Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance - Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)

Background Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making. Methods/Design Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550). Discussion MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.

Double muscle innervation using end-to-side neurorrhaphy in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

PURPOSE: To investigate if tests used in the preoperative period of upper abdominal or thoracic surgeries are able to differentiate the patients that presented cardiopulmonary postoperative complications. METHODS: Seventy eight patients, 30 submitted to upper abdominal surgery and 48 to thoracic surgery were evaluated. Spirometry, respirometry, manovacuometry, six-minute walk test and stair-climbing test were performed. Complications from immediate postoperative to discharge from hospital were registered. RESULTS: The postoperative complications rate was 17% in upper abdominal surgery and 10% in thoracic surgery. In the univariate regression, the only variable that kept the correlation with postoperative complications in the upper abdominal surgery was maximal expiratory pressure. In thoracic surgery, the maximal voluntary ventilation, six-minute walk test and time in stair-climbing test presented correlation with postoperative complications. After multiple regression only stair-climbing test continued as an important risk predictor in thoracic surgery. CONCLUSION: The respiratory pressure could differentiate patients with complications in upper abdominal surgery, whereas in thoracic surgery, only spirometric values and exercise tests could differentiate them.

Effect of thermocycling on the flexural and impact strength of urethane-based and high-impact denture base resins

Objective: Mechanical properties of the acrylic resins used for denture fabrication may be influenced by water and temperature. Thus, the aim of this study was to evaluate the effect of thermocycling on the flexural and impact strength of a high-impact (Lucitone 199) and a urethane-based denture material (Eclipse).Materials and methods: Flexural strength (64 x 10 x 3.3 mm) and impact strength (60 x 6 x 4 mm) specimens were made following the manufacturers' instructions and assigned to two groups (n = 10): control (C) - not thermocycled - and T - thermocycled (5000 cycles between 5 and 55 degrees C). Specimens were submitted to three-point bending and Charpy impact tests.Results: Flexural strength (MPa) and impact strength (kJ/m(2)) data were analysed with two-way ANOVA (p = 0.05). The flexural strength of material Eclipse (C, 136.5; T, 130.7) was significantly higher than that of resin Lucitone 550 (C, 99.4; T, 90.1). Material Eclipse exhibited significantly higher impact strength (C, 6.9; T, 5.3) than the resin Lucitone 550 (C, 3.5; T, 3.0). For both materials, a significant decrease in flexural and impact strengths was observed when the specimens were thermocycled.Conclusion: Flexural and impact strengths were higher for Eclipse than for Lucitone 550, in both groups. Thermocycling decreased the flexural and impact strengths of Eclipse and Lucitone 550.

Efeito de tratamentos da superfície de união e materiais reembasadores na resistência ao impacto de resina para base de prótese

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Facial Reanimation Utilizing Combined Orthodromic Temporalis Muscle Flap and End-to-Side Cross-Face Nerve Grafts

Individuals with facial paralysis of 6 months or more without evidence of clinical or electromyographic improvement have been successfully reanimated utilizing an orthodromic temporalis transfer in conjunction with end-to-side cross-face nerve grafts. The temporalis muscle insertion is released from the coronoid process of the mandible and sutured to a fascia lata graft that is secured distally to the commissure and paralyzed hemilip. The orthodromic transfer of the temporalis muscle overcomes the concave temporal deformity and zygomatic fullness produced by the turning down of the central third of the muscle (Gillies procedure) while yielding stronger muscle contraction and a more symmetric smile. The muscle flap is combined with cross-face sural nerve grafts utilizing end-to-side neurorrhaphies to import myelinated motor fibers to the paralyzed muscles of facial expression in the midface and perioral region. Cross-face nerve grafting provides the potential for true spontaneous facial motion. We feel that the synergy created by the combination of techniques can perhaps produce a more symmetrical and synchronized smile than either procedure in isolation.Nineteen patients underwent an orthodromic temporalis muscle flap in conjunction with cross-face (buccal-buccal with end-to-side neurorrhaphy) nerve grafts. To evaluate the symmetry of the smile, we measured the length of the two hemilips (normal and affected) using the CorelDRAW X3 software. Measurements were obtained in the pre- and postoperative period and compared for symmetry.There was significant improvement in smile symmetry in 89.5 % of patients.Orthodromic temporalis muscle transfer in conjunction with cross face nerve grafts creates a synergistic effect frequently producing an aesthetic, symmetric smile.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.spinger.com/00266.

Estudo de cerâmicas avançadas para fins de blindagem balística

The research involving new materials has always been considered as a differential in the development of a technology company. This occurred naturally since ancient times, often motivated by reasons of a certain age, where the most common material used was also the name of your time and may be cited as an example the Bronze Age, and later was the Iron. Currently, the use of firearms are they used in resolving conflicts between countries, or a more equivocal, as an instrument of social banditry make innovations in the area of shielding welcome, whether for personal use, in the form of vests or vehicle such as cars, tanks and even aircraft. In this context, is a Silicon Carbide Ceramic, with low density and high hardness. Thus, the aim of this study is the evaluation and comparison of these materials, seeking to improve their properties by means of additives such as boron and silicon metal and amorphous YAG. For this work, the specimens were pre-shaped by means of uniaxial later to be referred for isostatic pressing and sintering. The maximum percentage for each additive was 5%, except for the YAG whose percentage was 8.2% (mass percentage). All compositions were subjected to the same tests (x-ray diffraction, apparent density, optical microscopy, Vickers hardness, scanning electron Microscopita), so that one could draw a comparison between the materials under study, samples that showed better mechanical properties and micro structural, related here by hardness testing and microscopy (optical and SEM) were the silicon carbide doped with YAG and alumina samples, demonstrating the potential of these materials for ballistic protection. Other compositions have high porosity, which is highly undesirable, since in order to harmful influences on the mechanical properties discussed below

Sviluppo di una strategia per l’individuazione di squilibri di titolo tra cilindri di un motore a combustione interna

L’oggetto di questa tesi è l’individuazione di un metodo in grado di rilevare uno squilibrio cilindrico rilevante in un motore a combustione interna ad accensione comandata, sovralimentato dinamicamente. Il progetto si basa sull’osservazione sperimentale di un forte incremento dei valori assunti da indici basati sulla differenza dei tempi dente della ruota fonica, al manifestarsi di un brusco squilibrio di titolo in uno dei quattro cilindri. Ciò ha permesso di rilevare eventuali sbilanciamenti di titolo mediante una diagnosi intrusiva in grado di esaltarli. Questa metodologia a differenza di quelle basate sul segnale proveniente dalla sonda lambda, non risente del problema del mixing dei pacchetti di gas combusti all’interno della turbina. Il lavoro di tesi è consistito nel concepire un indice di rilevamento capace di esaltare il fenomeno sopra descritto, nel creare in ambiente Matlab-Simulink un modello che simuli la strategia in questione e renda possibile la realizzazione di un prototipo, per mezzo del quale è stata validata la strategia a bordo del veicolo. This thesis proposes a methodology to detect a relevant cylinder imbalance by means of flywheel speed fluctuation analysis in a turbocharged internal combustion engine. The main idea behind this project is the evidence that every time a significant cylinder imbalance is present, it is noticed an important increase of index based on tooth time sampled via flywheel. For this reason, it is possible to develop an intrusive strategy, which higliaghts a possible cylinder imbalance presence, in order to detect it. This method, unlike others based on the signal coming from Lambda sensor, doesn’t suffer from the presence of exhaust gases mixing effect inside the turbine. The objective of this thesis is to conceive a detection index able to put in evidence the phenomena described above, and to design a model inside the Matlab-Simulink environment, able to simulate the strategy and to make possible tests on the vehicle by means of a prototype.

Reference values of mechanical and thermal pain tests in a pain-free population

Quantitative sensory tests are widely used in human research to evaluate the effect of analgesics and explore altered pain mechanisms, such as central sensitization. In order to apply these tests in clinical practice, knowledge of reference values is essential. The aim of this study was to determine the reference values of pain thresholds for mechanical and thermal stimuli, as well as withdrawal time for the cold pressor test in 300 pain-free subjects. Pain detection and pain tolerance thresholds to pressure, heat and cold were determined at three body sites: (1) lower back, (2) suprascapular region and (3) second toe (for pressure) or the lateral aspect of the leg (for heat and cold). The influences of gender, age, height, weight, body-mass index (BMI), body side of testing, depression, anxiety, catastrophizing and parameters of Short-Form 36 (SF-36) were analyzed by multiple regressions. Quantile regressions were performed to define the 5th, 10th and 25th percentiles as reference values for pain hypersensitivity and the 75th, 90th and 95th percentiles as reference values for pain hyposensitivity. Gender, age and/or the interaction of age with gender were the only variables that consistently affected the pain measures. Women were more pain sensitive than men. However, the influence of gender decreased with increasing age. In conclusion, normative values of parameters related to pressure, heat and cold pain stimuli were determined. Reference values have to be stratified by body region, gender and age. The determination of these reference values will now allow the clinical application of the tests for detecting abnormal pain reactions in individual patients.

Scale Up of PLA Nanoparticle Synthesis by Solvent Displacement and Functionalization of the Particles with a Silica Shell for Targeted Drug Delivery Applications

Biodegradable polymer nanoparticles have the properties necessary to address many of the issues associated with current drug delivery techniques including targeted and controlled delivery. A novel drug delivery vehicle is proposed consisting of a poly(lactic acid) nanoparticle core, with a functionalized, mesoporous silica shell. In this study, the production of PLA nanoparticles is investigated using solvent displacement in both a batch and continuous manner, and the effects of various system parameters are examined. Using Pluronic F-127 as the stabilization agent throughout the study, PLA nanoparticles are produced through solvent displacement with diameters ranging from 200 to 250 nm using two different methods: dropwise addition and in an impinging jet mixer. The impinging jet mixer allows for easy scale-up of particle production. The concentration of surfactant and volume of quench solution is found to have minimal impact on particle diameter; however, the concentration of PLA is found to significantly impact the diameter mean and polydispersity. In addition, the stability of the PLA nanoparticles is observed to increase as residual THF is evaporated. Lastly, the isolated PLA nanoparticles are coated with a silica shell using the Stöber Process. It is found that functionalizing the silica with a phosphonic silane in the presence of excess Pluronic F-127 decreases coalescence of the particles during the coating process. Future work should be conducted to fine-tune the PLA nanoparticle synthesis process by understanding the effect of other system parameters and in synthesizing mesoporous silica shells.

Application of 3D documentation and geometric reconstruction methods in traffic accident analysis: with high resolution surface scanning, radiological MSCT/MRI scanning and real data based animation

The examination of traffic accidents is daily routine in forensic medicine. An important question in the analysis of the victims of traffic accidents, for example in collisions between motor vehicles and pedestrians or cyclists, is the situation of the impact. Apart from forensic medical examinations (external examination and autopsy), three-dimensional technologies and methods are gaining importance in forensic investigations. Besides the post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) for the documentation and analysis of internal findings, highly precise 3D surface scanning is employed for the documentation of the external body findings and of injury-inflicting instruments. The correlation of injuries of the body to the injury-inflicting object and the accident mechanism are of great importance. The applied methods include documentation of the external and internal body and the involved vehicles and inflicting tools as well as the analysis of the acquired data. The body surface and the accident vehicles with their damages were digitized by 3D surface scanning. For the internal findings of the body, post-mortem MSCT and MRI were used. The analysis included the processing of the obtained data to 3D models, determination of the driving direction of the vehicle, correlation of injuries to the vehicle damages, geometric determination of the impact situation and evaluation of further findings of the accident. In the following article, the benefits of the 3D documentation and computer-assisted, drawn-to-scale 3D comparisons of the relevant injuries with the damages to the vehicle in the analysis of the course of accidents, especially with regard to the impact situation, are shown on two examined cases.

Cognitive functioning, behavior, and quality of life after stroke in childhood

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion). Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN). Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10-21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79-129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p = .000; Digit Span p = .000, Arithmetic's p = .007, Divided Attention p = .028, Alertness p = .002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p = .000; impulsivity/hyperactivity p = .006; psychosomatics p = .006). Certain aspects of quality of life were reduced (autonomy p = .003; parents' relation p = .003; social acceptance p = .037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p = .000, hand alternation p = .001, foot tapping p = .043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5-10 years) led to better cognitive outcome than lesion in the very early (0-5 years) or late childhood (10-18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis. Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.

Ranking of tests for pain hypersensitivity according to their discriminative ability in chronic neck pain

BACKGROUND AND OBJECTIVES Quantitative sensory testing (QST) is widely used to investigate peripheral and central sensitization. However, the comparative performance of different QST for diagnostic or prognostic purposes is unclear. We explored the discriminative ability of different quantitative sensory tests in distinguishing between patients with chronic neck pain and pain-free control subjects and ranked these tests according to the extent of their association with pain hypersensitivity. METHODS We performed a case-control study in 40 patients and 300 control subjects. Twenty-six tests, including different modalities of pressure, heat, cold, and electrical stimulation, were used. As measures of discrimination, we estimated receiver operating characteristic curves and likelihood ratios. RESULTS The following quantitative sensory tests displayed the best discriminative value: (1) pressure pain threshold at the site of the most severe neck pain (fitted area under the receiver operating characteristic curve, 0.92), (2) reflex threshold to single electrical stimulation (0.90), (3) pain threshold to single electrical stimulation (0.89), (4) pain threshold to repeated electrical stimulation (0.87), and (5) pressure pain tolerance threshold at the site of the most severe neck pain (0.86). Only the first 3 could be used for both ruling in and out pain hypersensitivity. CONCLUSIONS Pressure stimulation at the site of the most severe pain and parameters of electrical stimulation were the most appropriate QST to distinguish between patients with chronic neck pain and asymptomatic control subjects. These findings may be used to select the tests in future diagnostic and longitudinal prognostic studies on patients with neck pain and to optimize the assessment of localized and spreading sensitization in chronic pain patients.

Axial suspension test to assess pre-operative spinal flexibility in patients with adolescent idiopathic scoliosis.

INTRODUCTION An accurate description of the biomechanical behavior of the spine is crucial for the planning of scoliotic surgical correction as well as for the understanding of degenerative spine disorders. The current clinical assessments of spinal mechanics such as side-bending or fulcrum-bending tests rely on the displacement of the spine observed during motion of the patient. Since these tests focused solely on the spinal kinematics without considering mechanical loads, no quantification of the mechanical flexibility of the spine can be provided. METHODS A spinal suspension test (SST) has been developed to simultaneously monitor the force applied on the spine and the induced vertebral displacements. The system relies on cervical elevation of the patient and orthogonal radiographic images are used to measure the position of the vertebras. The system has been used to quantify the spinal flexibility on five AIS patients. RESULTS Based on the SST, the overall spinal flexibility varied between 0.3 °/Nm for the patient with the stiffer curve and 2 °/Nm for the less rigid curve. A linear correlation was observed between the overall spinal flexibility and the change in Cobb angle. In addition, the segmental flexibility calculated for five segments around the apex was 0.13 ± 0.07 °/Nm, which is similar to intra-operative stiffness measurements previously published. CONCLUSIONS In summary, the SST seems suitable to provide pre-operative information on the complex functional behavior and stiffness of spinal segments under physiological loading conditions. Such tools will become increasingly important in the future due to the ever-increasing complexity of the surgical instrumentation and procedures.

Failure and impact behavior of facade panels made of glass fiber reinforced cement(GRC)

GRC is a cementitious composite material made up of a cement mortar matrix and chopped glass fibers. Due to its outstanding mechanical properties, GRC has been widely used to produce cladding panels and some civil engineering elements. Impact failure of cladding panels made of GRC may occur during production if some tool falls onto the panel, due to stone or other objects impacting at low velocities or caused by debris projected after a blast. Impact failure of a front panel of a building may have not only an important economic value but also human lives may be at risk if broken pieces of the panel fall from the building to the pavement. Therefore, knowing GRC impact strength is necessary to prevent economic costs and putting human lives at risk. One-stage light gas gun is an impact test machine capable of testing different materials subjected to impact loads. An experimental program was carried out, testing GRC samples of five different formulations, commonly used in building industry. Steel spheres were shot at different velocities on square GRC samples. The residual velocity of the projectiles was obtained both using a high speed camera with multiframe exposure and measuring the projectile’s penetration depth in molding clay blocks. Tests were performed on young and artificially aged GRC samples to compare GRC’s behavior when subjected to high strain rates. Numerical simulations using a hydrocode were made to analyze which parameters are most important during an impact event. GRC impact strength was obtained from test results. Also, GRC’s embrittlement, caused by GRC aging, has no influence on GRC impact behavior due to the small size of the projectile. Also, glass fibers used in GRC production only maintain GRC panels’ integrity but have no influence on GRC’s impact strength. Numerical models have reproduced accurately impact tests.