In vitro mechanical analysis of X-shaped femoroplasty with polymethyl methacrylate boundary a fall on the greater trochanter.

To evaluate with mechanical testing (MT) using synthetic femurs, an X-shaped femoroplasty technique with polymethyl methacrylate (PMMA), analyzing the results applied to the prophylaxis of proximal femur (PF) fractures caused by low-energy trauma. MT was performed simulating a fall on the greater trochanter, using fifteen Sawbones™ models. They were divided into three experimental groups (n = 5): control (DP) group, drilled without augmentation (DWA) group, and X-shaped augmentation (DX) group. Maximum load, stiffness, absorbed energy and displacement were analyzed primarily in all groups; and secondarily then, morphology and fracture type were verified in all groups while PMMA volume, temperature and time polymerization were analyzed only in the DX group. The MT results obtained for synthetic models respectively in the DP, DWA, and DX groups were: mean maximum load (5562.0 ±â€¯464.8) N, (4798.0 ±â€¯121.2) N, and (7132.0 ±â€¯206.9) N; mean stiffness values (673 ±â€¯64.34) N/mm, (636 ±â€¯8.7) N/mm, and (738 ±â€¯17.13) N/mm, and mean absorbed energy values (36,203 ±â€¯3819) N.mm, (27,617 ±â€¯3011) N.mm, (44,762 ±â€¯3219) N.mm; mean displacement values (13.6 ±â€¯1.45) N, (11.1 ±â€¯0.5) N, and (13.2 ±â€¯0.69) N. The mean volume, temperature reached during filling in the DX group were 9.8 mL, 42.54ºC with 1' 56" of polymerization. The fracture types were similar between the DP and DWA groups, affecting the trochanteric region, as distinctly to those in the DX group, which were restricted to the femoral neck. The values obtained in MT showed statistical significance when analyzed by one-way ANOVA (5%) for maximum load, stiffness, and absorbed energy between groups. In conclusion, X-shaped PMMA augmentation presents a protective biomechanical characteristic against PF fractures generated in synthetic models by boundary a fall on the greater trochanter.

PATELLAR FRACTURE IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: IN VITRO ANALYSIS.

Objective: To determine, by biomechanical analysis, safe patellar cut limits in anterior cruciate ligament (ACL) reconstruction that minimize fracture risks. Methods: From three-dimensional reconstruction, triangular cuts were made in the patella, with a depth of 6.5 mm and variable width and length (10 to 20 mm and 8 to 12 mm, respectively, both with an interval of 1 mm). The combinations of cuts constituted 55 models for tests, with five variations in width and 11 variations in length, tested with the finite element method (FEM). Results: The mean of the localized principal maximum (traction force) values was 4.36 Pa (SD 0.87 ± 0.76) and the localized principal minimum (compression force) was -4.33 Pa (SD 1.05 ± 1.11). Comparing width and length to the tension force of the values of the main maximum, we found statistical significance from 11 mm for width and 13 mm for length. Conclusion: In ACL reconstruction, the removal of the patellar bone fragment is safe for fragments smaller than 11 mm in width and 13 mm in length, which corresponds to 24% of the width and 28% of the length of the patella used. Level of Evidence II, Comparative Prospective Study.

Objetivo: Determinar, por meio de análise biomecânica, os limites de corte patelar seguros para a reconstrução do ligamento cruzado anterior (LCA) e que minimizem riscos de fratura. Métodos: A partir de reconstrução tridimensional, foram feitos cortes triangulares na patela, com profundidade de 6,5 mm e largura e comprimento variáveis (8 a 12 mm e 10 a 20 mm), respectivamente, com intervalo de 1 mm). As combinações dos cortes constituíram 55 modelos para ensaios, com 5 variações de largura e 11 variações de comprimento, ensaiados por meio do método dos elementos finitos (MEF). Resultados: A média dos valores da máxima principal localizada (força de tração) foi de 4,36 Pa (DP 0,87 ± 0,76), e a mínima principal localizada (força de compressão) foi de −4,33 Pa (DP 1,05 ± 1,11). Comparando largura e comprimento à força de tensões dos valores da máxima principal, houve significância estatística a partir de 11 mm para largura e 13 mm para comprimento. Conclusão: Na reconstrução do LCA, a retirada do fragmento ósseo patelar mostrou-se segura para fragmentos menores que 11 mm de largura e 13 mm de comprimento, o que corresponde a 24% da largura e 28% do comprimento da patela utilizada. Nível de Evidência II, Estudo Prospectivo Comparativo.

Patellar fracture in anterior cruciate ligament reconstruction: in vitro analysis / Fratura patelar na reconstrução do ligamento cruzado anterior: análise in vitro

ABSTRACT Objective: To determine, by biomechanical analysis, safe patellar cut limits in anterior cruciate ligament (ACL) reconstruction that minimize fracture risks. Methods: From three-dimensional reconstruction, triangular cuts were made in the patella, with a depth of 6.5 mm and variable width and length (10 to 20 mm and 8 to 12 mm, respectively, both with an interval of 1 mm). The combinations of cuts constituted 55 models for tests, with five variations in width and 11 variations in length, tested with the finite element method (FEM). Results: The mean of the localized principal maximum (traction force) values was 4.36 Pa (SD 0.87 ± 0.76) and the localized principal minimum (compression force) was −4.33 Pa (SD 1.05 ± 1.11). Comparing width and length to the tension force of the values of the main maximum, we found statistical significance from 11 mm for width and 13 mm for length. Conclusion: In ACL reconstruction, the removal of the patellar bone fragment is safe for fragments smaller than 11 mm in width and 13 mm in length, which corresponds to 24% of the width and 28% of the length of the patella used. Level of Evidence II, Comparative Prospective Study.

RESUMO Objetivo: Determinar, por meio de análise biomecânica, os limites de corte patelar seguros para a reconstrução do ligamento cruzado anterior (LCA) e que minimizem riscos de fratura. Métodos: A partir de reconstrução tridimensional, foram feitos cortes triangulares na patela, com profundidade de 6,5 mm e largura e comprimento variáveis (8 a 12 mm e 10 a 20 mm), respectivamente, com intervalo de 1 mm). As combinações dos cortes constituíram 55 modelos para ensaios, com 5 variações de largura e 11 variações de comprimento, ensaiados por meio do método dos elementos finitos (MEF). Resultados: A média dos valores da máxima principal localizada (força de tração) foi de 4,36 Pa (DP 0,87 ± 0,76), e a mínima principal localizada (força de compressão) foi de −4,33 Pa (DP 1,05 ± 1,11). Comparando largura e comprimento à força de tensões dos valores da máxima principal, houve significância estatística a partir de 11 mm para largura e 13 mm para comprimento. Conclusão: Na reconstrução do LCA, a retirada do fragmento ósseo patelar mostrou-se segura para fragmentos menores que 11 mm de largura e 13 mm de comprimento, o que corresponde a 24% da largura e 28% do comprimento da patela utilizada. Nível de Evidência II, Estudo Prospectivo Comparativo.

Evaluation of a Locking Autocompression Screw Model in Pauwels Type-3 Femoral Neck Fracture: In Vitro Analysis.

Femoral neck fractures in young adults are uncommon, resulting from high-energy trauma. Despite their infrequency in this population, there is higher rate of complications, especially in the more vertical fracture line, classified by Pauwels as a type-3 femoral neck fracture. The implant type is of paramount importance for maintaining anatomical reduction, since it must resist the deforming forces that act on the fracture. We comparatively evaluated two constructions of the novel locking autocompression implant (X-PIN and X-PIN+P) using the finite element method and previously established methods for treating Pauwels type-3 femoral neck fractures. Six fixation models were developed for the study: a dynamic hip screw (DHS), a DHS with an anti-rotation screw (DHS+P), the inverted triangle multiple cannulated screws construction (ASNIS), the multiple cannulated screws in an L-configuration (L), and the two models of the novel locking autocompression screw (X-PIN and X-PIN+P). Under the same conditions with a load of 2100 N, the following parameters were evaluated using SIMLAB® software: the main maximum (Max P), main minimum (Min P), localized maximum P1 (Max P1), localized maximum P2 (Max P2), total displacement, localized displacement, rotation displacement, and von Mises stress. Compared to the DHS+P and ASNIS models, the X-PIN+P model presented, respectively, increases of 51.6% and 64.7% for Max P, 85% and 247% for Min P, and 18.9% and 166.7% for von Mises stress. Max P1 did not differ between the models, but Max P2 was 55% and 50% lower for X-PIN+P than ASNIS and L, respectively. All displacement values were lower for X-PIN+P than the other models. In this FEM testing, the X-PIN+P was superior to the other models, which was due to improvement in all parameters of stress distribution, displacement, and von Mises stress compared to models using a lateral plate (DHS and DHS+P) or not (ASNIS and L).

Epigenética e exercício físico: influência em transtornos de ansiedade? / Epigenetics and physical exercise: influence in anxiety disorders?

Introdução: A embora o número de estudos que correlacionam os efeitos da atividade física com aspectos morfofisiológicos cerebrais e com transtornos de ansiedade tenha crescido, existe limitação no campo do treinamento de força (TF) e seu papel de modificador comportamental, assim como sua relação com eventos epigenéticos. Objetivo: realizar uma revisão sistemática da literatura em relação aos efeitos do exercício físico e à influência transgeracional das características epigenéticas em quadros de transtornos de ansiedade. Métodos: realizou-se uma pesquisa bibliográfica em Literatura científica nacional e internacional, nas bases eletrônicas: Literatura Latino-Americana em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Public Medline (PubMed). Na busca, sem limitação de período de tempo, utilizaram-se as seguintes palavras-chave, em português/inglês: "Ansiedade"; "Ansiedade e exercício físico"; "Treino de força e Transtorno de Ansiedade"; "Transtorno do Pânico"; "Transtorno de Ansiedade Generalizada"; "Epigenética". Resultados: notou-se que, nos quadros de transtornos de ansiedade, os ajustes fisiológicos aos quais o organismo se torna submetido extrapolam o âmbito do sistema nervoso autônomo e atingem o sistema endócrino e imunitário, tornando-se duradouro. A prática de exercício físico e a epigenética demonstraram relevante papel na modificação dos principais sinais e sintomas dessa psicopatologia. Conclusões: os artigos estudados apresentaram tipos de estudo bastante distintos entre si, demonstrando o benefício alcançado pela prática de exercício físico nos quadros de transtorno de ansiedade, mas não possibilitaram delinear que tipos e metodologias são os mais adequados. Ficou evidente a necessidade da correlação entre Treinamento de força e epigenética.

Introduction: Although the number of studies that correlate the effects of physical activity with brain morphophysiological aspects and anxiety disorders have grown in recent years, there is great limitation in the strength training (ST) field and its role as the modifier of such behaviors. Objective: to conduct a systematic review of the literature regarding the effects of physical exercise and the trans-generational influence of epigenetic characteristics in cases of anxiety disorders. Methods: A bibliographic research held in national and international scientific literature was carried out in the following electronic databases: Latin American Literature in Health Sciences (LILACS), Scientific Electronic Library On-line (SciELO) and Public Medline (PubMed). The search, without time limitation, used the following key words: "Anxiety"; "Anxiety and exercise"; "Strength training and Anxiety Disorder"; "Panic Disorder"; "Generalized Anxiety Disorder"; "Epigenetics". Results: In the anxiety disorder frames, some physiological adjustments which the body is subjected to undergo beyond the scope of the autonomic nervous system affecting the endocrine and immune systems, making them durable, were observed. The practice of physical exercises and epigenetics have shown important role in modifying the course of the main signs and symptoms that involves this psychopathology. Conclusions: The study criteria in the articles selected in the present research were quite distinct from each other. It was possible to demonstrate the benefit achieved by physical exercise on anxiety disorder frames, but it was not possible to delineate which types or methods are the best suited. The need for researches in the strength training (ST) field and trans-generational transmission became evident.

Representação artística das consequências neurológicas do Acidente Vascular Encefálico, nas obras de Otto Dix (1891-1969), a partir de seus 76 anos / Artistic representation of the neurological consequences of stroke in the works of Otto Dix (1891-1969), from the age of 76 / Representación artística de las consecuencias neurológicas del Accidente Vascular Encefálico en las obras de Otto Dix (1891-1969), a partir de sus 76 años

As doenças cerebrovasculares atingem cerca de 17 milhões de indivíduos por ano mundialmente, encontrando-se, entre elas, o Acidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito decorrente de alteração vascular focal. No presente estudo, reporta-se o caso do pintor alemão Otto Dix, acometido por AVE no hemisfério direito, aos 76 anos. Em decorrência do episódio, desenvolveu heminegligência e hemiparesia à esquerda, hemianopsia, distúrbio de construção visuoespacial moderado, e apraxia associada ao déficit de propriocepção do membro superior esquerdo. Descrevem-se as mudanças na representação visual nas obras produzidas por ele, após a doença, a fim de correlacionar as consequências neurológicas através da expressão gráfica.

Cerebrovascular diseases reach about 17 million individuals per year worldwide, including Stroke, which is characterized by sudden neurological deficit due to focal vascular alteration. In the present study, the case of the German painter Otto Dix, affected by stroke in the right hemisphere, at 76 years of age, is reported. As a result of the episode, he developed left hemielegiation and hemiparesis, hemianopsia, moderate visuo-spatial construction disorder, and apraxia associated with proprioception deficit of the left upper limb. The changes in the visual representation in the works produced by him, after the illness, are described in order to correlate the neurological consequences through graphic expression.

Las enfermedades cerebrovasculares alcanzan a cerca de 17 millones de individuos por año en todo el mundo, encontrándose entre ellas el Accidente Vascular Encefálico (AVE), que se caracteriza por déficit neurológico súbito resultante de alteración vascular focal. En el presente estudio, se reporta el caso del pintor alemán Otto Dix, acometido por AVE en el hemisferio derecho, a los 76 años. En consecuencia del episodio, desarrolló heminexia y hemiparesia a la izquierda, hemianopsia, disturbio de construcción visuoespacial moderado, y apraxia asociada al déficit de propriocepción del miembro superior izquierdo. Se describen los cambios en la representación visual en las obras producidas por él, después de la enfermedad, a fin de correlacionar las consecuencias neurológicas a través de la expresión gráfica.

Relação médico-paciente idoso no cinema: visões de atendimento / The doctor-elderly patient relationship in cinema: visions of care / Relación entre el médico y los pacientes ancianos en el cine: visiones de atención

Resumo Este artigo objetiva descrever diferentes visões de atendimento da relação médico-paciente idoso abordada em filmes de ficção. Pesquisou-se filmografia nacional e internacional, buscando filmes de longa-metragem que exibissem cenas em que a relação médico-paciente idoso fosse retratada de diferentes formas. Foi possível identificar nos dez filmes analisados expectativas referentes ao atendimento do paciente idoso, tanto na visão do paciente quanto na de seus familiares, evidenciando sentimentos e valores socioculturais presentes na inter-relação estabelecida durante o exercício profissional da medicina. Concluiu-se que a linguagem cinematográfica é útil para a formação do médico, que deve se preocupar com o sentido humano de seu trabalho, bem como para interpretar elementos que envolvem a complexa relação médico-paciente, particularmente com o idoso.

Abstract This article aims to describe different views of care through the doctor-elderly patient relationship as addressed in feature films. Research was carried out based on national and international filmography, seeking films containing scenes in which the doctor-elderly patient relationship was portrayed in different ways. In the ten films analyzed, it was possible to identify expectations regarding the care of the elderly patient, both from the patient's and their family's view, describing the feelings and socio-cultural values present in the interrelationship established during the professional practice of medicine. It was concluded that cinematographic language is useful for the training of physicians, who should be concerned with the human aspect of their work, as well as for the interpretation of elements involving the complex doctor-patient relationship, particularly among the elderly.

Resumen El objetivo de este artículo es describir las diferentes visiones de atención, abordadas en películas de ficción, sobre la relación entre el médico y los pacientes ancianos. Se investigó la filmografía nacional e internacional, buscando películas de larga duración que exhibieran escenas en las que la relación entre el médico y el paciente anciano se retratara de diferentes formas. En las diez películas analizadas, fue posible identificar expectativas referentes a la atención del paciente anciano, tanto en la visión del paciente como en la de sus familiares, evidenciando sentimientos y valores socioculturales presentes en la interrelación establecida en el ejercicio profesional de la medicina. Se concluyó que el lenguaje cinematográfico es útil para la formación del médico, quien debe preocuparse del sentido humano de su trabajo, para interpretar elementos que involucran la relación compleja entre el médico y el paciente, particularmente el anciano.