Sol-gel and Pechini niobium modified: synthesis, characterization and application in the 2,4-D herbicide degradation.

In this work, a comparison was made between the synthesis of niobium-based materials (Nb2O5), both in terms of material characterization and catalytic performance. The methods used were chemical mixtures: modified sol-gel and Pechini. The materials were calcined at different temperatures (753, 873 and 993K) and characterized by the following techniques: photoacousticspectroscopy (PAS), zero charge point (pHPZC), scanning electron microscopy (SEM/EDS), thermogravimetric analysis (TGA/DTG) and X-ray diffraction (XRD). The photocatalytic process was carried out to evaluate the degradation of 2,4-dichlorophenoxyacetic acid (2,4-D) under UV radiation (250 W mercury vapor lamp) and different experimental conditions. In addition, to better understand the influence of parameters such as pH, catalyst concentration (0.2, 0.5 and 0.8 g L-1) and calcination temperature, a Design of Experiments (DoE) was used. The results indicated that despite having similar structures and phases in the XRD analysis, the morphology presents two distinct surfaces, due to the preparation method. Differences in the synthesis method affected the catalytic activity in the parameters studied. Although the zero charge point values are close (6.18-6.36), we observed differences in the band gap depending on the calcination temperature. In the optimal condition studied, the catalyst prepared by the sol-gel method obtained the best results.

Texture image classification based on a pseudo-parabolic diffusion model.

This work proposes a novel method based on a pseudo-parabolic diffusion process to be employed for texture recognition. The proposed operator is applied over a range of time scales giving rise to a family of images transformed by nonlinear filters. Therefore each of those images are encoded by a local descriptor (we use local binary patterns for that purpose) and they are summarized by a simple histogram, yielding in this way the image feature vector. Three main novelties are presented in this manuscript: (1) The introduction of a pseudo-parabolic model associated with the signal component of binary patterns to the process of texture recognition and a real-world application to the problem of identifying plant species based on the leaf surface image. (2) We also introduce a simple and efficient discrete pseudo-parabolic differential operator based on finite differences as texture descriptors. While the work in [26] uses complete local binary patterns, here we use the original version of the local binary pattern operator. (3) We also discuss, in more general terms, the possibilities of exploring pseudo-parabolic models for image analysis as they balance two types of processing that are fundamental for pattern recognition, i.e., they smooth undesirable details (possibly noise) at the same time that highlight relevant borders and discontinuities anisotropically. Besides the practical application, the proposed approach is also tested on the classification of well established benchmark texture databases. In both cases, it is compared with several state-of-the-art methodologies employed for texture recognition. Our proposal outperforms those methods in terms of classification accuracy, confirming its competitiveness. The good performance can be justified to a large extent by the ability of the pseudo-parabolic operator to smooth possibly noisy details inside homogeneous regions of the image at the same time that it preserves discontinuities that convey critical information for the object description. Such results also confirm that model-based approaches like the proposed one can still be competitive with the omnipresent learning-based approaches, especially when the user does not have access to a powerful computational structure and a large amount of labeled data for training.

Complementary Approaches for Military Women with Chronic Pelvic Pain: A Randomized Trial.

Introduction: Active duty (AD) women suffer with chronic pelvic pain (CPP) while providers tackle diagnoses and treatments to keep them functional without contributing to the opioid epidemic. The purpose of this randomized trial was to determine the effectiveness of noninvasive, self-explanatory mindfulness-based stress reduction (MBSR) or self-paced healthy lifestyle (HL) interventions on CPP in AD women. Methods: A 6-week, interventional prospective study with AD women aged 21-55 years at Mountain Home (MTHM), Idaho, was conducted. Women were randomly assigned to MBSR (N = 21) or HL (N = 20) interventions. The primary outcome was pain perception. The secondary outcomes were depression and circulating cytokine levels. Results: Women in the MBSR group exhibited reduced pain interference (p < 0.01) and depression (p < 0.05) alongside decreased interleukin (IL)-4 (p < 0.05), IL-6 (p < 0.05), eotaxin (p < 0.05), monocyte chemoattractant protein-1 (p = 0.06), and interleukin-1 receptor antagonist (IL-1ra) (p < 0.01) and increased vascular endothelial growth factor (p < 0.05). Women in the HL group did not have changes in pain; however, they did exhibit reduced depression (p < 0.05) alongside decreased granulocyte-macrophage colony-stimulating factor (p < 0.05) and increased tumor necrosis factor alpha (p < 0.05), stromal cell-derived factor-1 (p < 0.01), and IL-1ra (p < 0.01). Conclusions: AD women receiving MBSR or HL had reduced depression scores and altered circulating cytokine levels; however, only those receiving MBSR had reduced pain perception. Findings support MBSR as an effective and viable behavioral treatment for AD women suffering from CPP and provide premise for larger randomized controlled studies. Clinical Trial Registration: MOCHI-An RCT of mindfulness as a treatment for CPP in AD Women NCT04104542 (September 26, 2019).

A Systematic Review of Nursing Practice Workarounds.

BACKGROUND: Nursing practice workarounds (NPWs) are a significant problem for health care organizations. Identified NPWs serve as a catalyst for innovation to improve efficiency, patient safety, and system design. To date, a systematic review of NPW literature has not been performed. OBJECTIVES: The aim of this systematic review was to synthesize evidence of NPW definitions, context, and prevention strategies, utilizing previous research to develop a framework that examines the current state of this phenomenon and implications for clinical practice, while highlighting the need for future research. METHODS: A systematic review of the literature was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Academic Search, Ovid MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar databases were reviewed for eligible studies from 2013 to 2020. Results were further screened and sorted by relevance and scored for quality. RESULTS: Thirteen studies were included. Studies lacked the use of theory, and NPW definitions were varied. Nursing workarounds occurred most frequently when implementing new technology (46%) and when administering medications (31%). Contributing factors were workplace stressors and obstructions in workflow environment. Workaround prevention strategies include open communication and a proactive approach addressing conditions, situations, and processes. Overall study quality was low. DISCUSSION: This systematic review provides valuable information for critical care nurses and administrators regarding NPW. Implications for practice include the need for proactive and open communication between nurses and administrators when new technology and/or patient care processes require NPW. Administrative considerations include process and environmental improvement strategies to remove perceived workflow barriers. Future research to examine causes and consequences of NPW is needed to identify interventions for NPW prevention. Specific nursing considerations include workload, staffing and time constraints, and impacts of work-related stress levels. Critical care nursing processes should be examined for common NPW challenges. Interventions developed to address these challenges should then be tested to further advance evidence-based critical care nursing care.

Cu/Nb2O5, Fe/Nb2O5 and Cu-Fe/Nb2O5 applied in salicylic acid degradation: Parameters studies and photocatalytic activity.

This study describes the synthesis of Cu/Nb2O5, Fe/Nb2O5, and Cu-Fe/Nb2O5 catalysts obtained by incorporating copper and/or iron metals into niobium pentoxide (Nb2O5). The new materials were characterized by the following techniques: Thermogravimetric Analysis (TA), surface and pore analysis, X-ray diffractometry (XRD), and Fourier Transform Infrared Spectroscopy (FT-IR). The catalyst was applied in the photocatalytic degradation of salicylic acid (SA). The influence of different parameters (calcined temperature, pH, and metal addition) on the photocatalytic reaction was evaluated. The results indicated that catalysts containing copper were more active and pH influenced the SA degradation process. SA removal results indicated that Cu/Nb2O5 photocatalyst presented a 1.5 fold higher degradation after 120 min in comparison to Cu-Fe/Nb2O5 and 4.6 fold higher than Fe/Nb2O5 catalyst, all them calcined at 400 °C. In tests carried out in the presence of formic acid, increasing the pH from about 3 to 7 allowed an almost 3.4-fold increase in SA degradation for the Cu-Fe/Nb2O5 catalyst calcined at 400 °C.

Musculoskeletal Biomarkers Response to Exercise in Older Adults.

Exercise is an essential component of any good health style, being particularly important for older adults to counteract the effects of aging, including sarcopenia and osteoporosis, which can result in lower fall probability. Exercise programs for older adults are especially designed for that population. A rigorous evaluation of those programs is necessary to assure most benefit is achieved. Serum biomarkers of proteins intrinsic to musculoskeletal homeostasis could contribute objectively to the assessment of the benefits of exercise. In this work, in addition to the usual physical fitness and balance tests, ELISA assays quantified the serum levels of six proteins and one polysaccharide important for the homeostasis of muscle (troponin T and alpha-actinin), tendon/ligament (tenomodulin), cartilage (cartilage oligomeric matrix protein and hyaluronan) and bone (osteocalcin and sclerostin), before and after 8 weeks of an exercise program tailored to older adults, Stay Strong Stay Healthy, offered at a Community Center and at an Independent Senior Living facility. Statistical significance was determined by non-parametric tests (Wilcoxon Signed Ranks and Mann-Whitney U). Physical fitness and balance improved as expected along with a significant decrease in sclerostin, pointing to less inhibition of bone deposition. However, when considering each type of dwelling separately, older adults always saw a significant decrease of the isoform of troponin T associated with fast-twitch muscles, suggesting that daily levels of physical activity may also have a role in the benefit of older adults from exercise.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches.

Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route ( p < 0.001), as well as lower hematimetric loss ( p < 0.001), shorter operative time ( p < 0.001), and improvement in immediate postoperative active mobility tests ( p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Fixation of Intertrochanteric Fractures with Dynamic Hip Screws: Randomized Controlled Trial Comparing Hardinge and Minimally Invasive Approaches / Fraturas intertrocantéricas fixadas com parafuso dinâmico de quadril: Ensaio clínico randomizado comparando a via lateral de Hardinge e o acesso minimamente invasivo

Abstract Objective To compare the techniques for the osteosynthesis of intertrochanteric fractures with dynamic hip screws (DHSs) through the Hardinge and minimally-invasive access routes of the hip, evaluating the operative time, the degree of pain in the immediate postoperative period, the hematimetric loss, and the functional aspects of active mobility. Methods A randomized, double-blinded clinical trial in which 66 patients with intertrochanteric fractures were submitted to osteosynthesis by DHS. The patients were divided into a test group, submitted to the minimally-invasive access, and a control group, in whom the surgery was performed through the Hardinge route. Results Patients submitted to the minimally-invasive treatment presented a lower degree of postoperative pain compared to the group treated by the Hardinge lateral route (p< 0.001), as well as lower hematimetric loss (p< 0.001), shorter operative time (p< 0.001), and improvement in immediate postoperative active mobility tests (p <0.05). Conclusion The study demonstrated the clinical superiority of the minimally-invasive access route parameters analyzed in relation to the Hardinge access for the fixation of intertrochanteric fractures when DHS is the choice osteosynthesis method. Level of evidence I.

Resumo Objetivo Comparar as técnicas de osteossíntese de fraturas intertrocantéricas com o parafuso dinâmico de quadril (dynamic hip screw, DHS, em inglês) pelas vias de acesso de Hardinge e minimamente invasiva do quadril, avaliando o tempo cirúrgico, o grau de dor no pós-operatório imediato, a perda hematimétrica, e os aspectos funcionais de mobilidade ativa. Métodos Estudo clínico randomizado e duplo-cego, em que 66 pacientes com fratura intertrocantérica foram submetidos a osteossíntese com DHS. Os pacientes foram divididos em um grupo teste, submetidos ao acesso minimamente invasivo, e um controle, em que a cirurgia foi realizada pela via de Hardinge. Resultados Os pacientes submetidos ao tratamento pela via minimamente invasiva apresentaram um grau de dor pós-operatória inferior em comparação ao grupo tratado pela via lateral de Hardinge (p< 0,001), assim como menor perda hematimétrica (p< 0,001), menor tempo operatório (p< 0,001), e melhora nos testes de mobilidade ativa pós-operatória imediata (p< 0,05). Conclusão O estudo demonstrou a superioridade clínica nos parâmetros analisados da via de acesso minimamente invasiva em relação ao acesso de Hardinge para a fixação de fraturas intertrocantéricas, quando o DHS for a opção de osteossíntese escolhida. Nível de evidência I.

Continuous process applied to degradation of triclosan and 2.8-dichlorodibenzene-p-dioxin.

This study describes the use of a prototype for the continuous photocatalytic reaction process using Fe/Nb2O5-immobilized catalyst for triclosan and 2.8-dichlorodibenzene-p-dioxin (2.8-DCDD)'s degradation. The experiments were carried out with different parameters and matrices in a steady state. In addition, photolysis and photocatalytic tests were performed. The results indicated that the generation of 2.8-DCDD was observed in matrices with Cl-. The Fe/Nb2O5-immobilized catalysts were efficient in the degradation of triclosan and 2.8-dichlorodibenzene-p-dioxin. However, 2.8-DCDD formation was not observed in the ultra-pure water matrix, which indicated influence of ions. The photocatalysis was more efficient than the photolysis when comparing both matrices and radiation. Even with a radiation oscillation, the solar process showed positive results.

Sincondrose Dolorosa da Patela ­ uma causa incomum de dor no joelho / Patellar painful Synchondrosis ­ An uncommon cause of knee pain

A patela é o maior osso sesamoide do corpo humano, posicionado longitudinalmente na fáscia do músculo quadríceps, entre os tendões quadríceps e patelar. A patela bipartida dolorosa, também conhecida como "sincrondose dolorosa", é uma causa conhecida de dor no joelho anterior, é um diagnóstico de exclusão. Objetivo: Relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: Revisão do prontuário do paciente no Hospital Luxemburgo, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: Homem de 45 anos com dor no joelho direito há 01 ano, principalmente na região anterior, que piora ao agachar. Ao exame físico apresenta edema com dor a palpação da patela. A radiografia demonstra patela bipartida. A ressonância magnética (RM) do joelho direito demonstra patela bipartida com união fibrosa entre o fragmento bipartido superolateral e a patela, associada a lesões condrais e edema subcondrais, compatível com "sincondrose dolorosa" da patela. Conclusão: Este relato demonstra a dificuldade de diagnosticar está lesão, pois seu o exame físico é inespecífico e a radiografia demonstra apenas a variação da normalidade ­ patela bipartida, sem evidenciar as alterações próprias da doença, caracterizada apenas pela RM.

The patella is the largest sesamoid bone in thehuman body, positioned longitudinally in the quadriceps muscle fascia, between the quadriceps and patellar tendons. The painful bipartite patella, also known as "painful synchondrosis", is a known cause of anterior knee pain, is a diagnosis of exclusion.Objective: Report a case and review the literature about this uncommon lesion. Materials and Methods: We carried out a review of medical records at Hospital Luxemburgo, a photographic record of diagnostic methods, and a review from the literature. Results: 45-year-old man with right knee pain for 1 year, mainly in the anterior region, which worsens when crouching. Physical examination shows edema with pain on palpation of the patella. Right knee radiography demonstrates a bipartite patella. Magnetic resonance imaging (MRI) of the right knee demonstrates a bipartite patella with a fibrous union between the superolateral bipartite fragment and the patella, associated with chondral lesions and subchondral edema, compatible with patella "painful synchondrosis". Conclusion: This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is nonspecific and the radiography shows only the normal variation ­ bipartite patella, without evidencing the disease alterations, characterized only by MRI.

Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis.

INTRODUCTION: Patients admitted to the hospital with sepsis are 8 times more likely to die than patients with other diagnoses. There is no diagnostic test that clearly identifies the presence of the dysregulated host response that is central to sepsis. Researchers have identified serum albumin as a possible predictor of mortality in a number of critically ill patient populations. However, these studies primarily focus on the levels on admission, neglecting the clinically significant decrease that occurs subsequently. The purpose of this study was to examine the relationship between the trend of serum albumin over time and mortality in adults admitted to the intensive care unit (ICU) with sepsis. METHODS: This retrospective, correlational study used existing medical record data. All patients admitted to the ICU at a Midwestern regional medical center with a primary sepsis diagnosis were included in the initial sample. Logistic regression analysis was used to assess the ability of serum albumin to predict mortality. RESULTS: Serum albumin trend, admission serum albumin level, and lowest serum albumin level were significant unique predictors of mortality. The probability of survival decreases by 70.6% when there is a strong negative trend in serum albumin level, by 63.4% when admission serum albumin is ≤2.45 g/dl, and by 76.4% when the lowest serum albumin is ≤1.45 g/dl. CONCLUSION: Clinicians are encouraged to measure serum albumin levels in patients with sepsis. Low serum albumin levels and a strong negative trend in serial measurements should instigate aggressive monitoring and treatment in this population.

Neural control of postural sway: Relationship to strength measures in young and elderly adults.

Age-related changes in postural sway are well-established, and studied from a control perspective using an inverted pendulum model. The purpose of the present work was to expand previous research in this area by investigating relationships between sway-related control parameters and musculoskeletal measures of muscle function and health. Eleven female older adults and eight female young adults completed blood draw, grip, leg extension, and balance tests. Serum levels of skeletal muscle-specific troponin T (sTnT), a biomarker for muscle health, were obtained from blood samples. Maximal grip force and leg extension torque were obtained from dynamometer tests. Center of pressure parameters were derived from force platform records obtained during eyes open and eyes closed balance tests. Sway control parameters were derived from an inverted pendulum model with PID-feedback control. Regression analyses were used to quantify the relationship between model parameters and grip strength, leg strength, and sTnT. Model integral gain (Ki) was observed to significantly predict grip strength in the eyes open condition. In the eyes closed condition, model derivative gain (Kd) was observed to significantly predict sTnT, and both proportional (Kp) and noise (Kn) model gains were observed to significantly predict grip and leg strength measures. Collectively, the relationship between control (Ki, Kd, Kp) and musculoskeletal health (strength, sTnT) parameters suggests a compensation mechanism, which may have served to minimize effects of reduced muscle function on sway amplitude, overshoot, and accuracy. Most associations were observed during eyes closed conditions, suggesting that visual input plays a larger role in regulating balance than the proposed compensation mechanisms. This work highlights the potential use for both strength and sTnT tests as biomarkers for postural control and balance impairment in older adults.

Metástase muscular em paciente jovem com carcinoma vulvar ­ uma complicação incomum / Muscular metastasis in a young patient with vulvar carcinoma ­ an unusual complication

A neoplasia vulvar representa 5% dos casos de câncer ginecológicos, sendo mais comum o carcinoma de células escamosas. Esse tipo de acometimento totaliza apenas 0,5% de todos os tipos malignos e acomete em sua maioria mulheres com idade superior a 70 anos. Apesar da dissecção cirúrgica ser padrão de tratamento para controle da doença, o índice de metástase é mais prevalente em linfonodos locais em torno de 20,5% enquanto linfonodos à distância 12,9%, seguido de disseminação menos comum para fígado, pulmão e ossos. O presente trabalho tem como objetivo expor o relato de caso de uma paciente de 37 anos com histórico de neoplasia maligna de vulva com disseminação para linfonodos inguinais, que mesmo após tratamento adequado, identificou-se via ressonância magnética disseminação metastática para corpos vertebrais, musculatura paravertebral dorsal e lombar, fato raro e pouco descrito na literatura

Vulvar neoplasm represents 5% of cases of gynecological cancer, and squamous cell carcinoma is more common. This type of involvement represents only 0.5% of all malignant types and affects mainly women over 70 years old. Although surgical dissection is a standard treatment for disease control, the metastasis index is more prevalent in local lymph nodes around 20.5% while distance lymph nodes at 12.9%, followed by less common spread to liver, lung and bone. The objective of this study was to present a case report of a 37-year-old female patient with a history of malignant vulvar neoplasia with dissemination to inguinal lymph nodes, which, even after adequate treatment, was identified by magnetic resonance imaging metastatic dissemination to vertebral bodies, paravertebral musculature dorsal and lumbar, a rare fact and little described in the literature

Functional Redundancy in bird community decreases with riparian forest width reduction.

Riparian ecosystems are suffering anthropogenic threats that reduce biodiversity and undermine ecosystem services. However, there is a great deal of uncertainty about the way species composition of assemblages is related to ecosystem function, especially in a landscape fragmentation context.Here, we assess the impact of habitat loss and disturbance on Functional Diversity (FD) components Functional Redundancy (FRed), Functional Evenness (FEve), and Functional Richness (FRic) of riparian forest bird assemblages to evaluate (a) how FD components respond to riparian forest width reduction and vegetation disturbance; (b) the existence of thresholds within these relationships; (c) which of the main birds diet guild (frugivores, insectivores, and omnivores) respond to such thresholds. We predict that FD components will be affected negatively and nonlinearly by riparian changes. However, guilds could have different responses due to differences of species sensitivity to fragmentation and disturbance. We expect to find thresholds in FD responses, because fragmentation and disturbance drive loss of specific FD components.Our results show that FRed and FEve were linearly affected by width and disturbance of riparian habitats, respectively. FRed was significantly lower in riparian forests assemblages below 400 m wide, and FEve was significantly higher above 60% disturbance. These responses of FD were also followed to the decline in insectivores and frugivores richness in riparian forests most affected by these changes.Consequently, our study suggests communities do not tolerate reduction in riparian forest width or disturbance intensification without negative impact on FD, and this becomes more critical for riparian area <400-m wide or with more than 60% disturbance. This minimum riparian width required to maintain FRed is greater than the minimum width required for riparian forests by Brazilian law. Thus, it is important to consider mechanisms to expand riparian habitats and reduce the disturbance intensity in riparian forests so that riparian bird community FD may be effectively conserved.

Effectiveness of treatment of transtrochanteric fractures with Dynamic Hip Screws using minimally invasive access.

OBJECTIVE: To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. METHODS: This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients' mean age was 80 years, ranging from 60 to 93 years. RESULTS: We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. CONCLUSION: Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation.

OBJETIVO: Analisar os resultados do tratamento de fraturas transtrocantéricas instáveis com o Dinamic Hip Screw (DHS) por via minimamente invasiva e avaliar aspectos funcionais, taxas de complicação e óbitos do método, em curto prazo. MÉTODOS: Trata-se de um estudo longitudinal prospectivo, com 140 pacientes submetidos à fixação de fraturas transtrocantéricas com sistema DHS, com acesso minimamente invasivo lateral do quadril, de janeiro a dezembro de 2013. Os pacientes foram avaliados pré e pós-operatoriamente (com seis meses de seguimento), de acordo com o escore de mobilidade de Parker e Palmer. A amostra apresentou 65,7% de mulheres, com o lado direito mais acometido (54,3%). A média de idade foi de 80 anos, variação entre 60 e 93. RESULTADOS: Notamos uma diminuição global no escore de mobilidade e aumento no grau de dependência desses pacientes em curto prazo. No entanto, obtivemos apenas dois óbitos na amostra estudada e nenhuma infecção ou falha na consolidação das fraturas. CONCLUSÃO: Apesar da eficácia do tratamento com DHS, com elevados índices de consolidação e baixa taxa de mortalidade, notamos que os pacientes, ainda assim, apresentam uma limitação funcional significativa no seguimento até seis meses pós-operatórios.

Effectiveness of treatment of transtrochanteric fractures with dynamic hip screws using minimally invasive access / Eficácia do tratamento das fraturas transtrocanterianas com dynamic hip screw com acesso minimamente invasivo

OBJECTIVE: To analyze the short-term results from treating unstable intertrochanteric fractures with Dynamic Hip Screws (DHS), using a minimally invasive route, focusing on the functional aspects and complication and mortality rates of the method. METHODS: This was a prospective longitudinal study on 140 patients who underwent fixation of transtrochanteric fractures with the DHS system with a lateral minimally invasive access in the hip, between January and December 2013. The patients were evaluated pre and postoperatively (after six months of follow-up) by means of the Parker and Palmer mobility score. Women comprised 65.7% of the sample, and 54.3% of the fractures were on the right side. The patients' mean age was 80 years, ranging from 60 to 93 years. RESULTS: We observed an overall decrease in the mobility score and an increase in the degree of dependence over the short term. However, we encountered only two deaths in the study sample and there were no cases of infection or nonunion. CONCLUSION: Despite the efficacy of the treatment with DHS, with high rates of fracture consolidation and a low mortality rate, we noted that the patients still showed significant functional limitation at the follow-up six months after the operation.

OBJETIVO: Analisar os resultados do tratamento de fraturas transtrocantéricas instáveis com o Dinamic Hip Screw (DHS) por via minimamente invasiva e avaliar aspectos funcionais, taxas de complicação e óbitos do método, em curto prazo. MÉTODOS: Trata-se de um estudo longitudinal prospectivo, com 140 pacientes submetidos à fixação de fraturas transtrocantéricas com sistema DHS, com acesso minimamente invasivo lateral do quadril, de janeiro a dezembro de 2013. Os pacientes foram avaliados pré e pós-operatoriamente (com seis meses de seguimento), de acordo com o escore de mobilidade de Parker e Palmer. A amostra apresentou 65,7% de mulheres, com o lado direito mais acometido (54,3%). A média de idade foi de 80 anos, variação entre 60 e 93. RESULTADOS: Notamos uma diminuição global no escore de mobilidade e aumento no grau de dependência desses pacientes em curto prazo. No entanto, obtivemos apenas dois óbitos na amostra estudada e nenhuma infecção ou falha na consolidação das fraturas. CONCLUSÃO: Apesar da eficácia do tratamento com DHS, com elevados índices de consolidação e baixa taxa de mortalidade, notamos que os pacientes, ainda assim, apresentam uma limitação funcional significativa no seguimento até seis meses pós-operatórios.

A multimodal assessment of balance in elderly and young adults.

Falling is a significant health issue among elderly adults. Given the multifactorial nature of falls, effective balance and fall risk assessment must take into account factors from multiple sources. Here we investigate the relationship between fall risk and a diverse set of biochemical and biomechanical variables including: skeletal muscle-specific troponin T (sTnT), maximal strength measures derived from isometric grip and leg extension tasks, and postural sway captured from a force platform during a quiet stance task. These measures were performed in eight young and eleven elderly adults, along with estimates of fall risk derived from the Tinetti Balance Assessment. We observed age-related effects in all measurements, including a trend toward increased sTnT levels, increased postural sway, reduced upper and lower extremity strength, and reduced balance scores. We observed a negative correlation between balance scores and sTnT levels, suggesting its use as a biomarker for fall risk. We observed a significant positive correlation between balance scores and strength measures, adding support to the notion that muscle strength plays a significant role in postural control. We observed a significant negative correlation between balance scores and postural sway, suggesting that fall risk is associated with more loosely controlled center of mass regulation.

Evaluation of the quality of life of patients undergoing hemiarthroplasty of the hip.

OBJECTIVE: This was a comparative analysis on the quality of life of patients who underwent hemiarthroplasty of the hip, assessed before the operation and 3 and 6 months after the operation, by means of the SF-36 questionnaire (Medical Outcomes Study 36-Item Short Form health survey). METHODS: A prospective study was conducted on 12 patients with femoral neck fractures who underwent partial hip arthroplasty between June 2013 and July 2014. Female patients predominated (58.3%). The mean age was 83 years and, in 91.7%, the fracture was due to falling from a standing position. The SF-36 questionnaire was applied before the operation and 3 and 6 months after the operation. RESULTS: With regard to physical health, the patients presented low scores for functional capacity and physical aspects. They had good scores for the subitem of general state and high scores regarding pain. Vitality, social aspect and mental health had moderate scores and emotional aspects had a low score. CONCLUSION: With the sample analyzed here, we can say that the hip hemiarthroplasty procedure for cases of unstable femoral neck fractures, in patients with low functional demands analyzed over a postoperative period of 6 months, does indeed allow quality of life to be maintained.

OBJETIVO: Análise comparativa da qualidade de vida dos pacientes submetidos à hemiartroplastia do quadril, no pré-operatório, com três e seis meses de operados, por meio do questionário SF-36 (Medical Outcomes Study 36-Item short form health survey). MÉTODOS: Estudo prospectivo em 12 pacientes com fratura do colo do fêmur, submetidos à artroplastia parcial do quadril, de junho de 2013 a julho de 2014. Houve predomínio do sexo feminino, com 58,3%. A média de idade foi de 83 anos e em 91,7% foi decorrente de queda da própria altura. Foram aplicados os questionários SF-36 no pré-operatório e três e seis meses do pós-operatório. RESULTADOS: Com relação à saúde física, os pacientes apresentaram baixa pontuação na capacidade funcional e nos aspectos físicos. Boa pontuação no subitem estado geral e alta pontuação no quesito dor. A vitalidade, os aspectos sociais e a saúde mental tiveram pontuações moderada e baixa no que diz respeito aos aspectos emocionais. CONCLUSÃO: Com a amostra analisada, podemos dizer que o procedimento de hemiartroplastia do quadril, nas fraturas do colo do fêmur instáveis, em pacientes com baixa demanda funcional analisados no período pós-operatório de seis meses, permite, sim, a manutenção da qualidade de vida.

Avaliação da qualidade de vida submetidos à hemiartroplastia dos pacientes do quadril / Evaluation of the quality of life of patients undergoing hemiarthroplasty of the hip

Análise comparativa da qualidade de vida dos pacientes submetidos à hemiar troplastia do quadril, no pré-operatório, com três e seis meses de operados, por meio do questionário SF-36 (Medical Outcomes Study 36 - Item short form health survey). Métodos: Estudo prospectivo em 12 pacientes com fratura do colo do fêmur, submetidos à artroplastia parcial do quadril, de junho de 2013 a julho de 2014. Houve predomínio do sexo feminino, com 58,3%. A média de idade foi de 83 anos e em 91,7% foi decorrente de queda da própria altura. Foram aplicados os questionários SF-36 no pré-operatório e três e seis meses do pós-operatório. Resultados: Com relação à saúde física, os pacientes apresentaram baixa pontuação na capacidade funcional e nos aspectos físicos. Boa pontuação no subitem estado geral e alta pontuação no quesito dor. A vitalidade, os aspectos sociais e a saúde mental tiveram pontuações moderada e baixa no que diz respeito aos aspectos emocionais. Conclusão: Com a amostra analisada, podemos dizer que o procedimento de hemiartroplastia do quadril, nas fraturas do colo do fêmur instáveis, em pacientes com baixa demanda funcional analisados no período pós-operatório de seis meses, permite, sim, a manutenção da qualidade de vida.

This was a comparative analysis on the quality of life of patients who underwent hemiarthroplasty of the hip, assessed before the operation and 3 and 6 months after the operation, by means of the SF-36 questionnaire (Medical Outcomes Study 36-Item Short Form health survey). METHODS: A prospective study was conducted on 12 patients with femoral neck fractures who underwent partial hip arthroplasty between June 2013 and July 2014. Female patients predominated (58.3%). The mean age was 83 years and, in 91.7%, the fracture was due to falling from a standing position. The SF-36 questionnaire was applied before the operation and 3 and 6 months after the operation. RESULTS: With regard to physical health, the patients presented low scores for functional capacity and physical aspects. They had good scores for the subitem of general state and high scores regarding pain. Vitality, social aspect and mental health had moderate scores and emotional aspects had a low score. CONCLUSION: With the sample analyzed here, we can say that the hip hemiarthroplasty procedure for cases of unstable femoral neck fractures, in patients with low functional demands analyzed over a postoperative period of 6 months, does indeed allow quality of life to be maintained.

Skeletal muscle troponin as a novel biomarker to enhance assessment of the impact of strength training on fall prevention in the older adults.

BACKGROUND: Loss of muscle mass and strength (i.e., sarcopenia) in the older adults is a strong predictor of falls, with subsequent morbidity and inability to execute activities of daily living. Use of biomarkers may enhance assessment of effects of community-based exercise interventions aimed at improving muscle strength. OBJECTIVE: The aim of this study was to investigate the use of troponin as a newly proposed biomarker of skeletal muscle health when determining the outcomes of strength-training programs designed for community-dwelling adults over the age of 65 years. METHODS: Outcomes of two strength training programs ("Peer Exercise Program Promotes Independence" and "Stay Strong, Stay Healthy") were assessed using physical performance tests designed for senior fitness evaluation, grip strength, and changes in serum levels of skeletal muscle-specific troponin T (sTnT). RESULTS: Improvement in physical performance, including a significant increase in grip strength, was associated with a significant reduction in serum levels of sTnT. DISCUSSION: Findings from these studies suggest that, when "Peer Exercise Program Promotes Independence" and "Stay Strong, Stay Healthy" are implemented for at least 10 weeks, significant gains in strength are achieved. This strength improvement was associated with a reduction in serum levels of troponin, supporting the use of troponin as a novel biomarker of muscle health in the assessment of strength training programs for the older adults. Reduced sTnT after exercise intervention suggests that skeletal muscles become stronger and less susceptible to damage because of the exercise regimens.