Building a Open Source Framework for Virtual Medical Training

This paper presents a framework to build medical training applications by using virtual reality and a tool that helps the class instantiation of this framework. The main purpose is to make easier the building of virtual reality applications in the medical training area, considering systems to simulate biopsy exams and make available deformation, collision detection, and stereoscopy functionalities. The instantiation of the classes allows quick implementation of the tools for such a purpose, thus reducing errors and offering low cost due to the use of open source tools. Using the instantiation tool, the process of building applications is fast and easy. Therefore, computer programmers can obtain an initial application and adapt it to their needs. This tool allows the user to include, delete, and edit parameters in the functionalities chosen as well as storing these parameters for future use. In order to verify the efficiency of the framework, some case studies are presented.

Glypican-3 reexpression regulates apoptosis in murine adenocarcinoma mammary cells modulating PI3K/Akt and p38MAPK signaling pathways

Glypican-3 (GPC3) is a proteoglycan involved in proliferation and cell survival. Several reports demonstrated that GPC3 is downregulated in some tumors, such as breast cancer. Previously, we determined that GPC3 reexpression in the murine mammary adenocarcinoma LM3 cells induced an impairment of their invasive and metastatic capacities, associated with a decrease of their motility and an increase of their cell death. We demonstrated that GPC3 inhibits canonical Wnt signaling, as well as it activates non canonical pathway. Now, we identified signaling pathways responsible for the pro-apoptotic role of GPC3 in LM3 cells. We found for the first time that GPC3 inhibits the PI3K/Akt anti-apoptotic pathway while it stimulates the p38MAPK stress-activated one. We report a concomitant modulation of CDK inhibitors as well as of pro- and anti-apoptotic molecules. Our results provide new clues regarding the mechanism involved in the modulation induced by GPC3 of mammary tumor cell growth and survival.

Physiological demands of match-play in elite tennis: A case study

The physiological and perceptual demands together with match notation of a four-set tennis match were studied in two elite professional players during the preparation for the 2008 Davis Cup. The design of this case report is unique in that it is the first to describe the demands of prolonged match-play (197 min) over four sets in ecologically valid conditions. The variables measured before and after each set included blood lactate and glucose concentrations, body mass, and perception of effort. Stroke count for each rally and heart rate were recorded during each set while salivary cortisol concentration was determined before and after the match. The rally length decreased as the match progressed. The results showed significant physiological stress, with each player losing greater than 2.5% of body mass (as fluid) and having elevated salivary cortisol concentrations after the match. Heart rate and perception of effort were also increased following each set indicating increasing stress. However, blood lactate decreased following the fourth set while blood glucose was maintained. The results also suggest that elite players may adjust work rates or tactics to cope with the increased perception of effort. This report shows that four sets of tennis are associated with increasing stress and fatigue.

A comparison between the concentration of mast cells in squamous cell carcinomas of the skin and oral cavity

FUNDAMENTS: The lethality of squamous cell carcinomas (SCC) of the skin is considered low. SCC in the mouth is usually associated with poor prognosis. Current evidence suggests that mast cells in the normal tissue contribute to the tumorigenesis of SCC, probably by promoting angiogenesis. OBJECTIVE: The aim of this study was to compare the concentration of mast cells in SCC of the mouth and skin and evaluate whether there is a correlation with the degree of differentiation of these tumors. MATERIAL AND METHODS: Thirty cases of SCC of the skin and 34 of the mouth were investigated. Toluidine blue staining was used to identify mast cells in blocks containing the central portion of the neoplasm. RESULTS: A concentration of between 0 and 10 mast cells was found in one single case of SCC of the skin and there were no cases of SCC of the mouth with concentrations of mast cells in the tumor >201. In the majority of cases of SCC of the mouth (47%; n=16), mast cell concentration was between 0 and 10, with a concentration >51 mast cells in 80% of cases of SCC of the skin. All the cases of SCC of the mouth with a concentration of mast cells between 100 and 200 and 80% of those with a concentration of 51-99 were located on the lip. The concentration of mast cells was unrelated to the degree of differentiation of the tumor. CONCLUSION: The concentration of mast cells is lower in SCC of the mouth except when the tumor is located on the lip. This may reflect a lower need for cell activation in the microenvironment to improve vascularization in oral cancer.

IS ORDINARY ELECTRIC DRILLS` VENTING PORT A POTENTIAL SOURCE OF SURGICAL INFECTION?

Objective: To evaluate the potential risk of surgical contamination by the venting port of ordinary electric drills (ED) employed in orthopaedic surgeries. Materials and Methods: an experimental laboratory, randomized study was developed to analyze EDs in surgical practice and new cleaned and sterilized equipment, which were contaminated with Bacillus atrophaeus spores at a concentration of 84 X 10(6) UFC. The air generated by the engine of each drill was collected and cultivated on sterile agar plates. Results: Positive culture was identified in two ED in surgical practice, as well as a positive culture to Bacillus atrophaeus with 1 CFU growth (1, 19 X 10(-8)). Conclusion: In the conditions of the experiment, the air generated by the venting port of the ED`s engine does not consist of a source of contamination for the surgical site.

Dysautonomia due to reduced cholinergic neurotransmission causes cardiac remodeling and heart failure

Overwhelming evidence supports the importance of the sympathetic nervous system in heart failure. In contrast, much less is known about the role of failing cholinergic neurotransmission in cardiac disease. By using a unique genetically modified mouse line with reduced expression of the vesicular acetylcholine transporter (VAChT) and consequently decreased release of acetylcholine, we investigated the consequences of altered cholinergic tone for cardiac function. M-mode echocardiography, hemodynamic experiments, analysis of isolated perfused hearts, and measurements of cardiomyocyte contraction indicated that VAChT mutant mice have decreased left ventricle function associated with altered calcium handling. Gene expression was analyzed by quantitative reverse transcriptase PCR and Western blotting, and the results indicated that VAChT mutant mice have profound cardiac remodeling and reactivation of the fetal gene program. This phenotype was attributable to reduced cholinergic tone, since administration of the cholinesterase inhibitor pyridostigmine for 2 weeks reversed the cardiac phenotype in mutant mice. Our findings provide direct evidence that decreased cholinergic neurotransmission and underlying autonomic imbalance cause plastic alterations that contribute to heart dysfunction.

Cardiac anti-remodelling effect of aerobic training is associated with a reduction in the calcineurin/NFAT signalling pathway in heart failure mice

Cardiomyocyte hypertrophy occurs in response to a variety of physiological and pathological stimuli. While pathological hypertrophy in heart failure is usually coupled with depressed contractile function, physiological hypertrophy associates with increased contractility. In the present study, we explored whether 8 weeks of moderate intensity exercise training would lead to a cardiac anti-remodelling effect in an experimental model of heart failure associated with a deactivation of a pathological (calcineurin/NFAT, CaMKII/HDAC) or activation of a physiological (Akt-mTOR) hypertrophy signalling pathway. The cardiac dysfunction, exercise intolerance, left ventricle dilatation, increased heart weight and cardiomyocyte hypertrophy from mice lacking alpha(2A) and alpha(2C) adrenoceptors (alpha(2A)/alpha(2C)ARKO mice) were associated with sympathetic hyperactivity induced heart failure. The relative contribution of Ca(2+)-calmodulin high-affinity (calcineurin/NFAT) and low-affinity (CaMKII/HDAC) targets to pathological hypertrophy of alpha(2A)/alpha(2C)ARKO mice was verified. While nuclear calcineurin B, NFATc3 and GATA-4 translocation were significantly increased in alpha(2A)/alpha(2C)ARKO mice, no changes were observed in CaMKII/HDAC activation. As expected, cyclosporine treatment decreased nuclear translocation of calcineurin/NFAT in alpha(2A)/alpha(2C)ARKO mice, which was associated with improved ventricular function and a pronounced anti-remodelling effect. The Akt/mTOR signalling pathway was not activated in alpha(2A)/alpha(2C)ARKO mice. Exercise training improved cardiac function and exercise capacity in alpha(2A)/alpha(2C)ARKO mice and decreased heart weight and cardiomyocyte width paralleled by diminished nuclear NFATc3 and GATA-4 translocation as well as GATA-4 expression levels. When combined, these findings support the notion that deactivation of calcineurin/NFAT pathway-induced pathological hypertrophy is a preferential mechanism by which exercise training leads to the cardiac anti-remodelling effect in heart failure.

Lumbar Epidural Anesthesia in the Treatment of Discal Lombosciatalgia: A Comparative Clinical Study between Methylprednisolone and Methylprednisolone with Levobupivacaine

Sousa FAEF, Colhado OCG - Lumbar Epidural Anesthesia in the Treatment of Discal Lombosciatalgia: A Comparative Clinical Study between Methylprednisolone and Methylprednisolone with Levobupivacaine. Background and objectives: Lumbar epidural technique has been used in the treatment of lombosciatalgia since 1953. In most cases, methylprednisolone is used along with a local anesthetic, and it is not known whether the isolated use of methylprednisolone is equally effective in relieving symptoms. The objective of this study was to compare the efficacy of two different solutions - methylprednisolone with saline and methylprednisolone with levobupivacaine injected in the epidural space to heal lombosciatalgia secondary to lumbar herniated disk. Methods: Sixty individuals ASA I and II, of both genders, ages 18 to 65 years participated in this randomized, double-blind study over a period of one year. They underwent interlaminar lumbar epidural analgesia without radioscopic control to heal a lombosciatalgia and they were divided into two groups: G-M (methylprednisolone + saline) and G-M + L (methylprednisolone + levobupivacaine + saline) both at a volume of 10 mL. Diagnosis was based on history, physical exam, and imaging exam (MRI). The Visual Analogue Scale (VAS) was applied in a total of two blockades, 15 days apart. Results: A reduction in pain severity was observed in the methylprednisolone-levobupivacaine group, but without statistical significance. Conclusions: The analgesic efficacy of the G-M + L solution was superior to that of the G-M solution in the treatment of discal lombosciatalgia regarding the shorter time to onset of analgesia, but this was not significant at the time of discharge, and both solutions were effective in the treatment of discal lombosciatalgia.

Women`s feelings about early contact with their infants on the labour ward

Objectives: to identify women`s feelings after early contact with their newborn infants in the delivery room, and to identify how health professionals involved in mother and infant care behave in the intrapartum setting. Design: a qualitative approach using semi-structured interviews and observation. Content analysis was used to derive the three themes that emerged from the interviews. Setting and participants: 23 postpartum women and their caregivers in a public maternity hospital in Ribeirao Preto, Brazil. Findings: three thematic categories emerged from the interviews: heightened fear, severe pain and intense conflict. The professionals` actions revealed that they have theoretical and practical abilities for humanisation of care, but their actions are fragmented. Final considerations: women can feel lonely, fearful and conflicted in the delivery room, and they also experience pain. Giving birth is a major event in a woman`s life, so it is important to facilitate a positive experience. Health professionals were found to display interventionist and impersonal attitudes; these influenced the potential choices of women at their first contact with their infant. Implications for practice: the focus of health care needs to extend beyond the institution. This means fewer normative actions performed by health professionals, enabling women to enjoy their early contact with their newborn infants. (C) 2010 Elsevier Ltd. All rights reserved.

Attempted Suicide in Reproductive Age Women

In this study, we described the frequency of attempted suicide among women of reproductive age (10 to 49 years) in a General University Hospital in Ribeirao Preto, Brazil (conducted 2005). Relevant comorbidities associated with the suicide attempt were calculated. Secondary data were obtained through the hospital`s records where attempted suicides were reported. Findings revealed 132 attempted suicides; most women took a toxic substance or their own medication. Half of the women previously had attempted suicide. Depression was the most frequent psychiatric diagnosis on discharge from the hospital, specifically borderline personality disorder, personality disorders axis B and depression without association.

Gait Pattern Adaptation for an Active Lower-Limb Orthosis Based on Neural Networks

This work deals with neural network (NN)-based gait pattern adaptation algorithms for an active lower-limb orthosis. Stable trajectories with different walking speeds are generated during an optimization process considering the zero-moment point (ZMP) criterion and the inverse dynamic of the orthosis-patient model. Additionally, a set of NNs is used to decrease the time-consuming analytical computation of the model and ZMP. The first NN approximates the inverse dynamics including the ZMP computation, while the second NN works in the optimization procedure, giving an adapted desired trajectory according to orthosis-patient interaction. This trajectory adaptation is added directly to the trajectory generator, also reproduced by a set of NNs. With this strategy, it is possible to adapt the trajectory during the walking cycle in an on-line procedure, instead of changing the trajectory parameter after each step. The dynamic model of the actual exoskeleton, with interaction forces included, is used to generate simulation results. Also, an experimental test is performed with an active ankle-foot orthosis, where the dynamic variables of this joint are replaced in the simulator by actual values provided by the device. It is shown that the final adapted trajectory follows the patient intention of increasing the walking speed, so changing the gait pattern. (C) Koninklijke Brill NV, Leiden, 2011

Influence of physical and geometrical parameters on three-dimensional load transfer mechanism at tunnel face

Three-dimensional discretizations used in numerical analyses of tunnel construction normally include excavation step lengths much shorter than tunnel cross-section dimensions. Simulations have usually worked around this problem by using excavation steps that are much larger than the actual physical steps used in a real tunnel excavation. In contrast, the analyses performed in this study were based on finely discretized meshes capable of reproducing the excavation lengths actually used in tunnels, and the results obtained for internal forces are up to 100% greater than those found in other analyses available in the literature. Whereas most reports conclude that internal forces depend on support delay length alone, this study shows that geometric path dependency (reflected by excavation round length) is very strong, even considering linear elasticity. Moreover, many other solutions found in the literature have also neglected the importance of the relative stiffness between the ground mass and support structure, probably owing to the relatively coarse meshes used in these studies. The analyses presented here show that relative stiffness may account for internal force discrepancies in the order of 60%. A dimensionless expression that takes all these parameters into account is presented as a good approximation for the load transfer mechanism at the tunnel face.

Punching Strength of Flat Slabs with Unbraced Shear Reinforcement

This paper analyzes the punching strength of concrete flat slabs with shear reinforcement that does not embrace flexural reinforcement. This paper also reports the results of tests of slabs without shear reinforcement. Finally, this paper shows some comparisons of tests of similar slabs without shear reinforcement and slabs with different types of shear reinforcement. The obtained results show that the use of shear reinforcement elements without embracement in the flexural reinforcement improves the punching strength of reinforced concrete flat slabs.

Embrittlement of electrical steel laminations by nitrogen pick-up during heat treatment

Heat treated electrical steel laminations have shown evidence of low ductility behavior, characterized by a small number of bends till fracture, on repeated bending tests. The laminations were produced using a new grade of electrical steel with much lower aluminum content than usual. The problem happens when the oxygen potential (measured by the dew point of the atmosphere) of the heat treatment atmosphere is abnormally high. Furthermore, ductility can be restored by a low-oxygen potential heat treatment. Although the heat treatment resulted in a loss of ductility, the magnetic properties were not deteriorated. The low ductility samples always show intergranular fracture, whereas the un-treated laminations fracture by cleavage. The low ductility is associated with the formation of silicon manganese nitride precipitates formed at grain boundaries, although they are not the cause of the low ductility. Ductility could be restored by a low dew point heat treatment but the inclusions remained in the grain boundaries. The low ductility and its recovery must be ascribed to the presence of nitrogen atoms segregated to the grain boundaries when the heat treatment atmosphere has a high oxygen potential. The lack of aluminum in the composition of the steel hinders the scavenging effect of this element on nitrogen atoms in solution in the steel. (C) 2009 Elsevier Ltd. All rights reserved.

Colloidal Processing of Glass-Ceramics for Laminated Object Manufacturing

Green tapes of Li(2)O-ZrO(2)-SiO(2)-Al(2)O(3) (LZSA) parent glass were produced by aqueous tape casting as the starting material for the laminated object manufacturing (LOM) process. The rheological behavior of the powder suspensions in aqueous media, as well as the mechanical properties of the cast tapes, was evaluated. According to xi potential measurements, the LZSA glass powder particles showed acid surface characteristics and an IEP of around 4 when in aqueous media. The critical volume fraction of solids was about 72 wt% (27 vol%), which hindered the processability of more concentrated slurries. The glass particles also showed an anisometric profile, which contributed to an increase in the interactions between particles during flow. Therefore, the suspensions could not be processed at high solids loadings. Aqueous-based glass suspensions were also characterized by shear thickening after the addition of dispersants. Three slurry compositions were formulated, suitable green tapes were cast, and tapes were successfully laminated by LOM to a gear wheel geometry. A higher tensile strength of the green tapes corresponded to a higher tensile strength of the laminates. Thermal treatment was then applied to the laminates: pyrolysis at 525 degrees C, sintering at 700 degrees C for 1 h, and crystallization at 850 degrees C for 30 min. A 20% volumetric shrinkage was observed, but no surface flaws or inhomogeneous areas were detected. The sintered part maintained the curved edges and internal profile after heat treatment.