Fibrous Structures: An Overview of Their Responsiveness to External Stimuli towards Intended Application.

In recent decades, the interest in responsive fibrous structures has surged, propelling them into diverse applications: from wearable textiles that adapt to their surroundings, to filtration membranes dynamically altering selectivity, these structures showcase remarkable versatility. Various stimuli, including temperature, light, pH, electricity, and chemical compounds, can serve as triggers to unleash physical or chemical changes in response. Processing methodologies such as weaving or knitting using responsive yarns, electrospinning, as well as coating procedures, enable the integration of responsive materials into fibrous structures. They can respond to these stimuli, and comprise shape memory materials, temperature-responsive polymers, chromic materials, phase change materials, photothermal materials, among others. The resulting effects can manifest in a variety of ways, from pore adjustments and altered permeability to shape changing, color changing, and thermal regulation. This review aims to explore the realm of fibrous structures, delving into their responsiveness to external stimuli, with a focus on temperature, light, and pH.

Giant Conjunctival Cyst of the Orbit in a Patient with Previous Enucleation.

Introduction: Conjunctival cysts of the orbit development are a rare complication in enucleated patients. They result from the entrapment of conjunctival epithelium within the orbit. Case Presentation: We report the case of a 25-year-old man with a history of enucleation for a retinoblastoma of the right eye who presented with difficulty in fitting his eye prothesis. On his past medical records, there was no reference to the placement of any orbital implant at the time of the surgery. Biomicroscopy of the right eye revealed a thickened bulbar conjunctiva, an inferior symblepharon, and a translucid central area with vascularization. Imaging was remarkable for a cystic cavity filling the whole right orbit. Biopsy revealed the diagnosis of a conjunctival cyst, and drainage was performed, alleviating the patient's symptoms. Conclusion: Orbital conjunctival cysts may pose a clinical problem, and treatment modalities include surgical excision, absolute alcohol injection, and trichloroacetic acid injection.

Immunoparalysis in critically ill children.

Immunoparalysis is associated with poorer outcomes in the paediatric intensive care unit (PICU) setting. We aimed to determine the group of patients with higher chances of immunoparalysis and correlate this status with increased risks of nosocomial infection and adverse clinical parameters. We conducted an exploratory study with prospective data collection in a university-affiliated tertiary medical, surgical, and cardiac PICU. Fifteen patients with multiple organ dysfunction syndrome were included over a period of 6 months. Monocyte's human leucocyte antigen (HLA)-DR expression and tumour necrosis factor (TNF)-α and interleukin (IL)-6 production were measured by flow-cytometry at three time points (T1 = 1-2 days; T2 = 3-5 days; T3 = 6-8 days). Using the paediatric logistic organ dysfunction-2 score to assess initial disease severity, we established the optimal cut-off values of the evaluated parameters to identify the subset of patients with a higher probability of immunoparalysis. A comparative analysis was performed between them. Sixty per cent were males; the median age was 4.1 years. Considering the presence of two criteria in T1 (classical monocytes mean fluorescence intensity [MFI] for HLA-DR ≤ 1758.5, area under the curve (AUC) = 0.775; and frequency of monocytes producing IL-6 ≤ 68.5%, AUC = 0.905) or in T3 (classical monocytes MFI of HLA-DR ≤ 2587.5, AUC = 0.675; and frequency of monocytes producing TNF-α ≤ 93.5%, AUC = 0.833), a variable to define immunoparalysis was obtained (100% sensitivity, 81.5% specificity). Forty per cent of patients were assigned to the immunoparalysis group. In this: a higher frequency of nosocomial infection (p = 0.011), vasoactive inotropic score (p = 0.014) and length of hospital stay (p = 0.036) was observed. In the subgroup with the diagnosis of sepsis/septic shock (n = 5), patients showed higher percentages of non-classical monocytes (p = 0.004). No mortality was recorded. A reduction in classical monocytes HLA-DR expression with lower frequencies of monocytes producing TNF-α and IL-6 during the first week of critical illness, appears to be a good marker of immunoparalysis; these findings relate to an increased risk of nosocomial infection and deleterious outcomes. The increased frequency of non-classical monocytes in patients with sepsis/septic shock is suggestive of a better prognosis.

Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction.

BACKGROUND: Lung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia. MATERIAL AND METHODS: Fifty-one patients with COVID-19 pneumonia participated in the study. Focused echocardiography (FoCUS) was carried out on day 1 to separate patients into two groups depending on whether they had FoCUS signs of CD (CD+ vs CD-). LUS scores, based on the thickness of the pleural line, the B-line characteristics, and the presence or not of consolidations, were obtained three times along the patient's admission (D1, D5, D10) and compared between CD+ and CD- patients. A correlation analysis was carried out between LUS scores and the ratio of the arterial partial pressure of oxygen to the fraction of the inspired oxygen (P/F ratio). RESULTS: Twenty-two patients were CD+ and 29 patients were CD-. Among the CD+ patients, 19 were admitted to the intensive care unit (ICU), seven received invasive mechanical ventilation (IMV), and one did not survive. Among the CD- patients, 11 were admitted to the ICU, one received IMV and seven did not survive. CD+ patients showed a significantly lower P/F ratio than CD- patients. However, LUS scores showed no between-group differences, except for fewer subpleural consolidations in the upper quadrants of CD+ than on CD- patients. CONCLUSION: In patients with COVID-19, CD contributed to a worse clinical course, but it did not induce significant changes in LUS. Our findings suggest that pathophysiological factors other than those reflected by LUS may be responsible for the differences in clinical condition between CD+ and CD- patients.

Evaluation of a Low-Cost Virtual Reality Surround-Screen Projection System.

Two of the most popular mediums for virtual reality are head-mounted displays and surround-screen projection systems, such as CAVE Automatic Virtual Environments. In recent years, HMDs suffered a significant reduction in cost and have become widespread consumer products. In contrast, CAVEs are still expensive and remain accessible to a limited number of researchers. This study aims to evaluate both objective and subjective characteristics of a CAVE-like monoscopic low-cost virtual reality surround-screen projection system compared to advanced setups and HMDs. For objective results, we measured the head position estimation accuracy and precision of a low-cost active infrared (IR) based tracking system, used in the proposed low-cost CAVE, relatively to an infrared marker-based tracking system, used in a laboratory-grade CAVE system. For subjective characteristics, we investigated the sense of presence and cybersickness elicited in users during a visual search task outside personal space, beyond arms reach, where the importance of stereo vision is diminished. Thirty participants rated their sense of presence and cybersickness after performing the VR search task with our CAVE-like system and a modern HMD. The tracking showed an accuracy error of 1.66 cm and .4 mm of precision jitter. The system was reported to elicit presence but at a lower level than the HMD, while causing significant lower cybersickness. Our results were compared to a previous study performed with a laboratory-grade CAVE and support that a VR system implemented with low-cost devices could be a viable alternative to laboratory-grade CAVEs for visual search tasks outside the user's personal space.

The Benefits of Custom Exergames for Fitness, Balance, and Health-Related Quality of Life: A Randomized Controlled Trial with Community-Dwelling Older Adults.

Objective: This research aimed to measure the benefits in older adults' motor performance and quality of life during a 12-week-long multidimensional training combining custom-made exergames and traditional exercise in a complementary manner, compared with traditional training alone. Materials and Methods: Community-dwelling older adults participated in a randomized controlled trial (N = 31) consisting of two weekly exercise sessions of 60 minutes for 12 weeks. Participants allocated to the exergames group (n = 15) had one individual session of exergames and one traditional exercise group session per week. Control group participants (n = 16) had two weekly traditional exercise group sessions. Outcome measures on fitness, balance, and health-related quality of life were measured at the start of the intervention, 6th, 12th, and 16th week (1-month follow-up). Results: The exergames group showed a significant increase in lower-body and upper-body strength from pre- to postintervention. When compared with control, participants had significantly higher developments of upper-body strength from pre- to postassessments. There was a significant decrease in shoulder range of motion between the end of the intervention and follow-up for participants in both conditions. Balance increased significantly during the intervention but decreased at follow-up in both conditions. The mental component of health-related quality of life was significantly higher at the end compared with the start of the intervention in the exergames group, and this difference was significantly higher when compared with control. Conclusion: Integrating personalized exergames designed for multidimensional fitness training in traditional settings can be an effective strategy to enhance older adults' motor performance and mental well-being.

IgG4-related hepatic inflammatory pseudotumour: could MRI suggest the correct diagnosis?

We report a case of a 62-year-old woman, HIV positive, with a 3-week history of jaundice and elevated cholestatic enzymes. Imaging studies displayed intrahepatic biliary dilatation and a central liver lesion. Pathology described lesions of active cholangitis, lymphoplasmacytic infiltration and fibrosis, suggesting a hepatic inflammatory pseudotumour (IPT) IgG4 related. IgG4-related lymphoplasmacytic form of IPT belongs to IgG4-related diseases. We discuss the importance to include IgG4-related hepatic IPT as part of the differential diagnosis of any liver lesion, highlighting potential imaging clues that may help in establishing the correct diagnosis.

Spontaneous regression of hepatocellular carcinoma: myth or reality?

We present a case of a 68-year-old man with chronic hepatitis C infection, with no evidence of chronic liver disease during the first years of follow-up, diagnosed with a hepatocellular carcinoma (HCC) with 40 mm (α-fetoprotein (AFP) 205 ng/mL). He underwent segmental liver resection and pathology analysis was consistent with HCC and cirrhosis in the adjacent liver. Four months after surgery, AFP raised up to 126 661 ng/mL and abdominal MRI revealed a multinodular HCC. Patient rejected treatment with sorafenib and started megestrol and an herbal medicine, soursop (Annona muricata). Six months later, AFP markedly decreased (28 ng/mL) and abdominal MRI showed decreasing size and number of lesions. At 5 years of follow-up, he has no evidence of HCC. Spontaneous regression of HCC is a rare condition and the underlying mechanism is unclear. In this case there is a temporal relation between the start of megestrol and Annona muricata and HCC regression.

Lessons Learned from Gamifying Functional Fitness Training Through Human-Centered Design Methods in Older Adults.

Background: The design of meaningful and enjoyable Exergames for fitness training in older adults possesses critical challenges in matching user's needs and motivators with game elements. These challenges are often due to the lack of knowledge of seniors' game preferences and technology literacy as well as a poor involvement of the target population in the design process. Objective: This research aims at describing a detailed and scrutinized use case of applying human-centered design methodologies in the gamification of fitness training routines and illustrates how to incorporate seniors' feedback in the game design pipeline. Materials and Methods: We focus on how to use the insights from human-centered inquiries to improve in-game elements, such as mechanics or esthetics, and how to iterate the game design process based on playtesting sessions in the field. Results: We present a set of four Exergames created to train the critical functional fitness areas of older adults. We show how through rapid prototyping methods and multidisciplinary research, Exergames can be rigorously designed and developed to match individual physical capabilities. Moreover, we propose a set of guidelines for the design of context-aware Exergames based on the lessons learned. Conclusion: We highlight the process followed; it depicts 19 weeks of various activities delivering particular and actionable items that can be used as a checklist for future games for health design projects.

Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: A prospective study.

BACKGROUND AND AIMS: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)-free survival. METHODS: In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT-free survival by time dependent covariate coding were analysed. RESULTS: Majority of patients belonged to Child-Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow-up was 29 (1-58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow-up, 82/236 (34.7%) patients developed cirrhosis decompensations. OLT-free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09-1.19) and OLT-free survival (HR 1.16;95%CI:1.11-1.21). CONCLUSION: Previous decompensations of cirrhosis and thrombocytopenia predict PVT development in cirrhosis suggesting a pathophysiologic role for severity of portal hypertension. PVT development did not independently predict cirrhosis decompensations or lower OLT-free survival.

Anticoagulation in Cirrhosis and Portal Vein Thrombosis Is Safe and Improves Prognosis in Advanced Cirrhosis.

BACKGROUND: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. AIMS: We analyzed the safety and effect of anticoagulant therapy (AT) on PVT recanalization and orthotopic liver transplant (OLT)-free survival. METHODS: Eighty consecutive patients from a prospective registry of cirrhosis and non-tumoral PVT at a tertiary center were analyzed. AT effect on PVT recanalization and OLT-free survival was determined by time-dependent Cox regression analysis. RESULTS: Average MELD score was 15 ± 7. Portal hypertension-related complications at PVT diagnosis were present in 65 (81.3%) patients. Isolated portal vein trunk/branch thrombosis was present in 53 (66.3%) patients. AT was started in 37 patients. AT was stopped in 17 (45.9%) patients, in 4 (10.8%) due to bleeding events. No variceal bleeding occurred while on AT. Anticoagulation was restarted in 6/17 (35.2%) patients due to rethrombosis. In 67 patients with adequate follow-up imaging, AT significantly increased the rate of PVT recanalization compared with those who did not receive anticoagulation [51.4% (18/35) vs 6/32 (18.8%), p = 0.005]. OLT-free survival after a median follow-up of 25 (1-146) months was 32 (40%). Although there was no significant effect of AT on overall OLT-free survival, OLT-free survival was higher among patients with MELD ≥ 15 receiving AT compared to those who did not (p = 0.011). Baseline MELD at PVT detection independently predicted PVT recanalization (HR 1.11, 95% CI 1.01-1.21, p = 0.027) and mortality/OLT (HR 1.12, 95% CI 1.05-1.19, p < 0.001). CONCLUSIONS: Although AT did not improve overall OLT-free survival, it was associated with higher survival in advanced cirrhosis. Anticoagulation increased PVT recanalization and should be maintained after PVT recanalization to avoid rethrombosis.

An unusual fat-containing presacral tumor in an elderly patient.

The authors present a case of a presacral myelolipoma diagnosed in an 84-year-old male patient with longstanding pelvic pain and past medical history of bladder cancer. Pelvic computed tomography (CT) revealed a well-encapsulated and lobulated presacral mass, with mixed fat and soft-tissue attenuation. Magnetic resonance (MR) imaging provided further confirmation of macroscopic intralesional fat and excluded either adjacent bone invasion or bladder cancer recurrence. A presacral myelolipoma was suspected based on imaging findings, with liposarcoma and teratoma having also been considered for the differential diagnosis. The histological confirmation of the tumor was only attained postoperatively. This case report alerts to the possible presacral location of myelolipomas, which should be considered for every fat-containing lesion detected in this region. The main clinical, imaging, and differential diagnoses of this entity are reviewed in this paper.

Distribution and quantitation of skin iron in primary haemochromatosis: correlation with total body iron stores in patients undergoing phlebotomy.

Measurement of the concentration of iron in the skin, if correlated with total body iron stores, may enable better informed decisions on when to initiate, change or stop therapy in hereditary heamochromatosis. Naïve haemochromatosis patients with iron overload and with C282Y and/or H63D HFE mutations were evaluated at the following time-points: disease diagnosis, end of the therapy programme, and 6 months after the end of therapy. The distribution and concentration of iron in the skin were assessed by quantitative nuclear microscopy methods, in parallel with serum and plasma iron concentration. Iron content in the liver was determined by nuclear magnetic resonance. Iron accumulated in the epidermis; its concentration increased from outer to inner layers, being maximal in the basal layer (7.33 ± 0.98 µmol/g). At all 3 time-points, most of the iron was associated with the extracellular space. During the phlebotomy programme the iron content of the skin and the liver decreased by a factor of 2. These data suggest that measurements of iron concentration in the epidermis, which is a readily accessible tissue, reflect iron overload in the liver.

Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values.

The objective of this study was to assess the efficacy of percutaneous catheter drainage, of early infected pancreatic fluid collections, in critically ill patients with severe acute pancreatitis. The patients in our series had a mean Ranson's score of 5.4. Nineteen (63.3%) of the 30 patients were cured with percutaneous drainage. In this group, the mean C-reactive protein value at the beginning of treatment was 172.8 U/l and 102.5 U/l at the end (P<.001). Cultures yielded multiple organisms in 23 patients (76.7%). The most frequently seen organisms were Escherichia coli, Staphylococcus aureus, and Enterococcus faecium.

Tratamento conservador do pé torto congênito idiopático pela técnica de Ponseti / Conservative treatment of idiopathic clubfoot Ponseti's method

O pé torto congênito idiopático é uma patologia frequente, e seu tratamento padrão tem como início as manipulações e gessos seriados, seguidos de liberação cirúrgica póstero-medial extensa nos casos não corrigidos. Ponseti defende a possibilidade de se evitar a cirurgia em cerca de 89 por cento dos casos, através de sua técnica de manipulação que difere das outras descritas anteriormente. Essa forma de tratamento tem tido destaque nos trabalhos atuais devido à superioridade de seus resultados a longo prazo, com maior mobilidade e flexibilidade dos pés, menos dor e bom aspecto estético. Descreve-se a técnica, suas indicações e resultados

Influence of surface composition on hydrogen peroxide decomposition catalyzed by Co(II) aminopyridine-supported compounds on amorphous silica gel.

Cobalt compounds supported on 2-, 3-, and 4-aminopyridine-modified silica surfaces, named Sil2Co, Sil3Co, and Sil4Co, respectively, were used to catalyze the decomposition of hydrogen peroxide on ethanolic solutions at 293, 298, and 303 K. The calculated k values (x10(-4) s(-1)) for Sil2Co, Sil3Co, and Sil4Co are 0.65, 1.24, and 4.78 (293 K); 1.23, 1.87, and 6.33 (298 K); and 1.80, 2.80, and 10.30 (303 K), respectively. All obtained results evidence that such decomposition is a first-order reaction. Zinc-, nickel-, and copper-supported compounds were also tested, but exhibited a very low catalytic activity. By using the k values at 298 and 303 K, and employing the equation ln (k1/k2) = E(a)/R(1/T2-1/T1), the activation energy values for the considered reaction were Sil2Co = 57.20, Sil3Co = 60.60, and Sil4Co = 73.10 kJ mol(-1), respectively. The low values calculated for E(a) are in agreement with a free-radical mechanism.

A artroplastia parcial e total do quadril. Sua evolução e a experiência no Hospital da Beneficência Portuguesa de São Paulo / The evolution and experience with partial and total hip replacement performed at the Beneficência Portuguesa Hospital of São Paulo

Os autores descrevem as próteses parcial e totais dos quadris, mostrando sua evolução até os dias atuais. A artroplastia parcial foi utilizada desde a década de sessenta (60) com resultados satisfatórios para a época. A partir de 1979 iniciou-se o emprego da artroplastia total cimentada e em 1985 as próteses não cimentadas tomaram posição definitiva e efetiva até nossos dias. Analisam os resultados obtidos com as próteses não cimentadas do quadril do tipo A.M.L. que vem sendo feitas desde 1985 na Beneficência Portuguesa de São Paulo, com excelentes resultados. os autores contam com mais de 3.000 cirurgias de artroplastias totais dos quadris já realizadas (cimentadas e não cimentadas), obtendo assim ampla experiência nesse campo da especialidade ortopédica

Luxaçao simultânea fechada interfalangeana em um dedo: relato de caso e revisäo bibliográfica / Simultaneous closed dorsal interphalangeal dislocation in one finger: report of a case and review literature

Os autores mostram um caso de luxacao simultanea fechada dorsal em um unico dedo, que ocorreu com um goleiro de futebol de salao. Esta e uma rara patologia e esta publicacao e a primeira relatada no Brasil

Cirurgia de Bristow-Latarjet na luxaçäo recidivante anterior do ombro: estudo de dez casos operados / Bristow-Latarjet's surgery in the anterior recurrent luxation of the shoulder: study of 10 operated cases

Os autores estudaram 10 casos de luxacao recidivante anterior do ombro, operados pela tecnica de Bristow-Latarjet. Obtiveram 90% de bons resultados, levando em consideracao a estabilidade articular e a volta as atividades fisicas habituais. Nao tiveram nenhuma recorrencia ou complicacao

Medida dos angulos de anteversao e inclinacao do componente acetabular na artroplastia total do quadril: estudo experimental / Measurement of inclination and anteversion of angle on acetabular component in total hip arthroplasty: experimental stydy

Os autores, atraves de medidas obtidas de um modelo experimental propoem o uso da anteversao planar, simplificando as medidas da anteversao ou retroversao do componente acetabular na artroplastia total do quadril