Elevação do seio maxilar versus implantes zigomáticos

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

OpenBU: Institutional Repository Procedures Manual

(adapted from the DSpace Procedures Manual developed by Kalamazoo College Digital Archive)

Hand-held spectroscopic device for in vivo and intraoperative tumor detection: contrast enhancement, detection sensitivity, and tissue penetration.

Surgery is one of the most effective and widely used procedures in treating human cancers, but a major problem is that the surgeon often fails to remove the entire tumor, leaving behind tumor-positive margins, metastatic lymph nodes, and/or satellite tumor nodules. Here we report the use of a hand-held spectroscopic pen device (termed SpectroPen) and near-infrared contrast agents for intraoperative detection of malignant tumors, based on wavelength-resolved measurements of fluorescence and surface-enhanced Raman scattering (SERS) signals. The SpectroPen utilizes a near-infrared diode laser (emitting at 785 nm) coupled to a compact head unit for light excitation and collection. This pen-shaped device effectively removes silica Raman peaks from the fiber optics and attenuates the reflected excitation light, allowing sensitive analysis of both fluorescence and Raman signals. Its overall performance has been evaluated by using a fluorescent contrast agent (indocyanine green, or ICG) as well as a surface-enhanced Raman scattering (SERS) contrast agent (pegylated colloidal gold). Under in vitro conditions, the detection limits are approximately 2-5 × 10(-11) M for the indocyanine dye and 0.5-1 × 10(-13) M for the SERS contrast agent. Ex vivo tissue penetration data show attenuated but resolvable fluorescence and Raman signals when the contrast agents are buried 5-10 mm deep in fresh animal tissues. In vivo studies using mice bearing bioluminescent 4T1 breast tumors further demonstrate that the tumor borders can be precisely detected preoperatively and intraoperatively, and that the contrast signals are strongly correlated with tumor bioluminescence. After surgery, the SpectroPen device permits further evaluation of both positive and negative tumor margins around the surgical cavity, raising new possibilities for real-time tumor detection and image-guided surgery.

Practice-Level Variation in Outpatient Cardiac Care and Association With Outcomes.

BACKGROUND: Utilization of cardiac services varies across regions and hospitals, yet little is known regarding variation in the intensity of outpatient cardiac care across cardiology physician practices or the association with clinical endpoints, an area of potential importance to promote efficient care. METHODS AND RESULTS: We included 7 160 732 Medicare beneficiaries who received services from 5635 cardiology practices in 2012. Beneficiaries were assigned to practices providing the plurality of office visits, and practices were ranked and assigned to quartiles using the ratio of observed to predicted annual payments per beneficiary for common cardiac services (outpatient intensity index). The median (interquartile range) outpatient intensity index was 1.00 (0.81-1.24). Mean payments for beneficiaries attributed to practices in the highest (Q4) and lowest (Q1) quartile of outpatient intensity were: all cardiac payments (Q4 $1272 vs Q1 $581; ratio, 2.2); cardiac catheterization (Q4 $215 vs Q1 $64; ratio, 3.4); myocardial perfusion imaging (Q4 $253 vs Q1 $83; ratio, 3.0); and electrophysiology device procedures (Q4 $353 vs Q1 $142; ratio, 2.5). The adjusted odds ratios (95% CI) for 1 incremental quartile of outpatient intensity for each outcome was: cardiac surgical/procedural hospitalization (1.09 [1.09, 1.10]); cardiac medical hospitalization (1.00 [0.99, 1.00]); noncardiac hospitalization (0.99 [0.99, 0.99]); and death at 1 year (1.00 [0.99, 1.00]). CONCLUSION: Substantial variation in the intensity of outpatient care exists at the cardiology practice level, and higher intensity is not associated with reduced mortality or hospitalizations. Outpatient cardiac care is a potentially important target for efforts to improve efficiency in the Medicare population.

Regularized iterative and non-iterative procedures for object restoration from experimental data

A regularized algorithm for the recovery of band-limited signals from noisy data is described. The regularization is characterized by a single parameter. Iterative and non-iterative implementations of the algorithm are shown to have useful properties, the former offering the advantage of flexibility and the latter a potential for rapid data processing. Comparative results, using experimental data obtained in laser anemometry studies with a photon correlator, are presented both with and without regularization. © 1983 Taylor & Francis Ltd.

Regularized iterative and noniterative procedures for object restoration in the presence of noise :an error analysis

An analysis is carried out, using the prolate spheroidal wave functions, of certain regularized iterative and noniterative methods previously proposed for the achievement of object restoration (or, equivalently, spectral extrapolation) from noisy image data. The ill-posedness inherent in the problem is treated by means of a regularization parameter, and the analysis shows explicitly how the deleterious effects of the noise are then contained. The error in the object estimate is also assessed, and it is shown that the optimal choice for the regularization parameter depends on the signal-to-noise ratio. Numerical examples are used to demonstrate the performance of both unregularized and regularized procedures and also to show how, in the unregularized case, artefacts can be generated from pure noise. Finally, the relative error in the estimate is calculated as a function of the degree of superresolution demanded for reconstruction problems characterized by low space–bandwidth products.

Laparoscopic Appendectomy in Italy: An Appraisal of 26,863 Cases

Objective: To evaluate the practice of laparoscopic appendectomy (LA) in Italy. Methods: On behalf of the Italian Society of Young Surgeons (SPIGC), an audit of LA was carried out through a written questionnaire sent to 800 institutions in Italy. The questions concerned the diffusion of laparoscopic surgery and LA over the period 1990 through 2001, surgery-related morbidity and mortality rates, indications for LA, the diagnostic algorithm adopted prior to surgery, and use of LA among young surgeons (<40 years). Results: A total of 182 institutions (22.7%) participated in the current audit, and accounted for a total number of 26863 LA. Laparoscopic surgery is performed in 173 (95%) institutions, with 144 (83.2%) routinely performing LA. The mean interval from introduction of laparoscopic surgery to inception of LA was 3.4 ± 2.5 years. There was an emergent basis for 8809 (32.8%) LA procedures (<6 hours of admission); 10314 (38.4%) procedures were performed on an urgent basis (<24 hours of admission); while 7740 (28.8%) procedures were elective. The conversion rate was 2.1% (561 cases) and was due to intraoperative complications in 197 cases (35.1%). Intraoperative complications ranged as high as 0.32%, while postoperative complications were reported in 1.2% of successfully completed LA. The mean hospital stay for successfully completed LA was 2.5 ± 1.05 days. The highest rate of intraoperative complications was reported as occurring during the learning curve phase of their experience (in their first 10 procedures) by 39.7% of the surgeons. LA was indicated for every case of suspected acute appendiceal disease by 51.8% of surgeons, and 44.8% order abdominal ultrasound (US) prior to surgery. A gynecologic counseling is deemed necessary only by 34.5% surgeons, while an abdominal CT scan is required only by 1.5%. The procedure is completed laparoscopically in the absence of gross appendiceal inflammation by 83%; 79.8% try to complete the procedure laparoscopically in the presence of concomitant disease; while 10.4% convert to open surgery in cases of suspected malignancy. Of responding surgeons aged under 40, 76.3% can perform LA, compared to 47.3% surgeons of all age categories. Conclusions: The low response rate of the present survey does not allow us to assess the diffusion of LA in Italy, but rather to appraise its practice in centers routinely performing laparoscopic surgery. In the hands of experienced surgeons, LA has morbidity rates comparable to those of international series. The higher diagnostic yield of laparoscopy makes it an invaluable tool in the management algorithm of women of childbearing age; its advantages in the presence of severe peritonitis are less clear-cut. Surgeons remain the main limiting factor preventing a wider diffusion of LA in our country, since only 47.3% of surgeons from the audited institutions can perform LA on a routine basis.

Surgical Neurology: Commentary

SCOPUS: no.j

Discretisation procedures for multi-physics phenomena

Procedures are described for solving the equations governing a multi-physics process. Finite volume techniques are used to discretise, using the same unstructured mesh, the equations of fluid flow, heat transfer with solidification, and solid deformation. These discretised equations are then solved in an integrated manner. The computational mechanics environment, PHYSICA, which facilitates the building of multi-physics models, is described. Comparisons between model predictions and experimental data are presented for the casting of metal components.

Dynamic fluid–structure interaction using finite volume unstructured mesh procedures

A three-dimensional finite volume, unstructured mesh (FV-UM) method for dynamic fluid–structure interaction (DFSI) is described. Fluid structure interaction, as applied to flexible structures, has wide application in diverse areas such as flutter in aircraft, wind response of buildings, flows in elastic pipes and blood vessels. It involves the coupling of fluid flow and structural mechanics, two fields that are conventionally modelled using two dissimilar methods, thus a single comprehensive computational model of both phenomena is a considerable challenge. Until recently work in this area focused on one phenomenon and represented the behaviour of the other more simply. More recently, strategies for solving the full coupling between the fluid and solid mechanics behaviour have been developed. A key contribution has been made by Farhat et al. [Int. J. Numer. Meth. Fluids 21 (1995) 807] employing FV-UM methods for solving the Euler flow equations and a conventional finite element method for the elastic solid mechanics and the spring based mesh procedure of Batina [AIAA paper 0115, 1989] for mesh movement. In this paper, we describe an approach which broadly exploits the three field strategy described by Farhat for fluid flow, structural dynamics and mesh movement but, in the context of DFSI, contains a number of novel features: • a single mesh covering the entire domain, • a Navier–Stokes flow, • a single FV-UM discretisation approach for both the flow and solid mechanics procedures, • an implicit predictor–corrector version of the Newmark algorithm, • a single code embedding the whole strategy.

Dynamic fluid-structure interactions using finite volume unstructured mesh procedures

A three-dimensional finite volume, unstructured mesh (FV-UM) method for dynamic fluid–structure interaction (DFSI) is described. Fluid structure interaction, as applied to flexible structures, has wide application in diverse areas such as flutter in aircraft, wind response of buildings, flows in elastic pipes and blood vessels. It involves the coupling of fluid flow and structural mechanics, two fields that are conventionally modelled using two dissimilar methods, thus a single comprehensive computational model of both phenomena is a considerable challenge. Until recently work in this area focused on one phenomenon and represented the behaviour of the other more simply. More recently, strategies for solving the full coupling between the fluid and solid mechanics behaviour have been developed. A key contribution has been made by Farhat et al. [Int. J. Numer. Meth. Fluids 21 (1995) 807] employing FV-UM methods for solving the Euler flow equations and a conventional finite element method for the elastic solid mechanics and the spring based mesh procedure of Batina [AIAA paper 0115, 1989] for mesh movement. In this paper, we describe an approach which broadly exploits the three field strategy described by Farhat for fluid flow, structural dynamics and mesh movement but, in the context of DFSI, contains a number of novel features: a single mesh covering the entire domain, a Navier–Stokes flow, a single FV-UM discretisation approach for both the flow and solid mechanics procedures, an implicit predictor–corrector version of the Newmark algorithm, a single code embedding the whole strategy.

Dynamic fluid-structure interaction using finite volume unstructured mesh procedures

A three dimensional finite volume, unstructured mesh method for dynamic fluid-structure interation is described. The broad approach is conventional in that the fluid and structure are solved sequentially. The pressure and viscous stresses from the flow algorithm provide load conditions for the solid algorithm, whilst at the fluid structure interface the deformed structure provides boundary condition from the structure to the fluid. The structure algorithm also provides the necessary mesh adaptation for the flow field, the effect of which is accounted for in the flow algorithm. The procedures described in this work have several novel features, namely: * a single mesh covering the entire domain. * a Navier Stokes flow. * a single FV-UM discretisation approach for both the flow and solid mechanics procedures. * an implicit predictor-corrector version of the Newmark algorithm. * a single code embedding the whole strategy. The procedure is illustrated for a three dimensional loaded cantilever in fluid flow.

Analysing the evacuation procedures employed on a Thames passenger boat using the maritimeEXODUS evacuation model

On the 19 June 2001, a Thames passenger/tour boat underwent several evacuation trials. This work was conducted in order to collect data for the validation of marine-based computer models. The trials involved 111 participants who were distributed throughout the vessel. The boat had two decks and two points of exit from the lower deck placed on either side of the craft, forward and aft. The boat had a twin set of staircases towards the rear of the craft, just forward of the rear exits. maritimeEXODUS was used to simulate the full-scale evacuation trials conducted. The simulation times generated were compared against the original results and categorised according to the exit point availability. The predictions closely approximate the original results, differing by an average of 6.6% across the comparisons, with numerous qualitative similarities between the predictions and experimental results. The maritimeEXODUS evacuation model was then used to examine the evacuation procedure currently employed on the vessel. This was found to have potential to produce long evacuation times. maritimeEXODUS was used to suggest modifications to the mustering procedures. These theoretical results suggest that it is possible to significantly reduce evacuation times.

Simple procedures to assess and compare the ecological niche of species

Hutchinson's (1957; Cold Spring Harbour Symp Quant Biol 22:415-427) niche concept is being used increasingly in the context of global change, and is currently applied to many ecological issues including climate change, exotic species invasion and management of endangered species. For both the marine and terrestrial realms, there is a growing need to assess the breadth of the niches of individual species and to make comparisons among them to forecast the species' capabilities to adapt to global change. In this paper, we describe simple non-parametric multivariate procedures derived from a method originally used in climatology to (1) evaluate the breadth of the ecological niche of a species and (2) examine whether the niches are significantly separated. We first applied the statistical procedures to a simple fictive example of 3 species separated by 2 environmental factors in order to describe the technique. We then used it to quantify and compare the ecological niche of 2 key-structural marine zooplankton copepod species, Calanus finmarchicus and C. helgolandicus, in the northern part of the North Atlantic Ocean using 3 environmental factors. The test demonstrates that the niches of both species are significantly separated and that the coldwater species has a niche larger than that of its warmer-water congeneric species.