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There is scarce research on the use of black soldier fly larvae (BSFL) meal in the diets of Atlantic salmon (Salmo salar) reared in a real farm. Thus, the current study aimed to evaluate the effect of feeding BSFL meal to salmon in terms of fillet quality and sensory analysis at farm level conditions. Fish were fed a total of three diets (pellet size; 4.5 mm and 9 mm); a control diet (Control: 0% BSFL meal) formulated using a standard commercial recipe, containing FM (10%) and plant-based proteins. Two experimental diets were formulated using partially defatted BSFL meal (53% crude protein), in which plant-based proteins at 37% inclusion level from the control diet (4.5 mm pellets) were replaced by BSFL meal at 5% (BSFL 5%) and 10% (BSFL 10%). While for the 9.0 mm pellets, plant-based proteins at 35% were replaced by the BSFL meal at 5% and 10% inclusion level. All the three diets were formulated to be iso-nitrogenous and iso-lipidic diets. Diets were assigned to the sea-cages in triplicate (12 ×12 m; 1900 m3); housing ∼6000 fish per cage from 173 ± 2.7 g to harvest size 3.45 ± 74 kg for a period of 13 months. Feeding salmon with BSFL meal had no negative impact on the general fillet physical, chemical, and nutritional parameters. The fillet sensory evaluation showed that the control samples were associated with the typical attributes such as fresh salmon taste, while BSLF 10% to rancid taste but these attributes were not significantly different among the dietary groups. Overall, the current study showed that diet containing BSFL meal did not affect the general fillet parameters compared to salmon fed a commercial diet and thus validate the inclusion of BSFL meal up to 10% reared for a whole production cycle in sea cages.

Microplastics (MPs) pose one of the major environmental threats to marine organisms and ecosystems on a global scale. Although many marine crustaceans are highly susceptible to MPs pollution, the toxicological effects and mechanisms of MPs on crustaceans are poorly understood. The current study focused on the impacts of MPs accumulation in shrimp Litopenaeus vannamei at the behavioral, histological and biochemical levels. The results demonstrated the accumulation of polystyrene MPs in various organs of L. vannamei, with highest MPs abundance in the hepatopancreas. The MPs accumulated in shrimp caused growth inhibition, abnormal swimming behavior and reduced swimming performance of L. vannamei. Following MPs exposure, oxidative stress and lipid peroxidation were also observed, which were strongly linked to attenuated swimming activity of L. vannamei. The above MPs-induced disruption in balance of antioxidant system triggered the hepatopancreatic damage in L. vannamei, which was exacerbated with increasing MPs concentrations (from 0.02 to 1 mg L−1). Furthermore, metabolomics revealed that MPs exposure resulted in alterations of metabolic profiles and disturbed glycolysis, lipolysis and amino acid metabolism pathways in hepatopancreas of L. vannamei. This work confirms and expands the knowledge on the sublethal impacts and toxic modes of action of MPs in L. vannamei.

Insects are a natural source of feed for fish and have received more attention as a potential source of sustainable high-quality protein. However, contrasting results in different feeding trials have been ascribed to the chitin contained in the exoskeleton of insects and highlighted the importance of developing reliable methods for the quantification of chitin to draw meaningful conclusions about its effect on fish health. A rapid method based on the hydrolysis of chitin into glucosamine and further quantification by liquid chromatography tandem mass spectrometry is evaluated. The method offers good selectivity, linearity, limit of detection (1.08 × 10−5 % w/v or 5.38 × 10−4 % w/w), limit of quantification (3.26 × 10−5 % w/v or 1.63 × 10−3 % w/w), trueness (88.39–109.29 %) and precision (2.24–10.72 %). The quantitative method was successfully applied to real samples of fish feed supplemented with chitin from black soldier fly (Hermetia illucens) larvae.

A simple and rapid method for the extraction of D-series resolvins (RvD1, RvD2, RvD3, RvD4, RvD5) released into Leibovitz’s L-15 complete medium by head kidney cells from Atlantic salmon and the further determination of liquid chromatography triple quadrupole mass spectrometry is proposed. A three-level factorial design was proposed to select the optimal concentrations of internal standards that were used in the evaluation of the performance parameters, such as linear range (0.1–50 ng mL−1), limits of detection and quantification (0.05 and 0.1 ng mL−1, respectively), and recovery values ranging from 96.9 to 99.8%. The optimized method was used to determine the stimulated production of resolvins by head kidney cells exposed to docosahexaenoic acid, and the results indicated that it is possible that the production was controlled by circadian responses.

Polyunsaturated fatty acids such as arachidonic and eicosapentaenoic acids are the precursors of eicosanoid metabolites (e.g prostaglandins and prostacyclins) which regulate inflammatory and immune response processes in fish organs. The present research studies the differential production of PGI2, PGI3, PGE2 and PGE3 by primary liver and head kidney cells isolated from salmon and challenged with single or combined ARA and/or EPA. There was a significant increase in the production of PGE2 and PGI3 in both types of cells after exposure to single and combined fatty acids. Increased production of PGE3 was only detected in liver cells after exposure to ARA+EPA. The levels of PGI2 in liver cells were significantly increased after exposure to all the tested fatty acid systems, while the production levels in head kidney cells were only significant after exposure to ARA or ARA+EPA, but not to EPA, where the production was non-significantly decreased compared to the control cells. In general, liver cells synthetized higher prostaglandin levels than prostacyclins, and the opposite was observed in head kidney cells, which synthetized highly remarkable amounts of prostacyclin compared to liver cells. The overall production for both types of cells and various fatty acid systems were characterized by a high proportion of the omega-3 fatty acid metabolites (PGE3+PGI3) compared to the omega-6 counterpart (PGE2+PGI2). Some potential production mechanisms are proposed and comprehensively discussed. The results of the present research are the first to deliver the differential production of prostacyclins and prostaglandins by liver and head kidney cells from salmon, thereby paving the way for understanding the significance of these prostanoids in fish physiology and disease.

ABSTRACT Objective: To evaluate awareness of prostate cancer in the population of the city of São Paulo. Methods: A total of 392 adults were randomly interviewed on public spaces in the city of São Paulo, and answered a questionnaire that addressed demographic questions and specific knowledge about the prostate cancer. A score was used to assess awareness of cancer in general, and of prostate cancer, considering satisfactory knowledge a score of 6 points. Results: The mean age was 36.9 years (standard deviation of ±12.6) and 58.2% of participants were male. No previous contact with information related to prostate cancer was reported by 45.5% of participants. For these cases, a greater proportion was observed among men aged over 50 years. As to the score, the mean was 3.7 (standard deviation of ±1.3), with a positive correlation among higher scores, higher income and education level. Less than 5% of participants believed they should only search for prostate cancer screening when symptomatic. Finally, among the less frequent responses to risk factors for prostate cancer, is “ethnic origin” (2.8%). Conclusion: Even though most participants did not have a satisfactory score, the level of awareness demonstrated in this study seems superior to that of other populational series. Hence it suggested the assessed population understood some essential concepts in prostate cancer, such as the importance of screening and the follow-up. The efforts made by the Sociedade Brasileira de Urologia on educational campaigns partially explain this. However, working in some concepts, like identifying risk factors for prostate cancer, might optimize screening outcomes.

Vitamin D is an essential vitamin for the normal formation of bones and calcium absorption. It is synthesized into our body through sunlight exposure and obtained by consuming foods rich in vitamin D (e.g., fatty fish, eggs yolk, dairy products). Its benefits on the health and performance of athletes are well documented. This article outlines some analytical challenges concerning the analytical quantification of vitamin D for its optimal intake, namely, a comprehensive study of the variability of the assay before categorizing any method as the golden standard, assurance of sample comparability to draw meaningful correlations, revision of the intake guidance based on appropriate statistical power analysis, and the implementation of rational strategies for preventing the underlying mechanism of preanalytical factors. Addressing these challenges will enable the effective management of vitamin D in the sports sector.

Serotonin (5-HT) is pivotal in the complex regulation of gut motility and consequent digestion of nutrients via multiple receptors. We investigated the serotonergic system in an agastric fish species, the ballan wrasse (Labrus bergylta) as it represents a unique model for intestinal function. Here we present evidence of the presence of enterochromaffin cells (EC cells) in the gut of ballan wrasse comprising transcriptomic data on EC markers like adra2a, trpa1, adgrg4, lmxa1, spack1, serpina10, as well as the localization of 5-HT and mRNA of the rate limiting enzyme; tryptophan hydroxylase (tph1) in the gut epithelium. Second, we examined the effects of dietary marine lipids on the enteric serotonergic system in this stomach-less teleost by administrating a hydrolyzed lipid bolus in ex vivo guts in an organ bath system. Modulation of the mRNA expression from the tryptophan hydroxylase tph1 (EC cells isoform), tph2 (neural isoform), and other genes involved in the serotonergic machinery were tracked. Our results showed no evidence to confirm that the dietary lipid meal did boost the production of 5-HT within the EC cells as mRNA tph1 was weakly regulated postprandially. However, dietary lipid seemed to upregulate the post-prandial expression of tph2 found in the serotonergic neurons. 5-HT in the intestinal tissue increased 3 hours after “exposure” of lipids, as was observed in the mRNA expression of tph2. This suggest that serotonergic neurons and not EC cells are responsible for the substantial increment of 5-HT after a lipid-reach “meal” in ballan wrasse. Cells expressing tph1 were identified in the gut epithelium, characteristic for EC cells. However, Tph1 positive cells were also present in the lamina propria. Characterization of these cells together with their implications in the serotonergic system will contribute to broad the scarce knowledge of the serotonergic system across teleosts.

This study proposes a performance index for the dimensional optimization of parallel manipulators with specific tasks. In particular, the index evaluates the dexterity of the mechanism to be designed and compares it with that of the required specific task, e.g., rehabilitation tasks. The proposed index is implemented to design a 3UPS + RPU parallel manipulator for performing physical rehabilitation treatments on lower limbs. First, the condition numbers of both the mechanism and the lower limb are determined. Subsequently, the indexes are compared such that both systems exhibit similar dexterity. As a case study, the approach is implemented in the dimensional synthesis of the 3UPS + RPU parallel manipulator. The optimization approach enables obtaining a dexterity space of the mechanism that best matches that of the lower limb. The results are graphically presented, showing the matching areas of both workspaces, verifying the effectiveness of the proposed index.

El empleo de canales de exportación independientes es la forma más extendida de exportación, si bien la ausencia de propiedad dificulta su gestión y afecta al rendimiento exportador. Dado el creciente interés académico y profesional por mejorar la gestión de los procesos de exportación de las empresas y la laguna existente en el estudio de las relaciones inter-organizativas orientadas al mercado (down-stream), se plantea como objetivo del presente estudio la exploración de los sistemas de control de gestión (SCG) en el contexto de los canales de exportación, desde la perspectiva de la empresa exportadora. Mediante la realización de un estudio cualitativo exploratorio, se pretende contribuir a la literatura sobre los SCG inter-organizativos ampliando su ámbito de interés a las relaciones down-stream de la cadena de suministros, esenciales para la competitividad de muchas empresas. Frente a estudios previos sobre SCG enfocados en relaciones proveedor-comprador, los resultados muestran que las empresas exportadoras analizadas (1) emplean múltiples mecanismos de control, principalmente cualitativos, que (2) se caracterizan por su ámbito amplio y la oportunidad en el tiempo, así como por sus bajos niveles de integración y agregación, y (3) usan algunos mecanismos -p.e., reuniones con los intermediarios- de modo interactivo, mientras que otras herramientas -p.e., contratos y acuerdos- son usadas de modo diagnóstico. Asimismo, la evidencia sugiere que la definición de sistemas formales en este contexto puede diferir de la tradicional, con amplias repercusiones sobre los marcos de análisis de los sistemas de control de gestión.

Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5) vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

Black soldier fly (Hermetia illucens) larvae are a promising source of protein and lipid for animal feeds. The nutritional composition of the BSF larvae depend partly on the composition of the feeding medium. The BSF lipid profile in part mimics the feeding media lipid profile, and micronutrients, like minerals and vitamins, can readily accumulate in black soldier fly larvae. However, investigative studies on bioconversion and accumulation of nutrients from media to black soldier fly larvae are scarce. Here we show that inclusion of the brown algae Ascophyllum nodosum in the substrate for black soldier fly larvae can introduce valuable nutrients, commonly associated with the marine environment, into the larvae. The omega-3 fatty acid eicosapentaenoic acid (20:5n-3), iodine and vitamin E concentrations increased in the larvae when more seaweed was included in the diet. When the feeding media consisted of more than 50% seaweed, the larvae experienced poorer growth, lower nutrient retention and lower lipid levels, compared to a pure plant based feeding medium. Our results confirm the plasticity of the nutritional make-up of black soldier fly larvae, allowing it to accumulate both lipid- and water-soluble compounds. A broader understanding of the effect of the composition of the feeding media on the larvae composition can help to tailor black soldier fly larvae into a nutrient profile more suited for specific feed or food purposes.

OBJETIVO: A haste intramedular (HIM) é o padrão ouro no tratamento das fraturas diafisárias da tíbia. Uma das complicações frequentes é a dor no joelho após o procedimento. MÉTODOS: Vias alternativas, como a suprapatelar para a introdução da haste como opção para evitar a dor no joelho no período pós-operatório tardio, têm sido estudadas. A questão é se nesta nova via ocorre alguma lesão às estruturas intra-articulares do joelho. RESULTADOS: Este estudo analisa a via suprapatelar e o risco para as estruturas adjacentes através da sua reprodução em 10 joelhos de cinco cadáveres. CONCLUSÃO: Foi visto facilidade para a localização do ponto de entrada por esta via, lesando apenas a gordura de Hoffa. Em três dos nossos casos houve lesão da superfície condral, sendo um obstáculo de difícil transposição e indicando necessidade de fabricação de material específico para minimizar a lesão das estruturas intra-articulares por essa via.OBJECTIVE: Intramedullary nails are the gold standard for treating tibial shaft fractures. Knee pain is a frequent complication after the procedure. Alternative routes such as the suprapatellar approach for nail insertion are seen as an option for avoiding late postoperative knee pain. The question is whether this approach might give rise to any injury to intra-articular structures of the knee. METHODS: This study analyzed the suprapatellar approach and the risk to adjacent structures by reproducing it in 10 knees of five cadavers. RESULTS: This approach was seen to make it easy to locate the entry point, with lesions only occurring in the Hoffa fat. In three of our cases, there were lesions of the chondral surface, which is an obstacle that is difficult to overcome. CONCLUSION: There is a need to develop specific material to minimize injury to intra-articular structures when using this route.

El empleo de canales de exportación independientes es la forma más extendida de exportación, si bien la ausencia de propiedad dificulta su gestión y afecta al rendimiento exportador. Dado el creciente interés académico y profesional por mejorar la gestión de los procesos de exportación de las empresas y la laguna existente en el estudio de las relaciones inter-organizativas orientadas al mercado (down-stream), se plantea como objetivo del presente estudio la exploración de los sistemas de control de gestión (SCG) en el contexto de los canales de exportación, desde la perspectiva de la empresa exportadora. Mediante la realización de un estudio cualitativo exploratorio, se pretende contribuir a la literatura sobre los SCG inter-organizativos ampliando su ámbito de interés a las relaciones down-stream de la cadena de suministros, esenciales para la competitividad de muchas empresas. Frente a estudios previos sobre SCG enfocados en relaciones proveedor-comprador, los resultados muestran que las empresas exportadoras analizadas (1) emplean múltiples mecanismos de control, principalmente cualitativos, que (2) se caracterizan por su ámbito amplio y la oportunidad en el tiempo, así como por sus bajos niveles de integración y agregación, y (3) usan algunos mecanismos -p.e., reuniones con los intermediarios- de modo interactivo, mientras que otras herramientas -p.e., contratos y acuerdos- son usadas de modo diagnóstico. Asimismo, la evidencia sugiere que la definición de sistemas formales en este contexto puede diferir de la tradicional, con amplias repercusiones sobre los marcos de análisis de los sistemas de control de gestión.Independent export channels are the most common exporting entry mode, although the lack of ownership hinders their management and affects export performance. Given the growing academic and professional interest to improve export processes’ management and the existent gap in the study of down-stream inter-organisational relationships, the present study aims at the exploration of management control systems (MCS) in the context of export channels. From the perspective of exporting firms, this exploratory qualitative study contributes to the literature on inter-organisational MCS enlarging its scope of interest to down-stream supply chain relationships, essential for the competitiveness of many firms.Whereas previous studies focused on seller-buyer relationships, the results show that the analysed exporting firms (1) use multiple control mechanisms, mainly qualitative; (2) these MCS are characterised by their wide scope and opportunity, as well as their low integration and aggregation; and (3) exporting firms use some mechanisms -e.g., meetings with intermediary firms- in an interactive way, while other tools -e.g., contracts and agreementsare used in a diagnostic way. Also, the evidence suggests that the definition of formal systems in this context can differ from the traditional one, with wide repercussions on the MCS analysis frameworks.

Esta investigación contribuye al conocimiento sobre los sistemas de control de gestión (SCG) en las relaciones inter-organizativas introduciendo la diversidad de género de la persona responsable de la dirección frontera. A través de un análisis cuantitativo exploratorio desarrollado en el contexto de la gestión de los canales de exportación externalizados, se investiga el efecto de las diferencias de género en el nivel de implantación de los diversos tipos de control (de resultados, de comportamiento y social) y en el modo de uso (diagnóstico e interactivo) de los SCG. Los resultados no evidencian diferencias significativas asociadas al género en cuanto al grado de implantación de los tipos de control ni a la utilidad e importancia conferida a los modos de uso de la información de los SCG. No obstante, los resultados sí indican una cierta preferencia de las mujeres por el uso interactivo, acorde con las habilidades y características socialmente atribuidas a su género.This research is intended to contribute to knowledge about the role of management control systems (MCS) in interorganisational relationships analysing gender diversity of boundary managers. By means of an exploratory quantitative analysis in the setting of externalized export channels, we research the effect of gender differences on implementation level of MCS control types (output, behaviour and social controls) and on MCS use mode (diagnostic and interactive uses). Results do not show significant differences related to gender regarding level of implementation of control types, or utility and importance conferred to use modes of MCS information. Notwithstanding, results suggest a slight preference of women for interactive use, according to skills and characteristics socially attributed to this gender.

ABSTRACT: Protozoal diseases caused by species of Sarcocystis can cause serious damage in sheep flocks, inducing decreased growth conversion rates and partial or complete loss of carcasses at the slaughterhouse. This article describes an outbreak of Sarcocystis gigantea infection in sheep slaughtered in a farm in Rio Grande do Sul State, Brazil. Between July and September 2013, three sheep showed multiple nodules in the esophagus that were microscopically characterized as encapsulated cysts filled with elongated, basophilic, nucleated structures morphologically consistent with S. gigantea bradyzoites. Diagnosis was made based on the epidemiological, macroscopic, and microscopic findings. This is the first report of this infection in sheep in Rio Grande do Sul and should be recognized by veterinarians, especially during meat inspection.

O Rio de Janeiro já vivencia a rotina de sede dos megaeventos. Assim, no intuito de promover políticas públicas, o Estado imprime intervenções para obras de infraestrutura. Nesta linha, a desapropriação ganha espaço enquanto ato/procedimento de direito público utilizado pelo Estado para apropriar-se do bem de terceiro, com fundamento no interesse social ou utilidade pública, de forma que esse terceiro pode entender-se prejudicado. Soma-se a preocupação com os reflexos imediatos na realidade social e nos direitos fundamentais, apresentando-se a contextualização e a justificativa da presente pesquisa. O objetivo é verificar o interesse público nessas desapropriações. Para tanto, foram estabelecidas duas vertentes de pesquisa relacionadas aos momentos práticos da desapropriação: (i) a verificação dos Decretos municipais para desapropriação; e (ii) a análise de ações judiciais. No que tange ao primeiro item, trabalha-se com a hipótese de que o Poder Executivo não aprofunda a análise do interesse público na desapropriação. Quanto ao segundo item, busca-se analisar o acesso ao Judiciário pelo desapropriado para contestar o mérito da desapropriação. Em paralelo, são estudados os conceitos de interesse público, o mérito, a discricionariedade, bem como a motivação dos atos administrativos, à luz do Direito-Administrativo Constitucional.

Based on the study of unemployment experiences of female ex-workers in a ceramics factory in Coimbra (Centre Region of Portugal), that went bankrupted in 2001, this article consists of two main parts. The first part discusses the outline of the analytic grid used in the qualitative research to understand unemployment experiences, and presents some of the main results obtained. The second part highlights the unemployment lived experiences of two women - Teresa and Andreia. It is argued that for unemployed older women in Portugal two main trends emerge: traced destinies, which express themselves through a higher investment in the private sphere; and, foreclosed futures, visible by a sharp reduction in the possible professional options available. These are two trends that, although always present in the Portuguese social configuration and in the labour market organisation, are also relevant to women’s unemployment experiences.

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The uncoupling protein 1 (UCP1) is a hallmark of brown adipocytes and pivotal for cold- and diet-induced thermogenesis.Here we report that cyclooxygenase (COX) activity and prostaglandin E(2) (PGE(2)) are crucially involved in induction of UCP1 expression in inguinal white adipocytes, but not in classic interscapular brown adipocytes. Cold-induced expression of UCP1 in inguinal white adipocytes was repressed in COX2 knockout (KO) mice and by administration of the COX inhibitor indomethacin in wild-type mice. Indomethacin repressed beta-adrenergic induction of UCP1 expression in primary inguinal adipocytes. The use of PGE(2) receptor antagonists implicated EP(4) as a main PGE(2) receptor, and injection of the stable PGE(2) analog (EP(3/4) agonist) 16,16 dm PGE(2) induced UCP1 expression in inguinal white adipose tissue. Inhibition of COX activity attenuated diet-induced UCP1 expression and increased energy efficiency and adipose tissue mass in obesity-resistant mice kept at thermoneutrality.Our findings provide evidence that induction of UCP1 expression in white adipose tissue, but not in classic interscapular brown adipose tissue is dependent on cyclooxygenase activity. Our results indicate that cyclooxygenase-dependent induction of UCP1 expression in white adipose tissues is important for diet-induced thermogenesis providing support for a surprising role of COX activity in the control of energy balance and obesity development.

Objective: Rare disease Background: Anal canal duplications (ACD) are rare in children older than 2 years old. While some patients are asymptomatic, others have a variety of nonspecific symptoms. The definitive treatment is surgical removal, but the best technique varies with each case based on the local situation and the location of the lesion. Case Reports: We present 2 cases of anal canal duplications in pediatric patients. Despite the atypical presentations of a concomitant cystic, a high suspicion of ACD led to surgical management using different techniques based on its location and local situation. The first patient had a sterile perianal abscess in the ischiorectal fossa, unresponsive to antibiotics and recurrent after surgical drainage. MRI revealed a fistula connecting the cyst to the exterior at the pectineal line, prompting a posterior approach for complete resection of the mass from the rectum. The second patient had an incidentally discovered ischiorectal mass. Imaging suggested a homogeneous cyst adhered to the rectal wall and easily accessible, leading to a successful robotic-assisted surgical resection. Both patients achieved complete anal sphincter function and full recovery postoperatively. Histological analysis in both cases presented typical characteristics found in ACD. Conclusions: Although ACD is rare in pediatric patients over 2 years of age, cystic or infected lesions in the ischiorectal fossa should be considered as differential diagnoses. Radiological imaging is crucial for understanding the cyst's location and determining the optimal surgical approach. As presented in our cases, an open posterior approach may be considered when the lesion is or has been complicated by previous infection, associated with a fistula, as opposed to non-complicated cases in which a mini-invasive approach may be ideal. [ABSTRACT FROM AUTHOR]