Confiabilidade interobservador da escala do equilíbrio de Berg entre fisioterapeutas com extensa e escassa prática clínica

This study aimed at assessing the interobserver reliability of the Brazilian-Portuguese version of the Berg Balance Scale (BBS). The assessment was made by physiotherapists with extensive or little clinical experience in non-institutionalized elderly individuals. Participants comprised 12 elderly subjects (10 women and 2 men) with mean ages of 75.8 ± 8.4 years (range = 63-87) and 18 physiotherapists with varying clinical experience. Inter-examiner reliability obtained for each scale item yielded weighted kappa value > 0.75 in 11 of the 14 items (varying from 0.37 to 1.0). The intra-class correlation coefficient (ICC) for the total sum of BBS scores between the two groups of physiotherapists was 0.996 (95% confidence interval, 0.987 0.999) with a Cronbach alpha coefficient of 0.996. We found no difference between the rater groups when we compared the sum score means obtained with the student s T-test (p = 0.86). Although some items had low reliability values, in general our results suggest that the Brazilian Version of the BBS showed good levels of interrater reliability and agreement when used by physiotherapists with different clinical practice levels and without previous training on non-institutionalized elderly patients. We concluded that the BBS can be useful as an important evaluation instrument on a protocol for Rehabilitation clinics. It may be used by various health professionals, as: Physicians, Physical therapists, Physical educators, Occupational therapists, Nurses and Phonoaudiologists, so confirming the interdisciplinary character of this study

Biodistribuição do pertecnetato de sódio (Na99mTcO4) em ratos submetidos à ressecção extensa de intestino delgado

Massive resection of the small intestine results in short bowel syndrome with anti-absorptive effect and repercussions on the metabolism. Morphologic and functional evaluation may be necessary in order to control wrapped organs. Scintigraphy an examination with little invading and no biologic damage can be used. The purpose were to assess the biodistribution of sodium pertecnetate in organs of rats subjected to massive resection of the small intestine, the intestinal adaptation of the remnant intestinal mucosa and weight curve evaluation in the postoperative period. Twenty-one Wistar rats were randomly allocated into three groups (n = 7). The operated group named short bowel (SB) after anesthetized was subjected to massive resection of the small intestine; the control group (C), and sham group (SHAM). On the 30th postoperative day, 0.l mL of sodium pertechnetate was injected into the venous orbital plexus. After 30 minutes, the rats were killed with an overdose of anesthetic, and fragments of the liver, spleen, pancreas, stomach, duodenum, small intestine, thyroid, lung, heart, kidney, bladder, muscle, femur and brain were harvested. The percentage of radioactivity per gram of tissue (%ATI/g) was determined using Gama Counter WizardTM 1470, PerkinElmer to all samples. Biopsies of 3 cm remaining jejunum were removed to histological analyses. Analysis of variance (ANOVA) and the Tukey test for multiple comparisons were used, considering p<0.05 as significant. The study had the participation of some departments and laboratories, as Nucleus of Experimental Surgery, Department of Surgery, Laboratory of Radiobiology, Department of Pathology and Service of Nuclear Medicine, certifying the character of a multidisciplinary research. The results were no significant differences in %ATI/g of the sodium pertechnetate in the organs of the groups studied (p>0.05). An increase in the weight of the SB rats was observed after the second postoperative week. The jejunal mucosal thickness of the SB rats was significantly greater than that of C and sham rats (p<0.05. The biodistribution of sodium pertechnetate was not affected by massive intestinal resection in rats. An adaptive response by the intestinal mucosa probably contributed to the reversion of weight loss and the biodistribution of sodium pertechnetate was not affected by the surgery

Caracterização de estruturas planares com substratos Iso/Anisotrópicos truncados através da técnica da ressonância transversa modificada

This work presents a theoretical and numerical analysis using the transverse resonance technique (TRT) and a proposed MTRT applied in the analysis of the dispersive characteristics of microstrip lines built on truncated isotropic and anisotropic dielectric substrates. The TRT uses the transmission lines model in the transversal section of the structure, allowing to analyze its dispersive behavior. The difference between TRT and MTRT consists basically of the resonance direction. While in the TRT the resonance is calculated in the same direction of the metallic strip normal axis, the MTRT considers the resonance in the metallic strip parallel plane. Although the application of the MTRT results in a more complex equivalent circuit, its use allows some added characterization, like longitudinal section electric mode (LSE) and longitudinal section magnetic mode (LSM), microstrips with truncated substrate, or structures with different dielectric regions. A computer program using TRT and MTRT proposed in this work is implemented for the characterization of microstrips on truncated isotropic and anisotropic substrates. In this analysis, propagating and evanescent modes are considered. Thus, it is possible to characterize both the dominant and higher order modes of the structure. Numerical results are presented for the effective permittivity, characteristic impedance and relative phase velocity for microstrip lines with different parameters and dimensions of the dielectric substrate. Agreement with the results obtained in the literature are shown, as well as experimental results. In some cases, the convergence analysis is also performed by considering the limiting conditions, like particular cases of isotropic materials or structures with dielectric of infinite size found in the literature. The numerical convergence of the formulation is also analyzed. Finally, conclusions and suggestions for the continuity of this work are presented

Análise dos Modos Ressonantes em Antenas de Microfita sobre Substratos Iso/Anisotrópicos por Técnicas da Ressonância Transversa

Neste trabalho, são utilizadas a Técnica da Ressonância Transversa (TRT) e a Técnica da Ressonância Transversa Modificada (MTRT), para a determinação das freqüências dos modos ressonantes de antenas de microfita com patch quadrado, retangular e circular e com substratos isotrópicos e anisotrópicos. Para isso, é proposto um modelo da cavidade equivalente, onde a antena tipo patch retangular é representada como sendo a superposição de duas linhas infinitas em microfita, uma de largura W, representando a dimensão que expressa a largura do patch, e a outra com largura L, representando a dimensão que expressa o comprimento do patch. A avaliação da eficiência e aplicabilidade dos métodos citados é realizada comparando-se com resultados experimentais e obtidos através de outras técnicas. Três situações serão verificadas: estruturas com substrato infinito, estrutura com substrato tipo pedestal e estruturas com substrato truncado além dos limites da fita metálica. Os resultados obtidos demonstram que as técnicas de análise de onda completa utilizadas neste trabalho, por um formalismo matemático mais rigoroso, são eficientes e precisas tanto na aplicação em estruturas com substrato isotrópico como nas que possuem substrato anisotrópico. Inicialmente são consideradas apenas as estruturas com substratos isotrópicos, com diferentes constantes dielétricas, e é avaliada a influência da largura do substrato sobre as freqüências dos modos ressonantes das antenas. Posteriormente, a análise do truncamento do dielétrico é realizada para estruturas com substrato anisotrópico. Em todos os casos, os resultados experimentais, obtidos a partir da construção de protótipos, são confrontados com os obtidos a partir de simulação, utilizando as técnicas TRT e MTRT. No final, as técnicas descritas são utilizadas para antenas tipo patch circular, sendo utilizada uma técnica de equivalência para transformar a antena circular em outra quadrada ou retangular equivalente, dependendo do modo que se queira encontrar. Os resultados obtidos são então analisados, observando-se uma boa concordância e indicando a viabilidade do método. Após isso, são apresentadas as conclusões e sugeridos alguns temas para a continuidade deste trabalho

Uso do transporte ósseo no tratamento de perda óssea segmentar extensa da tíbia: estudo experimental em cães

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

Cárie oculta extensa: relato de caso clínico

The pattern of caries lesions has been modified over decades. If the presence or absence of a caries lesion is based upon only a visual examination, its diagnosis might become underestimated since dentinal lesions underneath non cavitated or minimally demineralized enamel is highly frequent in dental clinics. The aim of this paper is to report a clinical case of a child with an upper molar with questionable occlusal aspect, presenting asymptomatic pulpal hyperplasia on the distolingual pit. Periapical radiographic examination was essential for diagnosing hidden caries and elaborating the treatment plan. As part of the approach, removal of the decayed tissue and pulpotomy with calcium hydroxide were performed. The association of an accurate visual examination to an adequate oral radiographyis is extremely important in cases which the presence of hidden caries is doubtful. As a result, an early diagnosis and the reduction of more invasive interventions related to the oral health care of pediatric patients can be achieved as well.

Correção da deficiência transversa da maxila por meio da expansão rápida da maxila cirurgicamente assistida

Fundamentation: The correction of maxillary transverse deficiencies involves orthodontic and surgical procedures that can be performed before or after skeletal maturity. The surgically assisted rapid maxillary expansion (SAR ME) is performed by osteotomies through the lateral walls of the maxilla, zygomatic and canines buttresses, palatal and pterygomaxillary sutures, causing the maxillary disjunction. Followed by activation of the expander to the desired over-expansion in order to correct intercuspal later. Objective: The purpose of this study was to discuss the issues involved in the diagnosis of maxillary atresia, SAR ME indications, as well as surgical technique, through a case study. Methods: The male patient, 19 years old, had severe transverse maxillary deficiency with facial pattern III , Class III , with great lip incompetence. The patient underwent general anesthesia in a hospital environment, the osteotomies was done according to the technique described by Epker and Wolford (1980). Postoperatively, the patient underwent activations daily for 15 days and after 6 months, the orthodontist installed fixed orthodontic appliance to prepare the patient to orthognathic surgery later. Conclusion: The diagnosis by clinical evaluation and models study is essential for the indication of SAR ME and this procedure provides good predictability in the correction of transverse deficiency, with minimal morbidity.

'Pergularain e I'--a plant cysteine protease with thrombin-like activity from Pergularia extensa latex

Pergularain e I, a cysteine protease with thrombin-like activity, was purified by ion exchange chromatography from the latex of Pergularia extensa. Its homogeneity was characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), native PAGE and reverse-phase high-performance liquid chromatography (RP-HPLC). The molecular mass of pergularain e I by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) was found to be 23.356 kDa and the N-terminal sequence is L-P-H-D-V-E. Pergularain e I is a glycoprotein containing approximately 20% of carbohydrate. Pergularain e I constituted 6.7% of the total protein with a specific activity of 9.5 units/mg/min with a 2.11-fold increased purity. Proteolytic activity of the pergularain e I was completely inhibited by iodoacetic acid (IAA). Pergularain e I exhibited procoagulant activity with citrated plasma and fibrinogen similar to thrombin. Pergularain e I increases the absorbance of fibrinogen solution in concentration-dependent and time-dependent manner. At 10 microg concentration, an absorbance of 0.48 was reached within 10 min of incubation time. Similar absorbance was observed when 0.2 NIH units of thrombin were used. Thrombin-like activity of pergularain e I is because of the selective hydrolysis of A alpha and B beta chains of fibrinogen and gamma-chain was observed to be insusceptible to hydrolysis. Molecular masses of the two peptide fragments released from fibrinogen due to the hydrolysis by pergularain e I at 5-min incubation time were found to be 1537.21 and 1553.29 and were in close agreement with the molecular masses of 16 amino acid sequence of fibrinopeptide A and 14 amino acid sequence of fibrinopeptide B, respectively. Prolonged fibrinogen-pergularain e I incubation releases additional peptides and their sequence comparison of molecular masses of the released peptides suggested that pergularain e I hydrolyzes specifically after arginine residues.

Localización y seguimiento de aeronaves mediante sistemas de multilateración de área extensa

El continuo crecimiento de la demanda del transporte aéreo, junto con los nuevos escenarios de intervención militar, están obligando a una optimización en el uso del espacio aéreo. De este modo, la UE y los EEUU (a través de SESAR y NextGen respectivamente) han asentado las bases para una nueva gestión del tráfico aéreo (ATM). Con ello, se pretende aumentar la capacidad de aeropuertos y rutas aéreas, otorgando mayor flexibilidad al uso del espacio aéreo sin comprometer la seguridad de los usuarios. Desde un punto de vista puramente técnico, la clave de este cambio de modelo está en el conocimiento de la posición de cada aeronave en cada instante. En este sentido, la tendencia en ATM es el uso de ADS-B como fuente principal de posicionamiento. Sin embargo, debido a que este sistema está basado en la difusión de la posición obtenida a través de GPS, es necesario un sistema de seguimiento independiente. Actualmente, la intención es migrar del radar secundario de vigilancia (SSR) a la multilateración de área extensa (WAM), con el fin de mejorar la integridad de la posición para aplicaciones en ruta. Aprovechando el rápido despliegue de ADS-B, se pretende reutilizar sus estaciones base para WAM. Cada estación base que recibe el mensaje ADS-B de la aeronave envía conjuntamente la medida del tiempo de llegada (TOA) de dicho mensaje al centro de tráfico aéreo. La posición de la aeronave se obtiene mediante multilateración, cuya técnica consiste en utilizar las medidas de TOA de un mismo mensaje ADS-B obtenidas en las distintas estaciones base. El objetivo es estimar la posición de cada aeronave con la mayor precisión posible. Para poder diseñar el sistema que permite alcanzar este objetivo, son dos los aspectos básicos a estudiar. Por una parte, la identificación y posterior caracterización de los errores (tanto sistemáticos como aleatorios) que afectan a la medida de TOA. Por otra parte, es necesario el estudio de los sistemas de seguimiento, basados en versiones sofisticadas del filtro de Kalman (IMM, UKF). Una vez establecidos estos dos pilares, la presente tesis doctoral propone un sistema que permite efectuar el seguimiento de las aeronaves, corrigiendo los efectos de las principales distorsiones que afectan a la medida de TOA: la refracción troposférica y el error de sincronismo. La mejora en la precisión de la localización ha sido evaluada mediante simulación de escenarios hipotéticos. ABSTRACT The ever-growing demand in the air transportation and the new military intervention scenarios, are generating a need to optimize the use of the airspace. This way, the EU and the USA (through SESAR and NextGen respectively) have set the ground to overhaul the current air traffic management. The intention is to enhance the capacity of airports and air routes, providing greater flexibility in the use of airspace without jeopardizing the security of the end-users. From a technical perspective, the key for this change lies in the knowledge of the aircraft position. The trend in Air Traffic Management (ATM) is to rely on ADS-B as the main source for aircraft positioning. However, this system is based on the aircraft’s self-declaration of its own (often GPS-based) navigation solution. It is therefore necessary to have an independent surveillance system. Nowadays, the intention is to gradually migrate from Secondary Surveillance Radar (SSR) towards Wide Area Multilateration (WAM) in order to enhance surveillance integrity for en-route applications. Given the fast deployment of ADS-B, the aim is to use its base stations for WAM. Each station sends the Time of Arrival (TOA) of the received ADS-B messages to the air traffic center (ATC). The aircraft position is obtained through multilateration, using the TOA of the same message measured by each station. The aim is to accurately estimate the position of each aircraft. Knowledge from two key areas has to be gathered prior to designing such a system. It is necessary to identify and then characterize the errors (both systematic and random) affecting the TOA measurements. The second element is the study of tracking systems based on sophisticated versions of the Kalman filtering (e.g. IMM, UKF). Based on this knowledge, the main contribution of this Ph.D. is an aircraft tracking system that corrects the effects of the main errors involved in the TOA measurement: tropospheric refraction and synchronization issues. Performance gains in positioning accuracy have been assessed by simulating hypothetical WAM scenarios.