainees-led cases. Primary outcomes were 30- day stroke rate, and 30-day morbimortality. A sub analysis was performed after grouping the patients in whether there was a neurological event in the previous six months - symptomatic or asymptomatic. RESULTS/CONCLUSIONS: Trainees-led cases had significantly longer clamping times and higher rates of stroke in asymptomatic patients compared with consultant-led cases. Patient's safety should be our top priority. Any practice leading to a significantly increased rate of post-operative stroke must be discontinued. Training protocols and adequate supervision must ensure that trainees possess the necessary skills and knowledge to safely and effectively perform carotid endarterectomy (CEA) procedures, thereby prioritizing patient safety.

Pedal Acceleration Time An Alternative Tool To Ankle-Brachial Index In Peripheral Arterial Disease.

INTRODUCTION: Ankle-Brachial Index (ABI) is a well-established diagnostic tool for evaluating peripheral arterial disease (PAD). Limitations in its application led to the development of alternative diagnostic methods, including Toe-Brachial Index (TBI) and Transcutaneous Pressure of Oxygen (TcPO2), yet these are not as widely available as ABI. Recently, Pedal Acceleration Time (PAT), has gained popularity as a new tool to assess PAD, requiring only an ultrasound. This study seeks to further establish the correlation between ABI and PAT, determining whether PAT can be a reliable alternative for diagnosing and assessing the severity of PAD. METHODS: ABI and PAT were measured in patients attending our consult with no history of vascular or endovascular surgery. Limbs with unmeasurable ABI were excluded. Patients were categorized into groups based on their PAD stage according to the Fontaine classification. Patient demographics, comorbidities and respective ABI and PAT were analysed. RESULTS: Sixty-nine patients (114 limbs) were included in the study. Mean age 68 ± 11.7 years, 78.3% male and 33.3% diabetic patients. Fifty-three claudicant limbs (46.5%) and 26 limbs (22.8%) with chronic limb threatening ischemia. Pearson correlation coefficient between ABI and PAT, showed a strong negative correlation (r= -0.78; p<0.01). Mean ABI and PAT for limbs in Fontaine stage I were 0.94 ± 0.17 and 82.0 ± 27.4 ms; Fontaine stage IIa 0.69 ± 0.21 and 141.3 ± 57.8 ms; Fontaine stage IIb 0.54 ± 0.14 and 173.4 ± 65.1 ms; Fontaine stage III 0.43 ± 0.15 and 216 ± 33.2 ms; Fontaine stage IV 0.49 ± 0.17 and 206.7 ± 78.1 ms, respectively. CONCLUSION: Our study suggests an inverse correlation between ABI and PAT, in accordance with the findings published in the literature, thus supporting the use of PAT as an easily reproducible and efficient alternative to ABI for evaluating the severity of PAD.

Infected Thrombosed Popliteal Artery Aneurysm With Cutaneous Fistula.

Introduction: Popliteal artery aneurysms (PAAs) pose some challenges in their surgical management and are often treated by exclusion and bypass procedures. However, post-operative complications, such as endoleaks and sac growth, can occur, potentially leading to serious consequences. Endoleaks, characterised by persistent flow within the aneurysm sac after repair, can cause sac expansion, increasing the risk of adverse outcomes, including the formation of cutaneous fistulae, a rare but potentially severe complication. Report: A 75 year old male with a history of previous bilateral PAA exclusion with a left femoropopliteal bypass using reversed great saphenous vein (GSV) graft in 2012 and a right femoropopliteal bypass using a PTFE prosthesis in 2017, both through medial approach, presented with pain and ulceration in the left popliteal region. Previous angiography had shown residual arterial flow through collateral vessels, requiring thrombin injection. Bilateral bypass thrombosis had also occurred after discontinuing anticoagulation. Computed tomography angiography confirmed a complicated excluded left popliteal aneurysm with superinfection. The patient underwent elective surgery, involving partial aneurysmectomy, endoaneurysmorrhaphy, and fistulectomy through a posterior approach. Post-operatively, the patient experienced resolution of symptoms and inflammatory signs. Discussion: The optimal approach for treating PAAs remains a subject of debate, with some experts advocating the posterior approach to prevent sac growth. However, others support the medial approach, reporting satisfactory results. In this case, the medial approach resulted in incomplete exclusion, leading to sac expansion and a cutaneous fistula. Timely re-intervention through the posterior approach successfully resolved the complication. This report highlights a rare but serious complication of incomplete PAA exclusion. Vigilant post-operative surveillance and intervention are crucial to manage such cases effectively. Further research is warranted to determine the optimal approach for PAA repair and prevent associated complications.

Thoracic aortic aneurysms, a single center's 10-years experience and analysis of outcomes.

INTRODUCTION: Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. METHODS: A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5 mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. RESULTS: We identified 34 patients treated for TAAs in this period. Mean age was 68 years [47-87] and 79.4% of patients were male. Mean aneurysm diameter was 63 mm [35-100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10 days [2-80] (6 days for elective repair versus 16 days for urgent repair, p = .016). Follow-up period ranged from 1 month to 10 years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5 mm versus 56.0 mm in patients with no morbidity; p = .027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p = .001), but not with higher mortality rates (p = .515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. CONCLUSIONS: TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes.

Aneurysmal Degeneration of the Brachial Artery Following Chronic Arteriovenous Fistula Ligation.

Introduction: Arteriovenous fistulas (AVF) are currently considered to be the best vascular access option for patients with end stage chronic kidney disease requiring haemodialysis. In rare cases of patients with chronic AVF, thrombosis or ligation of the access can lead to the development of brachial artery aneurysms. Despite being uncommon, reports of this phenomenon have arisen in recent decades due to an increase in the number of patients undergoing dialysis worldwide. This case presented with a brachial aneurysm that developed after AVF ligation. Case report: A 62 year old male presented to the emergency department with swelling of the medial aspect of his left arm associated with pain, inflammatory signs, and finger paraesthesia. Swelling had started two months previously but had worsened within the last week. He had history of kidney transplant 20 years ago and a chronic functioning radiocephalic fistula that had not been used since, and which had been ligated in the past year due to the development of venous aneurysms. Physical examination revealed a pulsatile mass in his left arm and absent radial and ulnar pulses, without signs of hand ischaemia. There was significant venous collateralisation of the arm and chest and numbness of the left fingers, suggesting venous and neurological compression. Computed tomography angiography showed a large left brachial artery aneurysm (108 x 87 x 180 mm). The patient underwent aneurysm sac emptying and collateral ligation followed by great saphenous vein interposition, with clinical improvement. Conclusion: The presence of a chronic AVF can lead to progressive changes in the arterial wall. Sudden ligation or thrombosis of a functioning AVF causes increased blood pressure within the artery, which may further contribute to its aneurysmal degeneration. In addition, immunosuppressive therapy following kidney transplant has been described as a synergistic risk factor leading to aneurysm formation. Despite being a rare complication, patients with a chronic AVF should be monitored closely after vascular access ligation.

Coral Reef Aorta: Literature Review and Analysis of the Published Cases in the Last 20 Years.

BACKGROUND: Coral reef aorta (CRA) is defined by the presence of heavily calcified exophytic plaques that protrude into the aortic lumen. However, the exact causes and development of this condition are still not fully understood. When the aortic branches are affected, it can result in various symptoms. Despite ongoing research, there is currently no established consensus on the best treatment for CRA. This review aims to examine the latest findings regarding the clinical presentation and approach to treating patients with CRA. METHODS: We conducted a systematic electronic search of the literature using the PubMed and Embase databases. Throughout the search, we adhered to the guidelines outlined in the PRISMA framework. From the identified publications, we extracted information pertaining to patients' characteristics, symptoms, and types of treatment from a total of 124 cases reported over the past 20 years. The primary focus of our analysis was to assess the improvement of signs and symptoms, as well as to evaluate any postoperative complications. To achieve this, we performed both descriptive and inferential analyses on the collected data. Additionally, we conducted subgroup analyses based on treatment types and symptoms observed at presentation, presenting the findings in the form of odds ratios (ORs). RESULTS: After removing duplicate articles, we carefully screened the titles of 67 retrieved articles and excluded those that did not align with the purpose of our study. Subsequently, we thoroughly analyzed the remaining 41 articles along with their references, ultimately including 29 studies that were deemed most relevant for our systematic review. We examined a total of 124 cases of patients diagnosed with CRA, comprising 77 (62.1%) females and 48 (38.7%) males, with a mean age of 59 years (range: 37-84). The predominant signs and symptoms observed were intermittent claudication, reported in 57 (46.0%) patients, followed by refractory hypertension in 45 (36.3%) patients, intestinal angina in 28 (22.6%) patients, and renal insufficiency in 15 (12.1%) patients. Among the treated patients, 110 (88.7%) underwent open surgery repair (OSR), 11 (8.9%) received endovascular treatment, and 3 (2.4%) underwent laparoscopy. Postoperatively, a significant number of patients experienced substantial relief or complete resolution of their symptoms, as well as improved control of hypertension and renal function. In the group of patients treated with OSR, the inhospital stay mortality rate was 10.9%, the morbidity rate was 28.2%, and the reintervention rate was 15.5%. The high mortality rate during hospital stays in this group may be associated with such invasive procedures performed on patients who have substantial cardiovascular burden and multiple comorbidities. Conversely, no postoperative complications were reported in the group of patients treated with endovascular procedures or laparoscopic surgery. CONCLUSIONS: While coral reef aorta (CRA) is considered a rare condition, it is crucial for the medical community to remain vigilant about its diagnosis, particularly in patients presenting with symptoms such as intermittent claudication, refractory hypertension, renal impairment, or intestinal angina. Based on the findings of this review, both OSR and endovascular treatment have shown promise as viable therapeutic options. Although endovascular therapies may not always be feasible or may have reduced durability in these calcified bulky lesions, they should be considered in patients with multiple comorbidities, due to the high postoperative mortality rates associated with more invasive approaches. Additionally, these endoluminal procedures have demonstrated good patency rates during the 18-month follow-up period. It is essential to emphasize that the treatment strategy should be determined on a case-by-case basis, involving a multidisciplinary team to tailor it to the specific needs of each individual patient.

An Incidental Finding Of A Persistent Sciatic Artery - Case Report And Literature Review.

Persistent sciatic artery is a rare anatomic variation due to the lack of regression during fetal development, associated sometimes with abnormalities of the iliofemoral arterial axis and predisposing the patients to aneurysm formation and thromboembolism, which can compromise the limb. In our department, we assisted a 59-year-old male with an acute limb ischemia as result of an incidental finding of a thrombosed persistent sciatic artery aneurysm.

Bioactive compounds and physical-chemical characteristics of two genotypes of peach trees submitted to nitrogen fertilization

Nitrogen, which is the primary nutrient peach trees need, may affect their fruit quality. Thus, this study aimed at evaluating the effect of nitrogen fertilization on two genotypes of peach trees, regarding their fruit quality, in three consecutive crops. The experiment was carried out in the experimental area that belongs to the Embrapa Clima Temperado, located in Pelotas, Rio Grande do Sul (RS), Brazil, from 2016, 2016, 2017 and 2018. Four doses of nitrogen (0, 60, 120 and 180 Kg ha-1) and two peach tree genotypes ('Cascata 1513' and 'Cascata 1067') were used. For the fruit, we evaluated epidermis color, pulp firmness, epidermis firmness, soluble solids concentration, titratable acidity, concentration of total phenolic compounds, anthocyanins and antioxidant activity. Fruit underwent physical, chemical and bioactive compound analyses. Results showed that the highest dose of nitrogen (180 Kg ha-1) applied to the soil retards fruit ripening, while no application of nitrogen fertilization brings fruit maturation forward. Nitrogen fertilization via soil does not favor anthocyanins in fruit. Doses of 60 and 120 Kg ha-1 of nitrogen are recommended because they lead to improvement in peach color, epidermis firmness and acidity. Peach tree genotypes influence soluble solids, juice pH, phenolic compounds and antioxidant activity of their fruit.

Second primary gastric cancers in a region with an overall high risk of gastric cancer / Segundos cánceres primarios gástricos en una región con un alto riesgo global de cáncer gástrico

OBJECTIVE: To compare the incidence rates of gastric cancer among cancer survivors with those in the general population, and estimate the probability of a gastric second primary cancer being diagnosed 10 years after any other first primary cancer. METHOD: A cohort of first primary cancers (other than gastric) diagnosed in Northern Portugal between 2000 and 2006 (n=64,648) was followed until 31/12/2012 for gastric second primary cancers. Incidence rates, standardized incidence ratios and the cumulative incidence of gastric second primary cancers were calculated. RESULTS: Overall, 330 patients developed gastric second primary cancers (21.2% within two months). The incidence rate of gastric second primary cancers was higher within two months of the first primary cancer (standardized incidence ratios: 5.20 in males and 7.89 in females), particularly among survivors of cancers of the oesophagus, colon and rectum, than in the remaining period (standardized incidence ratios: 0.64 in males and 0.74 in females). The 10-year risk of a gastric second primary cancer was 0.6% (males: 0.7%; females: 0.4%). CONCLUSION: The incidence rate of gastric second primary cancers among cancer survivors was higher than in the general population only soon after the first primary cancer, and lower thereafter. Despite the high mortality, the probability of a gastric second primary cancer within 10-years of the first primary cancer was 0.6%

OBJETIVO: Comparar las tasas de incidencia de cáncer gástrico entre los sobrevivientes de cáncer con las de la población general y estimar la probabilidad de que se diagnostique un segundo cáncer primario gástrico 10 años después de cualquier otro primer cáncer primario. MÉTODO: Se siguió una cohorte de pacientes con un primer cáncer primario (excluyendo los gástricos) en el norte de Portugal entre 2000 y 2006 (n=64.648) hasta el 31/12/2012 para identificar un segundo cáncer primario gástrico. Se calcularon las tasas de incidencia, las razones de incidencia estandarizadas (RIE) y la incidencia acumulada de segundos cánceres primarios gástricos. RESULTADOS: En total, 330 pacientes desarrollaron un segundo cáncer primario gástrico (21,2% en 2 meses). La tasa de incidencia de los segundos cánceres primarios gástricos fue mayor dentro de los 2 meses posteriores al primero (RIE: 5,20 en hombres y 7,89 en mujeres), en particular entre los sobrevivientes de cáncer de esófago, colon y recto, que en el período restante (RIE: 0,64 en hombres y 0,74 en mujeres). El riesgo a 10 años de un segundo cáncer primario gástrico fue del 0,6% (hombres: 0,7%; mujeres: 0,4%). CONCLUSIONES: La tasa de incidencia de segundos cánceres primarios gástricos entre los sobrevivientes de cáncer fue más alta que en la población general solo poco después del primer cáncer, y más baja a partir de entonces. A pesar de la alta mortalidad, la probabilidad de un segundo cáncer primario gástrico a 10 años del primero fue del 0,6%

Nitrogen fertilization associated with cold storage and its impacts on the maintenance of peach quality / Adubação nitrogenada associada ao armazenamento refrigerado e seus impactos na manutenção da qualidade do pêssego

Nitrogen, which is considered the most important nutrient for peach trees, may interfere in both quantitative production characteristics and quality of fruits. This study aimed at evaluating the effect of the combination of doses of N fertilization and different periods of cold storage on physico-chemical and phytochemical characteristics of peaches in post-harvest. The experiment had a randomized complete block design in a 4x3 factorial scheme, i. e., four doses of fertilization (0, 60, 120 and 180 Kg N ha-1) and three periods of storage (on the harvest day, on both the 15th and the 30th storage days at 1±1ºC, each followed by a day of simulated commercialization at 20±1ºC). The following aspects were evaluated in fruits yielded by peach trees of the genotype Cascata 1067: fruit color, soluble solid content, titratable acidity, pulp firmness, mass loss, total phenolic compounds and antioxidant activity. Different periods of cold storage and doses of N fertilization were found to affect epidermis luminosity, pulp firmness and titratable acidity of fruits. Peaches may be stored at low temperatures for 15+1 days. After that, loss of fruit firmness increases. N fertilization affects neither the soluble solid content nor the epidermis color of peaches, but both parameters are influenced by storage. Values of phenolic compounds and antioxidant activity decrease when there is N increment in the soil and when longer storage is carried out. Results suggest that peach composition may be affected by cultural practices, such as N fertilization, in harvest and after storage.

O nitrogênio é o nutriente considerado de maior importância para o pessegueiro, podendo interferir nas características quantitativas da produção, bem como na qualidade dos frutos. O objetivo do trabalho foi avaliar o efeito da combinação de doses de adubação nitrogenada e de diferentes períodos de armazenamento refrigerado nas características físico-químicas e fitoquímicas de pêssegos na pós-colheita. O delineamento experimental foi o de blocos casualizados em esquema fatorial 4x2, quatro doses de adubação (0, 60, 120 e 180 Kg N ha-1) e três períodos de armazenamento (dia da colheita, aos 15 e 30 dias armazenamento refrigerado a 1±1ºC, seguido de um dia de simulação de comercialização a 20±1ºC). Avaliou-se, nos frutos de pessegueiro do genótipo Cascata 1067, a coloração dos frutos, o teor de sólidos solúveis, acidez titulável, firmeza da polpa, perda de massa, compostos fenólicos totais e a atividade antioxidante. Verificou-se que diferentes períodos de armazenamento refrigerado e doses de adubação nitrogenada afetam a luminosidade da epiderme, a firmeza de polpa e a acidez titulável dos frutos. Os pêssegos podem ser armazenados em baixa temperatura até 15+1 dias, após esse período, a perda de firmeza nos frutos é elevada. A adubação nitrogenada não altera o teor de sólidos solúveis e a coloração da epiderme dos pêssegos, mas esses parâmetros são influenciados durante o armazenamento. Os compostos fenólicos e atividade antioxidante decrescem com o incremento de nitrogênio no solo, bem como durante o avanço dos dias de armazenamento. Os resultados sugerem que a composição dos pêssegos pode ser afetada com práticas culturais como a adubação de nitrogênio na colheita e após o armazenamento.

External Iliac Artery Laceration Caused by Hip Prosthesis Migration / Laceração da artéria ilíaca externa por migração de prótese da anca

Abstract Hip arthroplasty is a common and safe intervention in orthopedic surgery. However, the proximity of this joint to large vessels makes the occurrence of vascular injury a rare but serious and possibly lethal complication of this surgical technique. Acute vascular injuries in the context of a hip arthroplasty have variable etiologies and clinical presentations, and are more common in revision surgeries and in situations of medial intrapelvic migration and of chronic infection of the hip prosthesis. In the present article, the authors present a case of acute and late major vascular complication in the context of hip arthroplasty revision. The patient developed an acute laceration of the external iliac artery caused by chronic and progressive medial intrapelvic acetabular migration of the hip prosthesis associated with chronic infection.

Resumo A artroplastia da anca é uma intervenção frequente e segura na cirurgia ortopédica. No entanto, a proximidade dessa articulação com vasos de grande calibre faz com que a ocorrência de lesão vascular maior seja uma complicação rara, mas grave e possivelmente letal, dessa técnica cirúrgica. As lesões vasculares agudas no contexto de uma artroplastia da anca têm etiologia e apresentação clínica variáveis e são mais frequentes em cirurgias de revisão e situações de migração medial intrapélvica e de infecção crônica de próteses da anca. No presente artigo, os autores apresentam um caso com complicação vascular maior aguda e tardia em contexto de revisão de prótese da anca. Trata-se de um paciente que desenvolveu uma laceração aguda da artéria ilíaca externa em contexto de migração acetabular intrapélvica crônica progressiva da prótese da anca associada a infecção crônica.

Bilateral knee dislocation with associated bilateral popliteal arterial injury / Luxação bilateral dos joelhos com lesão bilateral da artéria poplítea

ABSTRACT Tibiofemoral unilateral knee dislocations are uncommon, making bilateral dislocations even rarer injuries. Knee dislocation is considered one of the most serious injuries that can affect this joint. Associated complications such as popliteal artery injury are responsible for the important morbidity in these patients. The authors report the case of a 52-year-old man with a traumatic bilateral knee dislocation with associated bilateral popliteal arterial injury. His clinical presentation along with radiographic and angiographic findings are described. Surgical and non-surgical treatment and functional outcomes are also reported.

RESUMO As luxações unilaterais tibiofemurais do joelho são incomuns, o que torna as luxações bilaterais ainda mais raras. A luxação do joelho é considerada um dos ferimentos mais graves nessa articulação. As complicações associadas, tais como a lesão da artéria poplítea, são responsáveis pela importante morbidade observada nesses pacientes. Os autores relatam o caso de um homem de 52 anos com luxação traumática bilateral do joelho associada a lesão bilateral da artéria políptea. O estudo descreve a apresentação clínica e os achados radiográficos e angiográficos. Os tratamentos cirúrgico e não cirúrgico e os resultados funcionais também são relatados.

Produção de amoreira-preta sob diferentes sistemas de condução / Blackberry yield on different trellis systems

RESUMO: O objetivo do trabalho foi avaliar o efeito da produção e qualidade dos frutos de cultivares de amoreiras-pretas conduzidas em diferentes sistemas de condução. O delineamento experimental adotado foi o de blocos casualizados em parcelas subdivididas, em um fatorial 3x3. Utilizaram-se as cultivares 'Tupy', 'Guarani' e 'Xavante' e os sistemas de condução: sem tutor, espaldeira em "T" e espaldeira em fios paralelos. Avaliou-se a produção de frutas, o número médio de frutas, a massa média de frutas por planta nas safras de 2009/2010, 2010/2011 e 2011/2012. Nas duas últimas safras, também foi avaliado o conteúdo de sólidos solúveis. Os sistemas de condução influenciaram no comportamento produtivo das amoreiras-pretas, sendo que o sistema em espaldeira em "T" proporcionou maior produção e número de frutas, no entanto, a maior massa média de frutas foi obtida nas plantas conduzidas sem tutor. As plantas conduzidas em espaldeira em "T" e espaldeira apresentaram maior produção (1357,4 e 1217,8g planta-1, respectivamente) e número de frutas (341,7 e 320, respectivamente). Dentre as cultivares, a produção diferiu entre elas, destacando-se a 'Tupy' e 'Guarani' com 2098g e 2094g planta-1, respectivamente. Entretanto, o maior número de frutas por planta foi superior nas plantas de 'Guarani', sendo inversamente proporcional à massa média de frutas para esta cultivar. A cultivar 'Tupy' apresenta maior produção em relação às demais cultivares avaliadas. O número médio de frutas por planta foi superior nas plantas de 'Guarani'. Nas condições do presente trabalho conclui-se que o desempenho produtivo de amoreira-preta depende de cada cultivar e também do sistema de condução adotado.

ABSTRACT: The objective of this study was to evaluate the effect of different management systems on plant varieties of blackberry. The experimental design was in completely randomized blocks in a split plot, 3x3 factorial design, with cultivars 'Tupy', 'Guarani' and 'Xavante' and three drive systems: without tutor, espalier in wires parallel, and espalier 'T'. The production of fruits, e average number of fruits and average mass per plant, fruit soluble solids were evaluated in 2009/2010, 2010/2011 and 2011/2012 harvests. In the last two seasons it was also rated the fruit soluble solids and harvests. The conduction system influenced the productive behavior of the blackberry, and the system espalier 'T' highest yield and fruit number. Plants conducted in espalier 'T' and espalier had higher production (1357.4 and 1217.8g plant-1, respectively) and number of fruits (341.7 and 320.6 respectively), since the system without tutor provides fruit with higher average mass. Among the cultivars, the production differed between them, highlighting the 'Tupy' and 'Guarani' with 2098g and 2094g plant-1, respectively. However, the highest number of fruits per plant was higher in plants 'Guarani', being inversely proportional to the average mass of fruit for this cultivar. Cultivar 'Tupy' had better performance compared to other cultivars. The average number of fruits per plant was higher in plants 'Guarani'. Under the conditions of this study it was concluded that the productive performance of blackberry cultivar depends on the individual and also the conduction system adopted.

Tipo de terapêutica e fatores de prognóstico na paralisia de Bell: estudo retrospectivo de cinco anos em um hospital português / Therapeutic approach and prognostic factors in Bell´s palsy: retrospective study of five years in a Portuguese hospital

OBJETIVOS: Comparar as abordagens terapêuticas na paralisia de Bell (corticoterapia versus corticoterapia mais terapia antiviral, assim como tratamento fisioterápico) e investigar potenciais fatores relacionados com sua evolução clínica e prognóstico. MÉTODOS: Estudo retrospectivo dos casos de paralisia de Bell atendidos no Hospital Garcia de Orta, em Almada, Portugal, entre 2009 e 2013 (cinco anos). Avaliou-se a gravidade da disfunção inicial da paralisia pela escala de House-Brackmann. A avaliação das abordagens terapêuticas e dos fatores de prognóstico foi realizada com base na taxa e tempo de recuperação, sendo a recuperação considerada total quando o grau de House-Brackmann foi I após a terapêutica. Diabetes mellitus e gravidez e/ou puerpério foram avaliados também como fatores de risco para recorrência. Foram utilizados testes não paramétricos, com nível de significância p<0,05. RESULTADOS: Registraram-se 180 casos de paralisia de Bell no período do estudo, correspondendo a uma incidência média de 36 casos/ano. A principal terapêutica utilizada foi a combinação entre corticosteroide e antiviral, em 67,2% dos casos. A taxa de recuperação total com uso dessa combinação foi de 65,5% (57 de 87 doentes) versus 72,4% (21 de 29 pacientes) com corticoterapia isolada. Relativamente ao tempo de recuperação, 72,4% (63 de 87 doentes) recuperaram em três meses com o uso da combinação versus 75,8% (22 de 29 doentes) com corticoterapia isolada. Não se verificou, portanto, associação estatisticamente significativa entre o tipo de terapêutica tanto relativamente à taxa (p=0,689) como relativamente ao tempo de recuperação (p=0,977). A presença de otalgia e/ou disgeusia foi o único fator estatisticamente relacionado com a evolução clínica, associando-se a uma menor taxa (51,2% versus 74,4%) (p=0,004) e a um maior tempo de recuperação (60,5% versus 79,2% de taxa de recuperação aos três meses) (p=0,011). Verificou-se associação estatisticamente significativa do tratamento fisioterápico com maior taxa de recuperação (p=0,049). Em 24,1% (sete de 29) dos doentes com diabetes mellitus houve recorrência da paralisia, contrastando com apenas 6,0% (nove de 51) de recorrência em doentes sem diabetes mellitus (p=0,006). CONCLUSÕES: Não houve diferença significativa na taxa de recuperação ou no tempo de recuperação da paralisia de Bell entre os casos que receberam terapêutica com corticosteroide e antiviral ou corticoterapia isolada. O tratamento fisioterápico associou-se à maior taxa de recuperação. Dos fatores de prognóstico estudados, apenas a queixa de otalgia e/ou disgeusia foi significativa, constituindo fator de mau prognóstico na paralisia de Bell. A presença de diabetes mellitus revelou-se fator de risco para recorrência da paralisia.

AIMS: To compare therapeutic approaches (corticosteroids vs. corticosteroids + antivirals, as well as physical therapy) in patients with Bell's palsy and to investigate potential factors related to its clinical course and prognosis. METHODS: Retrospective study of clinical cases of Bell's palsy treated at Hospital Garcia de Orta, Almada, Portugal, between 2009 and 2013 (five years). The severity of the initial dysfunction caused by the palsy was assessed using the House-Brackmann scale. Therapeutic approaches and prognostic factors were evaluated based on the rate and time of recovery, and full recovery occurred when a House-Brackmann grade I was observed after therapy. Diabetes mellitus and pregnancy and/or the postpartum period were also evaluated as risk factors for recurrence. Non-parametric tests were used and the significance level was set as p <0.05. RESULTS: One hundred and eighty cases of Bell's palsy were recorded throughout the study period, corresponding to an average incidence of 36 cases/year. The main therapeutic approach consisted of the combination of corticosteroids and antivirals in 67.2% of the cases. The full recovery rate with the combination therapy was 65.5% (57 out of 87 patients) vs. 72.4% (21 out of 29 patients) in corticosteroid therapy alone. As to recovery time, 72.4% (63 out of 87 patients) recovered in 3 months with the use of the combination therapy vs. 75.8% (22 out of 29 patients) in those treated with corticosteroids alone. Therefore, no statistical significance between the type of therapy used and recovery rate (p=0.689) or recovery time (p=0.977). Only otalgia and/or dysgeusia was/were statistically associated with the clinical course, showing a lower recovery rate (51.2% vs. 74.4%) (p=0.004) and longer recovery time (60.5% vs. 79.2% at 3 months) (p=0.011). There was a statistically significant association of physical therapy with higher recovery rate (p=0.049). Palsy recurred in 24.1% of the patients with diabetes (7 out of 29) compared with only 6.0% (9 out of 51) among non-diabetic patients (p=0.006). CONCLUSIONS: No significant difference was observed in recovery rate or recovery time among the cases treated with the combined therapy and those treated with corticosteroids alone. Physical therapy was associated with a higher recovery rate. Among the prognostic factors, only otalgia and/or dysgeusia was/were statistically significant, indicating a poor prognosis of Bell's palsy. The presence of diabetes mellitus proved to be a risk factor for recurrence.

Incompatibilidade de enxertia induz aumento da suscetibilidade de cultivares de pessegueiro à Xanthomonas arboricola pv. Pruni / Graft incompatibility induces susceptibility increase of peach cultivars to Xanthomonas arboricola pv. Pruni

O objetivo deste trabalho foi avaliar a compatibilidade de enxertia, a suscetibilidade à bacteriose e a frutificação de oito combinações, assim como, a influência da compatibilidade sobre a severidade da doença e a frutificação do pessegueiro. O experimento foi realizado ao nível de campo, sob infecção natural da bactéria, no Centro Agropecuário da Palma, pertencente à FAEM/UFPel, em Capão do Leão-RS. Foram avaliadas as combinações entre as cultivares 'Chimarrita' e Maciel e os porta-enxertos 'Aldrighi', 'Capdeboscq', 'Tsukuba 1' e 'Umezeiro'. O pomar foi implantado em delineamento experimental de blocos casualizados com quatro repetições, sendo cada unidade experimental composta de cinco plantas. Foi avaliada, a compatibilidade de enxertia, o diâmetro do caule, a severidade de dano e o índice de doença, a área foliar e a frutificação. As combinações entre as cultivares 'Chimarrita' e 'Maciel' e o porta-enxerto 'Umezeiro', apresentaram menor compatibilidade de enxertia, maior severidade de dano e índice de bacteriose, além de menor frutificação que as demais. Os resultados obtidos possibilitaram concluir que as combinações 'Chimarrita'/'Umezeiro' e 'Maciel'/'Umezeiro' são incompatíveis, além de, mais suscetíveis à bacteriose e menos produtivas, comparadas às demais. Pode-se dizer também, que a incompatibilidade de enxertia induz maior suscetibilidade das plantas à infecção por bacteriose, resultando em maior severidade da doença e menor frutificação.

The objective of this study was to evaluate the graft compatibility, susceptibility to bacterial leaf spot and fruiting on eight combinations, as well as the influence of graft compatibility in the severity of the disease and fruiting. The research was conducted at the field under natural bacterial infection, in the Agricultural Center of Palma, belonging to the FAEM/UFPel, in Capão do Leão-RS. It was evaluated the combinations composed by grafting among the 'Chimarrita' and 'Maciel' cultivars and the rootstocks 'Aldrighi', 'Capdeboscq', 'Tsukuba 1' and 'Umezeiro'. The orchard was implanted in a randomized block design with four replications, each experimental unit composed of five plants. The graft compatibility, stem diameter, injury severity, disease index, leaf area and fruiting were evaluated. The combinations between 'Chimarrita' and 'Maciel' cultivars and 'Umezeiro' rootstocks showed lower graft compatibility, highest injury severity, disease index, as well as, lower fruiting. The results obtained allow to conclude that 'Chimarrita'/'Umezeiro' and 'Maciel'/ 'Umezeiro' combinations are incompatibles, more susceptible to bacterial leaf spot and less productive compared to the others. Furthermore, the graft incompatibility induces higher susceptibility of plants to bacterial leaf spot infection, resulting in greater disease severity and lower fruiting.