889 resultados para FLEXURAL PSORIASIS


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Dissertação para obtenção do Grau de Mestre em Engenharia Civil – Perfil de Estruturas

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Applying a certain prestress level to the carbon fiber reinforced polymer (CFRP) reinforcement according to either externally bonded reinforcing (EBR) or near surface mounted (NSM) techniques can mobilize the strengthening potentialities of this high tensile strength composite material. For the prediction of the flexural behavior of reinforced concrete (RC) structures strengthened with prestressed EBR or NSM CFRPs, however, simplified analytical and design formulations still need to be developed as a guidance for engineers to design this type of strengthened structures by hand calculation without any programming help. Hence, the current work aims to briefly explain a developed simplified analytical approach, with a design framework, to predict the flexural behavior of RC beams flexurally strengthened with either prestressed EBR or NSM CFRP reinforcements. Moreover, an upper limit for the prestress level is proposed in order to optimize the ductility performance of the NSM prestressing technique. The good predictive performance of the analytical approaches was appraised by simulating the results of experimental programs composed of RC beams strengthened with prestressed NSM CFRP reinforcements.

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This study aims to develop an innovative carbon fibre reinforced polymer (CFRP) laminate with a U configuration to address strengthening interventions, where the increment of both flexural and shear capacity of reinforced concrete (RC) elements is required. This strengthening solution combines the near surface mounted (NSM) and embedded through section (ETS) techniques in the same application, since these techniques have already evidenced high performance on flexural and shear strengthening of RC beams using FRP systems, respectively. In fact, the proposed hybrid technique aims to mobilize the advantages provided by these two strengthening techniques by using an innovative CFRP laminate. The strengthening efficacy of this new hybrid NSM/ETS technique was numerically assessed and compared to the corresponding efficiency of NSM and ETS techniques applied separately for the flexural and shear strengthening of RC beams, respectively. The numerical models are described and the main relevant results are presented and discussed.

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The objective of this paper is to propose a simplified analytical approach to predict the flexural behavior of simply supported reinforced-concrete (RC) beams flexurally strengthened with prestressed carbon fiber reinforced polymer (CFRP) reinforcements using either externally bonded reinforcing (EBR) or near surface mounted (NSM) techniques. This design methodology also considers the ultimate flexural capacity of NSM CFRP strengthened beams when concrete cover delamination is the governing failure mode. A moment–curvature (M–χ) relationship formed by three linear branches corresponding to the precracking, postcracking, and postyielding stages is established by considering the four critical M–χ points that characterize the flexural behavior of CFRP strengthened beams. Two additional M–χ points, namely, concrete decompression and steel decompression, are also defined to assess the initial effects of the prestress force applied by the FRP reinforcement. The mid-span deflection of the beams is predicted based on the curvature approach, assuming a linear curvature variation between the critical points along the beam length. The good predictive performance of the analytical model is appraised by simulating the force–deflection response registered in experimental programs composed of RC beams strengthened with prestressed NSM CFRP reinforcements.

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In the present work are described and discussed the results of an extensive experimental program that aims to study the long-term behaviour of cracked steel fibre reinforced self-compacting concrete, SFRSCC, applied in laminar structures. In a first stage, the influence of the initial crack opening level (wcr = 0.3 and 0.5 mm), applied stress level, fibre orientation/dispersion and distance from the casting point, on the flexural creep behaviour of SFRSCC was investigated. Moreover, in order to evaluate the effects of the creep phenomenon on the residual flexural strength, a series of monotonic tests were also executed. It was found that wcr = 0.5 mm series showed a higher creep coefficient comparing to the series with a lower initial crack opening. Furthermore, the creep performance of the SFRSCC was influenced by the orientation of the extracted prismatic specimens regarding the direction of the concrete flow within the cast panel.

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Hybrid Composite Plate (HCP) is a reliable recently proposed retrofitting solution for concrete structures, which is composed of a strain hardening cementitious composite (SHCC) plate reinforced with Carbon Fibre Reinforced Polymer (CFRP). This system benefits from the synergetic advantages of these two composites, namely the high ductility of SHCC and the high tensile strength of CFRPs. In the materialstructural of HCP, the ultra-ductile SHCC plate acts as a suitable medium for stress transfer between CFRP laminates (bonded into the pre-sawn grooves executed on the SHCC plate) and the concrete substrate by means of a connection system made by either chemical anchors, adhesive, or a combination thereof. In comparison with traditional applications of FRP systems, HCP is a retrofitting solution that (i) is less susceptible to the detrimental effect of the lack of strength and soundness of the concrete cover in the strengthening effectiveness; (ii) assures higher durability for the strengthened elements and higher protection to the FRP component in terms of high temperatures and vandalism; and (iii) delays, or even, prevents detachment of concrete substrate. This paper describes the experimental program carried out, and presents and discusses the relevant results obtained on the assessment of the performance of HCP strengthened reinforced concrete (RC) beams subjected to flexural loading. Moreover, an analytical approach to estimate the ultimate flexural capacity of these beams is presented, which was complemented with a numerical strategy for predicting their load-deflection behaviour. By attaching HCP to the beams’ soffit, a significant increase in the flexural capacity at service, at yield initiation of the tension steel bars and at failure of the beams can be achieved, while satisfactory deflection ductility is assured and a high tensile capacity of the CFRP laminates is mobilized. Both analytical and numerical approaches have predicted with satisfactory agreement, the load-deflection response of the reference beam and the strengthened ones tested experimentally.

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Background: Psoriasis is accepted as a multisystemic disease with several important systemic manifestations. Thus, underlying comorbidities have to be taken into account in the choice of treatment. Objective: To explore the role of anti-TNF therapy in the treatment of psoriasis in a patient with acute-on-chronic pancreatitis. Methods: Here, we present the case of a 75-year-old patient with severe psoriasis also suffering from chronic alcohol-induced pancreatitis with recurrent acute flares. A recent life-threatening episode of acute pancreatitis and ischemic liver precluded the reintroduction of methotrexate. Cyclosporine was also excluded as it has been reported to induce acute pancreatitis. Thus, an anti-TNF treatment was initiated in close collaboration with a gastroenterologist. Results: A year after starting anti-TNF therapy the patient continues to show complete clinical remission of his psoriasis. No side effects, particularly no bacterial infections, were reported. No relapses of the patient's underlying chronic pancreatitis were observed throughout the entire treatment with regular clinical and laboratory monitoring, suggesting that chronic pancreatitis is not per se a contraindication for anti-TNF therapy. Conclusion: This case study opens the way for further questioning on the role of TNF in the pathogenesis of chronic and acute pancreatitis and the use of anti-TNF therapy in its treatment. © 2013 S. Karger AG, Basel.

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BACKGROUND Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE). METHODS Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach's alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes. RESULTS The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach's alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = -0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting 'much improved' health status at study completion was 1.01 (large effect size). CONCLUSIONS The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.

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Sección: "Buenas prácticas en gestión clínica"

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Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

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El objetivo fundamental del estudio fue valorar el cumplimiento terapéutico en pacientes con psoriasis. A tal fin se realizó una encuesta online a pacientes que constaba de 75 preguntas. Según la información aportada por los 679 encuestados, el cumplimiento fue del 15,17%. El cumplimiento no mostró relación con la intensidad de la psoriasis ni con la afectación psicológica o de la calidad de vida. Sin embargo, el cumplimiento fue menor en los pacientes que seguían tratamiento tópico y mayor en los que seguían tratamiento sistémico. El cumplimiento también fue mayor en el grupo de pacientes que eran visitados con mayor frecuencia.

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El úso de anti-TNF-α se ha asociado a reactivación de infección tuberculosa latente (ITL). Los IGRAs son pruebas in vitro más sensibles y mas específicas que la prueba de la prueba de la tuberculina (PT). El objetivo de este trabajo es el de contrastar la correlación entre los resultados de las técnicas in vitro y la PT. Analizamos 103 pacientes con psoriasis en tratamiento sistémico. Los resultados de nuestra serie permiten sugerir una mayor sensibilidad y especificidad de los IGRAs en la detección de ITL respecto a la PT, de forma independiente al estado de inmunosupresión y al fármaco empleado, con alta concordancia entre los IGRAs.