Strategies to evaluate the impact of rectal volume on prostate motion during three-dimensional conformal radiotherapy for prostate cancer

Abstract Objective: To evaluate the rectal volume influence on prostate motion during three-dimensional conformal radiotherapy (3D-CRT) for prostate cancer. Materials and Methods: Fifty-one patients with prostate cancer underwent a series of three computed tomography scans including an initial planning scan and two subsequent scans during 3D-CRT. The organs of interest were outlined. The prostate contour was compared with the initial CT images considering the anterior, posterior, superior, inferior and lateral edges of the organ. Variations in the anterior limits and volume of the rectum were assessed and correlated with prostate motion in the anteroposterior direction. Results: The maximum range of prostate motion was observed in the superoinferior direction, followed by the anteroposterior direction. A significant correlation was observed between prostate motion and rectal volume variation ( p = 0.037). A baseline rectal volume superior to 70 cm3 had a significant influence on the prostate motion in the anteroposterior direction ( p = 0.045). Conclusion: The present study showed a significant interfraction motion of the prostate during 3D-CRT with greatest variations in the superoinferior and anteroposterior directions, and that a large rectal volume influences the prostate motion with a cutoff value of 70 cm3. Therefore, the treatment of patients with a rectal volume > 70 cm3 should be re-planned with appropriate rectal preparation.

Carbamato de etila em bebidas alcoólicas (cachaça, tiquira, uísque e grapa)

The presence of ethyl carbamate in cachaças, tiquiras, whiskies and grapes was investigated by GC-MS, monitoring the m/z 62 ion. The external standard method was used for quantitation in 188 samples (126 cachaças, 37 tiquiras, 6 grappas and 19 whiskies). The results of the study for cachaça were analysed considering the geographic origin, distillation type (still or column), bottle coloration (amber or transparent) and ageing. The average contents of ethyl carbamate in cachaças and tiquiras were 0.77 and 2.4 mg L-1, respectively. These values were higher than the mean concentration found in grapes (0.045 mg L-1) and whiskies (0.14 mg L-1). On average the cachaças distilled in column tend to present higher values of ethyl carbamate than those from still. In the sampling studied it was not possible to define a correlation between content of ethyl carbamate, bottle coloration and ageing time.

A topical microemulsion for the prevention of allergic rhinitis symptoms: results of a randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial (Nares study)

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients" satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p = 0.017) and mean total nasal symptoms (0.7 vs. 0.9; p = 0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (−0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion.

Innovations of ageing and societal transition : Dynamics of change of the socio-technical regime of ageing

The purpose of this dissertation is to examine the dynamics of the socio-technical system in the field of ageing. The study stems from the notion that the ageing of the population as a powerful megatrend has wide societal effects, and is not just a matter for the social and health sector. The central topic in the study is change: not only the age structures and structures of society are changing, but also at the same time there is constant development, for instance, in technologies, infrastructures and cultural perceptions. The changing concept of innovation has widened the understanding of innovations related to ageing from medical and assistive technological innovations to service and social innovations, as well as systemic innovations at different levels, which means the intertwined and co-evolutionary change in technologies, structures, services and thinking models. By the same token, the perceptions of older people and old age are becoming more multi-faceted: old age is no longer equated to illnesses and decline, but visions of active ageing and a third age have emerged, which are framed by choices, opportunities, resources and consumption in later life. The research task in this study is to open up the processes and mechanisms of change in the field of ageing, which are studied as a complex, multi-level and interrelated socio-technical system. The question is about co-effective elements consisting of macro-level landscape changes, the existing socio-technical regime (the rule system, practices and structures) and bottom-up niche-innovations. Societal transitions do not account for the things inside the regime alone, or for the long-term changes in the landscape, nor for the radical innovations, but for the interplay between all these levels. The research problem is studied through five research articles, which offer micro-level case studies to macro-level phenomenon. Each of the articles focus on different aspects related to ageing and change, and utilise various datasets. The framework of this study leans on the studies of socio-technical systems and multi-level perspective on transitions mainly developed by Frank Geels. Essential factors in transition from one socio-technological regime to another are the co-evolutionary processes between landscape changes, regime level and experimental niches. Landscape level changes, like the ageing of the population, destabilise the regime in the forms of coming pressures. This destabilization offers windows for opportunity to niche-innovations outside or at fringe of the regime, which, through their breakthrough, accelerate the transition process. However, the change is not easy because of various kinds of lock-ins and inertia, which tend to maintain the stability of the regime. In this dissertation, a constructionist approach of society is applied leaning mainly to the ideas of Anthony Giddens’ theory of structuration, with the dual nature of structures. The change is taking place in the interplay between actors and structures: structures shape people’s practices, but at the same time these practices constitute and reproduce social systems. Technology and other material aspects, as part of socio-technical systems, and the use of them, also take part in the structuration process. The findings of the study point out that co-evolutionary and co-effective relationships between economic, cultural, technological and institutional fields, as well as relationships between landscape changes, changes in the local and regime-level practices and rule systems, are a very complex and multi-level dynamic socio-technical phenomenon. At the landscape level of ageing, which creates the pressures and triggers to the regime change, there are three remarkable megatrends: demographic change, changes in the global economy and the development of technologies. These exert pressures to the socio-technical regime, which as a rule system is experiencing changes in the form of new markets and consumer habits, new ways of perceiving ageing, new models of organising the health care and other services and as new ways of considering innovation and innovativeness. There are also inner dynamics in the relationships between these aspects within the regime. These are interrelated and coconstructed: the prevailing perceptions of ageing and innovation, for instance, reflect the ageing policies, innovation policies, societal structures, organising models, technology and scientific discussion, and vice versa. Technology is part of the inner dynamics of the sociotechnological regime. Physical properties of the artefacts set limitations and opportunities with regard to their functions and uses. The use of and discussion about technology, contributes producing and reproducing the perceptions of old age. For societal transition, micro-level changes are also needed, in form of niche-innovations, for instance new services, organisational models or new technologies, Regimes, as stabilitystriven systems, tend to generate incremental innovations, but radically new innovations are generated in experimental niches protected from ‘normal’ market selection. The windows of opportunity for radical novelties may be opened if the circumstances are favourable for instance by tensions in the socio-technical regime affected by landscape level changes. This dissertation indicates that a change is taking place, firstly, in the dynamic interactionbetween levels, as a result of purposive action and governance to some extent. Breaking the inertia and using the window of opportunity for change and innovation offered by dynamics between levels, presupposes the actors’ special capabilities and actions such as dynamic capabilities and distance management. Secondly, the change is taking place the socio-technological negotiations inside the regime: interaction between technological and social, which is embodied in the use of technology. The use of technology includes small-level contextual scripts that also participate in forming broader societal scripts (for instance defining old age at the society level), which in their turn affect the formation of policies for innovation and ageing. Thirdly, the change is taking place by the means of active formation of the multi-actor innovation networks, where the role of distance management is crucial to facilitate the communication between actors coming from different backgrounds as well as to help the niches born outside the regime to utilise the window of opportunity offered by regime destabilisation. This dissertation has both theoretical and practical contributions. This study participates in the discussion of action-oriented view on transition by opening up of the socio-technological, coevolutionary processes of the multi-faceted phenomenon of ageing, which has lacked systematic analyses. The focus of this study, however, is not on the large-scale coordination and governance, but rather on opening up the incremental elements and structuration processes, which contribute to the transition little by little, and which can be affected to. This increases the practical importance of this dissertation, by highlighting the importance of very tiny, everyday elements in the change processes in the long run.

L'Univers

1904/05/06 (Numéro 13200).

Demanda de potência do ventilador para aeração de material em compostagem

Neste trabalho, objetivou-se ajustar curvas de perda na pressão estática do ar, quando forçado em camadas de material orgânico, com diferentes espessuras, e dois estádios de degradação bioquímica, para possibilitar o cálculo da demanda de potência do sistema de ventilação. Os resíduos utilizados para a medição da perda de pressão do ar foram cama de frango misturada com casca dos frutos do cafeeiro, razão entre massas de 2,5:1, de forma a se obter relação C/N inicial de 30:1. Foi verificado que a perda na pressão estática do ar aumentou linearmente com a espessura da camada de composto orgânico e que houve aumento na perda de pressão estática com o aumento na vazão específica do ar, o que praticamente não foi alterado pelo estádio de degradação bioquímica do material em compostagem. Todos os modelos testados (potencial, logarítmico e quadrático) ajustaram-se bem aos dados experimentais, na faixa de vazão específica de ar entre 0,045 e 0,159 m³ s-1 m-2, podendo ser usado para predizer os gradientes de pressão estática no composto orgânico. A potência demandada pelo sistema de ventilação foi de 1,16 W t-1 no material, antes da compostagem, e de 2,38 W t-1, após 60 dias de compostagem, em camada com 1 m de espessura. Em camada de 2 m de espessura, a demanda foi de 17,70 e 21,65 W t-1, respectivamente.

The effectiveness of vocationally oriented multidisciplinary rehabilitation (ASLAK®) amongst public sector employees

In Finland, vocationally oriented medical rehabilitation (ASLAK®) is a common preventive rehabilitation measure with the primary goal of preserving and improving work ability. The ASLAK® programme has been used for almost 30 years, although limited data exist on its effectiveness. The aims of this study were to determine whether the increased risk of work disability predicts the participants’ likelihood to be granted ASLAK® rehabilitation and to assess the effectiveness of the programme in decreasing the risk of work disability and modifying health-risk behaviours. This study is a part of the on-going Finnish Public Sector Study conducted by the Finnish Institute of Occupational Health. Data on 53 416 employees (81% women) were gathered from employers’ records, national health registers and repeated survey responses. During the 5-year follow-up, increased levels of the risk factors for work disability did not predict participation in the rehabilitation programme. During the 2.8-year followup (range 0.04–5.0 years), the risk of long-term work disability (sick leave >90 days or retirement) overall or, more specifically, due to musculoskeletal or mental diseases did not differ between the rehabilitants who participated in ASLAK® in 1997–2005 and their propensity score matched controls. There was no evidence of ASLAK® being effective in changing participants’ health-risk behaviours or in improving perceived general or mental health. The results suggest that potential participant recognition, mainly taking place in occupational health care, may fail to identify those with a higher risk of work disability. No evidence on the effectiveness of the programme was found in the study cohort when measured by the selected indicators.

Enxerto homólogo congelado de diafragma na correção dos defeitos da parede abdominal de ratos

OBJETIVOS: Análise morfológica e biomecânica do enxerto homólogo congelado de diafragma para correção de defeito da parede abdominal em ratos. MÉTODOS: Os animais foram distribuidos em controle (20 ratos Wistar) e experimento (30 ratos Wistar). Os do grupo controle foram submetidos à laparotomia mediana e sutura da parede abdominal; já os do grupo experimento, à ressecção da parede abdominal e reconstrução com enxerto homólogo congelado de diafragma. Os animais foram submetidos à eutanásia no 3° e 6° mês de pós-operatório e avaliados quanto à presença de complicações pós-operatórias, integridade do enxerto, presença de aderências, avaliação tensiométrica, avaliação histopatológica com H/E e com sirius-red (colágeno tipo I e III). RESULTADOS: Houve integração do enxerto em todos os animais sem complicações. Aderências foram semehantes entre os grupos controle e experimento após três e seis meses. Observaram-se maior força máxima, força de ruptura e tensão nos animais do grupo experimento aos três meses de pós-operatório (p=0,001; p=0,012 e p=0,001, respectivamente). Na correlação entre as diferentes variáveis estudadas houve correlação estatisticamente significante entre força máxima e tensão nos grupos controle e experimento (p=0,001 e p= 0,001), e nos subgrupos três e seis meses (p=0,002 e p=0,001). Correlacionaram-se força máxima e colágeno tipo I (p=0,04) e Índice de Maturação do Colágeno (IMaC) e força máxima (p=0,03) ambos somente no grupo controle, mas nos subgrupos 3 e 6 meses (p=0,045 e p=0,038). O número de monomorfonucleares e força máxima também apresentou significância estatística tanto para o grupo controle quanto para o experimento (p=0,005 e p=0,004, respectivamente). CONCLUSÃO: O enxerto homólogo congelado de diafragma mostrou ser boa alternativa no reparo de grandes defeitos da parede abdominal em ratos.

O etil-2-cianoacrilato como selante após ressecção parcial de ceco em rattus norvegicus albinus

OBJETIVO: Avaliar a utilização do etil-2-cianoacrilato no tratamento de uma lesão provocada em um segmento parcialmente excluso do intestino do rato: o ceco. MÉTODOS: Utilizaram-se 45 ratos machos da linhagem Wistar, distribuidos em três grupos iguais, sendo que foi realizada a ressecção parcial do ceco. Os grupos foram denominados como: Grupo 1: a lesão foi tratada com aplicação de etil-2-cianoacrilato; Grupo 2: sutura e aplicação de etil-2-cianoacrilato; Grupo 3: sutura em bolsa. Os animais foram acompanhados no pós-operatório e metade de cada grupo foi necropsiada no 14º e restante no 28º pós-operatório. Dessa forma, foram submetidos à avaliação macroscópica, sendo coletadas amostras do ceco para avaliação histológica e, por fim, realizou-se a análise estatística RESULTADOS: O ganho de peso pós-experimento foi diferente nos grupos (p=0,028). A presença de microabcessos foi maior no 28º dia de pós-operatório no grupo 2, em comparação com o grupo 3 (p=0,003). A deposição de colágeno no 28º dia de pós-operatório foi maior no grupo 1 (p=0,036) e a intensidade da inflamação no 14º dia de pós-operatório foi maior no grupo 1 (p=0,045). Nos demais parâmetros avaliados, não ocorreu diferença estatística. CONCLUSÃO: A utilização do etil-2-cianoacrilato foi efetiva no tratamento do coto cecal excluso de ratos frente à avaliação macroscópica, microscópica e evolução pós-operatória.

Embolização de mioma uterino em mulheres portadoras de miomas volumosos

OBJETIVO: avaliar a eficácia da embolização de mioma uterino (EMUT) em pacientes com miomas volumosos no que diz respeito tanto à evolução clínica quanto à redução do tamanho dos mesmos. MÉTODOS: vinte e seis pacientes com média etária de 36,5 anos, portadoras de miomas uterinos sintomáticos com volume acima de 1.000 cm³, foram submetidas à EMUT. Todas possuíam indicação para tratamento percutâneo. Os procedimentos foram realizados sob anestesia epidural e sedação, empregando-se protocolo institucional de analgesia. Após punção femoral unilateral, foi realizado o cateterismo seletivo das artérias uterinas e infusão de microesferas calibradas por meio de microcateter. A avaliação clínica pós-procedimento foi realizada em ambulatório de ginecologia segundo o protocolo de atendimento. Todas as pacientes tinham ressonância nuclear magnética (RNM) antes do procedimento e 15 pacientes RNM de controle após 6 meses. RESULTADOS: o sucesso técnico foi de 100%. Não houve complicação relacionada aos procedimentos. A média de volume uterino das 15 pacientes foi 1.401 cm³ antes da embolização (min. 1.045 cm³, max. 2.137 cm³) e, após 6 meses 799 cm³ (min. 525 cm³, max. 1.604 cm³), constituindo uma redução média de 42,9%. A melhora clínica foi constatada em 25 das 26 pacientes. Uma paciente com útero de 1.098 cm³ apresentou necrose e expulsão parcial do mioma, sendo submetida à miomectomia. Outra paciente foi submetida à miomectomia após seis meses devido ao desejo de gravidez, apesar da redução parcial do volume dos miomas. Uma paciente com volume uterino de 2.201 cm³ necessitou de segunda intervenção para alcançar um resultado adequado. Nenhuma paciente foi submetida à histerectomia. Foram utilizadas em média 9,2 seringas de microesferas por paciente. CONCLUSÃO: a embolização de miomas uterinos de grande volume é um procedimento factível, com aceitáveis resultados clínico e radiológico. Pode ser considerada uma opção para as pacientes que desejam a preservação uterina e também servir como terapêutica adjuvante à miomectomia de alto risco.

Impacto do parto vaginal após uma cesárea prévia sobre os resultados perinatais

OBJETIVO: Analisar o impacto do parto vaginal, após uma cesárea prévia, sobre os resultados perinatais. MÉTODOS: Estudo caso-controle, com seleção de casos incidentes e controles consecutivos, no qual foram analisadas variáveis maternas e perinatais. Compararam-se gestantes secundigestas com parto cesáreo prévio (n=375) e que deram à luz via transpélvica (PVPC), com gestantes com os mesmos critérios de inclusão, mas submetidas a operação cesariana (PCPC, n=375). Foram considerados critérios de inclusão: gestantes secundigestas que tenham dado à luz por meio de parto cesariana na gestação anterior; gestação única e de termo; feto em apresentação cefálica, sem malformação congênita; ausência de placenta prévia ou qualquer tipo de sangramento de terceiro trimestre gestacional. RESULTADOS: No estudo, a taxa de PVPC foi de 45,6%, sendo que 20 deles (5,3%) foram ultimados com o fórceps. Observou-se associação significante entre PVPC e idade materna inferior a 19 anos (p<0,01), etnia caucasiana (p<0,05), número médio de consultas de pré-natal (p<0,001), tempo de ruptura prematura das membranas (p<0,01), tempo de trabalho de parto inferior a 12h (p<0,045), índice de Apgar inferior a sete no 5º minuto (p<0,05), tocotraumatismo fetal (p<0,01) e anoxia (p<0,006). No grupo de recém-nascidos por PCPC observou-se maior frequência de taquipneia transitória (p<0,014), disfunções respiratórias (p<0,04) e maior tempo de internação na unidade de tratamento intensivo neonatal (p<0,016). Houve apenas um caso de ruptura uterina no grupo PVPC. O número de neomortos foi idêntico em ambos os grupos. CONCLUSÕES: A via de parto vaginal em secundigestas com cesárea prévia associou-se a aumento significativo da morbidade neonatal. Serão necessários mais estudos para elaborar estratégias que visem melhorias dos resultados perinatais e de auxílio aos profissionais, de forma que estes possam melhor orientar as suas pacientes na escolha da via de parto mais adequada.

Pressure Drop in Vertical Core-Annular Flow

An experimental apparatus for the study of core annular flows of heavy oil and water at room temperature has been set up and tested at laboratory scale. The test section consists of a 2.75 cm ID galvanized steel pipe. Tap water and a heavy oil (17.6 Pa.s; 963 kg/m³) were used. Pressure drop in a vertical upward test section was accurately measured for oil flow rates in the range 0.297 - 1.045 l/s and water flow rates ranging from 0.063 to 0.315 l/s. The oil-water input ratio was in the range 1-14. The measured pressure drop comprises gravitational and frictional parts. The gravitational pressure drop was expressed in terms of the volumetric fraction of the core, which was determined from a correlation developed by Bannwart (1998b). The existence of an optimum water-oil input ratio for each oil flow rate was observed in the range 0.07 - 0.5. The frictional pressure drop was modeled to account for both hydrodynamic and net buoyancy effects on the core. The model was adjusted to fit our data and shows excellent agreement with data from another source (Bai, 1995).

Härmänkankaan pohjavesialueen suojelusuunnitelma : Virolahti

Härmänkankaan pohjavesialueen suojelusuunnitelma on tehty osana vuosina 2012–2014 toteutettua kymPOVERI (Kymenlaakson pohjavesiriskit hallintaan) -hanketta. Hankkeessa laadittiin pohjavesialueiden suojelusuunnitelmat 32:lle Kymenlaakson vedenhankinnan kannalta tärkeälle pohjavesialueelle. Pohjavesialueen suojelusuunnitelmaan on koottu tietoa pohjavesialueen hydrogeologisista olosuhteista käyttäen hyväksi vanhoja alueella tehtyjä tutkimuksia sekä hankkeen yhteydessä suoritettujen maastokartoitusten ja -tutkimusten tuloksia. Suojelusuunnitelmaan on koottu tietoa alueella sijaitsevista pohjavedelle riskiä aiheuttavista toiminnoista, kuten teollisuus- ja yritystoiminnoista, liikenteen ja tienpidon riskeistä, pilaantuneista maa-alueista, maa-ainestenotosta, maa- ja metsätaloudesta, asutuksesta, jätevesistä, öljy- ja polttoainesäiliöistä, maalämmöstä ja muuntamoista. Suojelusuunnitelmassa on annettu toimenpidesuosituksia sekä yksittäisille riskikohteille että eri riskiryhmille yleisesti. Suojelusuunnitelmassa käsitellään kaavoitustilanne alueella ja annetaan ohjeita maankäytön suunnitteluun pohjavesialueilla. Lisäksi suunnitelmaan on kirjattu toimintaohjeet mahdollisissa vahinko- ja onnettomuustapauksissa.

Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 ± 10 years). All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure), presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55%) patients. Significant increases in systolic blood pressure (P = 0.022), rate-pressure product (P = 0.045) and exercise duration (P = 0.003) were detected after the procedure. Twenty-seven (32%) patients presented angina during the exercise test before the procedure and 16 (19%) after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 ± 154 vs 381 ± 145 s, P = 0.008). Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

Alloxan-induced diabetes delays repair in a rat model of closed tibial fracture

A closed fracture was performed on the left tibia of 3-month-old Wistar rats weighing 250 to 350 g that were either healthy (N = 24) or made diabetic with alloxan (N = 24) to investigate the effect of alloxan-induced diabetes on the course of bone fracture healing. Histomorphometric analysis of the fracture site was performed at 7, 14, 25, and 35 days. After 7 days, diabetic rats had significantly less cartilage (P = 0.045) and greater fibrous connective (P = 0.006) tissue formation at the fracture site compared to controls. In contrast, marked callus formation was seen in diabetic rats with significant osteogenesis (P = 0.011, P = 0.010, P = 0.010, respectively, for 14, 25, and 35 days) and chondrogenesis (P = 0.028, P = 0.033, P = 0.019) compared to controls. Radiographic analysis revealed a displaced fracture with poor bone fragment alignment and delayed consolidation at these times in the diabetic group. The levels of alkaline phosphatase were significantly higher in diabetic rats at 25 days (P = 0.009). These results suggest that the initial excessive formation of fibrous connective tissue associated with delay in chondrogenesis and osteogenesis may not provide suitable stability of the fractured site, contributing to the inappropriate alignment of fragments and an increase in the volume of callus in later stages of repair. The resulting displaced fracture in diabetic rats requires long periods for remodeling and complete bone consolidation.