974 resultados para Total Knee Arthroplasty Revision


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BACKGROUND: The association between smoking and total energy expenditure (TEE) is still controversial. We examined this association in a multi-country study where TEE was measured in a subset of participants by the doubly labeled water (DLW) method, the gold standard for this measurement. METHODS: This study includes 236 participants from five different African origin populations who underwent DLW measurements and had complete data on the main covariates of interest. Self-reported smoking status was categorized as either light (<7 cig/day) or high (≥7 cig/day). Lean body mass was assessed by deuterium dilution and physical activity (PA) by accelerometry. RESULTS: The prevalence of smoking was 55% in men and 16% in women with a median of 6.5 cigarettes/day. There was a trend toward lower BMI in smokers than non-smokers (not statistically significant). TEE was strongly correlated with fat-free mass (men: 0.70; women: 0.79) and with body weight (0.59 in both sexes). Using linear regression and adjusting for body weight, study site, age, PA, alcohol intake and occupation, TEE was larger in high smokers than in never smokers among men (difference of 298 kcal/day, p = 0.045) but not among women (162 kcal/day, p = 0.170). The association became slightly weaker in men (254 kcal/day, p = 0.058) and disappeared in women (-76 kcal/day, p = 0.380) when adjusting for fat-free mass instead of body weight. CONCLUSION: There was an association between smoking and TEE among men. However, the lack of an association among women, which may be partly related to the small number of smoking women, also suggests a role of unaccounted confounding factors.

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A espectroscopia de raios-X por reflexão total (TXRF) é uma técnica promissora para análise de elementos-traço (ETs), principalmente por não ser necessária a digestão das amostras, reduzindo assim a geração de resíduos e emissão de vapores tóxicos. Este trabalho comparou os teores dos ETs: Cr, Mn, Ni, Zn, Cu, As, Se, Hg e Pb, coletados em solos de área de agricultura intensiva e vegetação nativa, determinados por TXRF e por espectrometria de absorção atômica de chama ou forno de grafite (FAAS/GFAAS). Adicionalmente, compararam-se os teores dos ET com valores de referência para solos não contaminados. As amostras de solo foram coletadas na profundidade 0,0-0,2 m em municípios representativos de cada região agrícola do Estado de Mato Grosso (Rondonópolis, Alto Garça, Primavera do Leste, Campo Novo, Nova Mutum, Lucas do Rio Verde, Sorriso, Sinop, Campo Novo dos Parecis, Campos de Julho e Vila Bela da Santíssima Trindade). Em cada município, foram selecionadas seis áreas, totalizando 72 amostras, todas georreferenciadas. Para a leitura dos teores de ET no aparelho de TXRF S2 Picofox™, foram preparadas suspensões de solo usando Triton X-100 a 5 % v/v utilizando gálio como padrão interno, enquanto no FAAS/GFAAS as amostras foram submetidas à digestão ácida pelo método 3051A. Considerando área cultivada e área nativa, respectivamente, os teores médios dos ET por TXRF, em mg kg-1, foram: Cr, 69 e 62; Zn, 16 e 8; Pb, 28 e 21; Mn, 56 e 42; As, 2 e 2; Cu, 9 e 8; e Ni, 2 e 2. O Cd, Se e Hg não foram detectados por TXRF nas amostras analisadas. Para As, Cr, Mn, Zn, Ni, Cu e Pb, houve correlação linear (p<0,001) positiva entre as técnicas e, no geral, os teores obtidos para esses ET em TXRF foram superiores aos do FAAS/GFAAS. Os teores de todos os elementos detectados pelo TXRF, exceto o Cr, estão dentro das faixas dos relatados para solos não contaminados e muito inferiores aos limites de alerta estipulados na literatura.

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The use of leaf total nitrogen concentration as an indicator for nutritional diagnosis has some limitations. The objective of this study was to determine the reliability of total N concentration as an indicator of N status for eucalyptus clones, and to compare it with alternative indicators. A greenhouse experiment was carried out in a randomized complete block design in a 2 × 6 factorial arrangement with plantlets of two eucalyptus clones (140 days old) and six levels of N in the nutrient solution. In addition, a field experiment was carried out in a completely randomized design in a 2 × 2 × 2 × 3 factorial arrangement, consisting of two seasons, two regions, two young clones (approximately two years old), and three positions of crown leaf sampling. The field areas (regions) had contrasting soil physical and chemical properties, and their soil contents for total N, NH+4-N, and NO−3-N were determined in five soil layers, up to a depth of 1.0 m. We evaluated the following indicators of plant N status in roots and leaves: contents of total N, NH+4-N, NO−3-N, and chlorophyll; N/P ratio; and chlorophyll meter readings on the leaves. Ammonium (root) and NO−3-N (root and leaf) efficiently predicted N requirements for eucalyptus plantlets in the greenhouse. Similarly, leaf N/P, chlorophyll values, and chlorophyll meter readings provided good results in the greenhouse. However, leaf N/P did not reflect the soil N status, and the use of the chlorophyll meter could not be generalized for different genotypes. Leaf total N concentration is not an ideal indicator, but it and the chlorophyll levels best represent the soil N status for young eucalyptus clones under field conditions.

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Decorrente dos sistemas de manejo empregados no solo, como o sistema de preparo convencional (SPC) versus o sistema de plantio direto de hortaliças (SPDH), modificações nos atributos edáficos ocorrem; por exemplo, nos índices de agregação do solo e seu teor de carbono orgânico total (COT). Objetivaram-se quantificar os teores de COT e avaliar os índices de agregação do solo e a distribuição dos agregados por classes de diâmetro sob cultivo de cebola em SPDH e SPC, comparados a uma área de mata adjacente em Ituporanga, SC. Os tratamentos constituíram-se da semeadura de plantas de cobertura, solteiras e consorciadas, em SPDH: vegetação espontânea (VE); 100 % aveia; 100 % centeio; 100 % nabo-forrageiro; consórcio de nabo-forrageiro (14 %) e centeio (86 %); e consórcio de nabo-forrageiro (14 %) e aveia (86 %). Adicionalmente, foram avaliadas uma área de cultivo de cebola em SPC por ±37 anos e uma área de mata (floresta secundária; ±30 anos), ambas adjacentes ao experimento. Em setembro de 2013, cinco anos após a implantação dos tratamentos com plantas de cobertura, foram coletadas amostras indeformadas do solo nas camadas de 0-5, 5-10 e 10-20 cm e separados os agregados para avaliar a estabilidade via úmida. Nos agregados, foi quantificado o COT; após a separação em classes de diâmetro (8,00 mm>Ø≥0,105 mm), calcularam-se o diâmetro médio ponderado (DMP) e o geométrico (DMG) dos agregados; a distribuição deles em macroagregados (Ø≥2,0 mm), mesoagregados (2,0>Ø≥0,25 mm) e microagregados (Ø<0,25 mm); e o seu índice de sensibilidade (IS). Os dados foram submetidos à análise de variância e de componentes principais (ACP). Os maiores teores de COT foram encontrados na área de mata (52,83; 37,77; e 26,70 g kg-1, respectivamente para 0-5, 5-10 e 10-20 cm); e os menores, no SPC (18,23 g kg-1, 0-5 cm). Os tratamentos com plantas de cobertura, solteiras ou consorciadas, não apresentaram diferenças entre si (p≤0,05) para o COT, nem em relação à área testemunha (VE). O SPC apresentou os menores índices de DMP (3,425; 3,573; e 3,401 mm), DMG (2,438; 2,682; e 2,541 mm) e IS (0,77; 0,79; e 0,81), nas três camadas avaliadas. Para o DMP e DMG, não foram verificadas diferenças (p≤0,05) entre tratamentos no SPDH; porém, esses índices foram superiores aos do SPC; os de DMP, iguais aos da área de mata; e os de DMG, maiores na camada de 0-5 e 5-10 cm. Na camada de 10-20 cm, no SPDH, o tratamento com nabo-forrageiro apresentou maiores valores de DMP (4,520 mm), DMG (4,284 mm) e IS (1,07). Em relação à distribuição dos agregados por classes de diâmetro, o SPC evidenciou, respectivamente, os menores (14,22; 14,75; e 13,86 g) e maiores (4,94; 3,44; e 3,52 g/3,0; 3,0; e 3,76 g) valores para macro e meso/microagregados, enquanto o SPDH demonstrou maiores valores de macroagregados (médias de 19,90; 20,48; e 18,56 g) em comparação à mata (16,0; 16,31; e 15,47 g) e ao SPC (14,22; 14,75; e 13,86 g) nas três camadas avaliadas. O uso de plantas de cobertura, solteiras ou consorciadas, em SPD de cebola foi eficiente para recuperar e aumentar os teores de COT e os índices de DMP, DMG e IS em relação ao SPC; e, em comparação à área de mata, aumentou o DMG (0-5 e 5-10 cm). O nabo-forrageiro aumentou a agregação do solo (DMG e IS) na camada de 10-20 cm em relação aos demais tratamentos com plantas de cobertura. A ACP evidenciou a perda de COT e o aumento dos meso e microagregados no SPC, assim como a substituição do SPC por SPDH com plantas de cobertura elevou a formação de macroagregados estáveis em água, com posterior aumento do DMP, DMG e IS.

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PURPOSE: Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea. However, the physiologic impact of CPAP on cerebral blood flow (CBF) is not well established. Ultrasound can be used to estimate CBF, but there is no widespread accepted protocol. We studied the physiologic influence of CPAP on CBF using a method integrating arterial diameter and flow velocity (FV) measurements obtained for each vessel supplying blood to the brain. METHODS: FV and lumen diameter of the left and right internal carotid, vertebral, and middle cerebral arteries were measured using duplex Doppler ultrasound with and without CPAP at 15 cm H(2)O, applied in a random order. Transcutaneous carbon dioxide (PtcCO(2)), heart rate (HR), blood pressure (BP), and oxygen saturation were monitored. Results were compared with a theoretical prediction of CBF change based on the effect of partial pressure of carbon dioxide on CBF. RESULTS: Data were obtained from 23 healthy volunteers (mean ± SD; 12 male, age 25.1 ± 2.6 years, body mass index 21.8 ± 2.0 kg/m(2)). The mean experimental and theoretical CBF decrease under CPAP was 12.5 % (p < 0.001) and 11.9 % (p < 0.001), respectively. The difference between experimental and theoretical CBF reduction was not statistically significant (3.84 ± 79 ml/min, p = 0.40). There was a significant reduction in PtcCO(2) with CPAP (p = <0.001) and a significant increase in mean BP (p = 0.0017). No significant change was observed in SaO(2) (p = 0.21) and HR (p = 0.62). CONCLUSION: Duplex Doppler ultrasound measurements of arterial diameter and FV allow for a noninvasive bedside estimation of CBF. CPAP at 15 cm H(2)O significantly decreased CBF in healthy awake volunteers. This effect appeared to be mediated predominately through the hypocapnic vasoconstriction coinciding with PCO(2) level reduction. The results suggest that CPAP should be used cautiously in patients with unstable cerebral hemodynamics.

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This report provides a summary of the updates to the traffic signal content within the Iowa Statewide Urban Design and Specifications (SUDAS) Design Manual Chapter 13 and Standard Specifications Division 8. Major focal points included pole footing design, cabinets and controllers, monitoring systems, communications systems, and figure updates. This work was completed through a project task force with a variety of participants (contractors, Iowa Department of Transportation, city traffic engineers, consultant, vendors, and University research and support staff).

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The aim of the present study was to investigate the effects of continuous and acute L-carnitine supplementation of total parenteral nutrition (TPN) on protein and fat oxidation in severe catabolism. A critically ill and severely malnourished male patient received TPN (non protein energy = 41 kcal/kg/day, provided equally as fat and glucose) over 38 days, without L-carnitine for 23 days and with carnitine supplements (15 mg/kg/day) for the following 15 days. Subsequently, he was given carnitine-free enteral nutrition for 60 more days. A four-hour infusion of 100 mg L-carnitine was given on day 11 of each TPN period. Indirect calorimetry was carried out after 11 days of either carnitine-free or supplemented TPN and at the initiation of enteral nutrition. Additional measurements were performed 4 hours and 24 hours after the acute infusions of carnitine. The rate of protein oxidation and the respiratory quotient were found to be higher, and the rate of fat oxidation to be lower, with carnitine-supplemented TPN, than with either carnitine-free TPN or enteral nutrition. Acute infusion of carnitine resulted in an increased rate of protein oxidation and a reduced rate of fat oxidation on both TPN-regimens. These unfavourable effects on protein metabolism may be due to an impairment of fat oxidation by excess amounts of carnitine.

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To analyse the association between chondrocalcinosis and osteoarthritis (OA) of the hands and knees in an unselected elderly rural population. METHODS--A community based cross sectional study was performed in individuals randomly selected from a previous epidemiological survey on the prevalence of chondrocalcinosis in people older than 60 years from Osona county, Catalonia, northeastern Spain. Radiological OA (grade 2 or more of Kellgren's classification) was evaluated in 26 individuals with chondrocalcinosis and in 104 controls. A total of 18 articular areas of both knees (medial and lateral tibiofemoral compartments) and hands (first, second and third metacarpophalangeal (MCP), first carpometacarpal, trapezium-scaphoid, radiocarpal and distal radioulnar joints) were studied. RESULTS--Radiological changes of OA in the knees were more common in subjects with chondrocalcinosis than in those without it, with an odds ratio adjusted for age and gender (aOR) of 4.3 (95% confidence interval (CI) 1.6 to 11.8, p = 0.005). OA was also more frequent in almost all areas of the hands in individuals with chondrocalcinosis, though the difference reached statistical significance only in the MCP joints (aOR 3.1; 95% CI 1.1 to 8.8; p = 0.033). However, taking into account the side and the different joint compartments analysed, the association between chondrocalcinosis and OA was significant only in the lateral tibiofemoral compartment and the left MCP joints. CONCLUSIONS--In an elderly population unselected for their rheumatic complaints, there was a real association between OA and chondrocalcinosis. This association was particularly relevant in the lateral tibiofemoral compartment of the knee and in the first three left MCP joints.

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The aim of this study was to determine the effect of using video analysis software on the interrater reliability of visual assessments of gait videos in children with cerebral palsy. Two clinicians viewed the same random selection of 20 sagittal and frontal video recordings of 12 children with cerebral palsy routinely acquired during outpatient rehabilitation clinics. Both observers rated these videos in a random sequence for each lower limb using the Observational Gait Scale, once with standard video software and another with video analysis software (Dartfish(®)) which can perform angle and timing measurements. The video analysis software improved interrater agreement, measured by weighted Cohen's kappas, for the total score (κ 0.778→0.809) and all of the items that required angle and/or timing measurements (knee position mid-stance κ 0.344→0.591; hindfoot position mid-stance κ 0.160→0.346; foot contact mid-stance κ 0.700→0.854; timing of heel rise κ 0.769→0.835). The use of video analysis software is an efficient approach to improve the reliability of visual video assessments.

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Estrone is a powerful growth-inducing hormone that is present in milk, mainly in the form of fatty acid esters, at concentrations that promote growth in experimental animals. We present here a method useful for the measurement of this natural hormone in foods and applied it to several common dairy products. Samples were frozen, finely powdered, and lyophilized then extracted with trichloromethane/methanol; the dry extract was saponified with potassium hydroxide. The free estrone evolved was extracted with ethyl acetate and was used for the estimation of total estrone content through radioimmunoassay. Application of the method to dairy products showed high relative levels of total estrone (essentially acyl-estrone) in milk, in the range of 1 ¿M, which were halved in skimmed milk. Free estrone levels were much lower, in the nanomolar range. A large proportion of estrone esters was present in all other dairy products, fairly correlated with their fat content. The amount of estrone carried by milk is well within the range, where its intake may exert a physiological response in the sucklings for which it is provided. These growth-inducing and energy expenditure-lowering effects may affect humans ingesting significant amounts of dairy products.

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Introduction.- Retinoids are effective and widely used for the treatment of severe acne. Their use can be, however, associated with numerous side effects. For example, some rare cases of premature epiphyseal closure were reported.Observation.- A sixteen-year-old soccer player consulted for bilateral progressive anterior knee pain, since two months, evoking a femoro-patellar origin. After physiotherapy, the pain decreases on the right but remained on the left. The history taking brought out the use of isotretinoin for more than 6 months (0.5 mg/kg). Magnetic resonance imaging (MRI) findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more marked on the left. The diagnosis of retinoid induced premature ephysieal closure was retained. The treatment was stopped, with a resolution of symptoms within two months. The control MRI of the left knee present persisting small sequelar thumbprint-like growth plate lesion. Eighteen months later, neither limb-length discrepancy nor static disorder was noticed.Discussion.- Premature epiphyseal closure is a rare complication of retinoid treatment of acne. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. The knee seems the most involved joint. The clinical presentation is aspecific, sometimes lightly symptomatic. A careful pharmacological history and an appropriate imaging are necessary. MRI is now the gold standard. It shows an irregularity of the growth plate with an oedema on both sides. In chronic phase, a thumbprint-like image may persist. The symptoms resolution arises in few weeks after the treatment interruption. A single case of static disorder was reported until now. The small size of the growth plate interruptions, insufficient to lead to a growth disorder if the medicament is stopped early enough, explains probably it. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.