Cirurgias odontológicas em usuários de anticoagulantes orais

Em razão do crescimento do número de indivíduos submetidos à terapêutica anticoagulante também nos consultórios odontológicos, realizamos um levantamento retrospectivo de prontuários de pacientes anticoagulados com derivados cumarínicos e uma revisão sobre os protocolos de atendimento, a fim de procurar estabelecer diretrizes para um tratamento cirúrgico-odontológico adequado e seguro. A avaliação do paciente com relação ao seu nível de anticoagulação através do Índice Normatizado Internacional (INR) ou Tempo de Protrombina (TP) e a classificação da amplitude do trauma cirúrgico são fatores importantes a serem avaliados antes do procedimento cirúrgico. Nosso levantamento mostrou que, em 47 cirurgias, sem alteração da medicação sistêmica, apenas um caso apresentou hemorragia pós-operatória, controlada por manobras de hemostasia local. Desse modo, observamos que, dentre os vários protocolos propostos na literatura, a manutenção da terapia anticoagulante, com a utilização de hemostáticos locais se necessário, parece o mais adequado à maioria dos casos cirúrgicos ambulatoriais.

Análisis experimental y por el método de los elementos finitos del estado de tensiones en uniones carpinteras de empalme de llave

In this research, the halved and tabled traditional timber scarf joint is analyzed. This joint consists in two end joint pieces usually subjected to tension. Initially, the study is discussed from an experimental point of view. In this way, 3 critical cross-sections are established (section of the notch, section of the horizontal plane and reduced section) and mechanical tests are performed to achieve the failure on each of critical sections by changing the geometry of the joint. The study is completed by developing a finite element model which allows verify experimental results and extend the analysis to other geometries. This model has to simulate the real behavior of the material which is being studied, so mechanical tests are performed to obtain the elastic constants and the coefficients of friction of the material. In the reduced section, an abrupt decrease of the effective cross-section takes place, and this effect is also experimentally analyzed. These tests indicate that a crack is initiated before the bending-tension failure occurs in the reduced section. The test material consists of wood of Pinus sylvestris L. coming from the “Valsaín´s Sawmill” (Segovia) with “premium quality” according to the nonstructural wood visual classification of sawmill. It is observed that initiation of a crack, in the mortise (bottom of reduced section), and shear stress concentration, at the initial part of the heel (beginning of horizontal plane), completely determine the mechanical behaviour of the joint, resulting in 3 failure modes: local compression failure in the section of the notch, shear failure in the horizontal plane, and failure of stresses concentration, mainly perpendicular to the grain tension, at the bottom of reduced section. The geometric optimization is obtained for halved and tabled traditional scarf joint, when the joint has made with similar properties of wood than tested specimens, for any height and width of the cross-section. It is considered the failure due to the initiation of a crack in reduced section, by applying a correction coefficient into the usual equation used to design the members subjected to both tension and bending. Therefore, it is possible to obtain, analytically, the design conditions to be met of the 3 critical cross-sections. According to the theoretical optimization, the tension strength of complete cross-section is reduced until 14%, when using this type of joint. The experimental optimization indicates even a greater reduction, until 6%. En el presente trabajo de investigación se analiza el comportamiento mecánico de las uniones tradicionales de empalme de llave, que consisten en dos piezas unidas por sus testas transmitiéndose entre ellas principalmente un esfuerzo de tracción. Inicialmente, el estudio se aborda desde un punto de vista experimental. De este modo, se establecen las 3 secciones críticas o de estudio (sección del encaje, sección rasante del cogote y sección reducida) y se realizan ensayos mecánicos, variando la geometría de la unión, para alcanzar la rotura en cada una de ellas. Se completa el estudio mediante la elaboración de un modelo por elementos finitos que permite verificar los resultados experimentales y ampliar el análisis a otras geometrías. Este modelo debe simular el comportamiento real del material objeto de estudio, por lo que se realizan ensayos para obtener las constantes elásticas y los coeficientes de rozamiento del mismo. También se analiza, experimentalmente, el efecto entalladura que reduce bruscamente la sección completa del tirante, estableciendo que el fallo por flexotracción en la sección reducida de la pieza, no llega a producirse por el inicio previo de una grieta. El material de ensayo consiste en madera de Pinus sylvestris L. (pino silvestre) procedente del Aserradero de Valsaín (Segovia) y de calidad “Extra” o “Primera” según la clasificación visual no estructural del aserradero. Se observa que el inicio de una grieta en la mortaja del rediente y la concentración de tensiones tangenciales en la parte inicial del cogote, determinan completamente el comportamiento mecánico de la unión, dando lugar a 3 modos distintos de rotura: fallo por compresión en la sección del encaje, fallo por cortante en la sección rasante y fallo por concentración de tensiones, principalmente tracciones perpendiculares, en el rebaje de la sección reducida. Se consigue optimizar geométricamente cualquier empalme de llave confeccionado con madera de características similares a la ensayada, para cualquier valor de la altura y de la anchura de la sección. Se considera el agotamiento en la sección reducida causado por el inicio de grieta, mediante la aplicación de un coeficiente corrector en la expresión habitual de agotamiento por flexotracción, en consecuencia, finalmente es posible obtener, de modo analítico, un valor del índice de agotamiento en cada una de las 3 secciones de estudio. La optimización teórica del empalme de llave indica que la capacidad resistente del tirante bruto se reduce al 14%, cuando se coloca este tipo de unión tradicional. Experimentalmente se obtiene, que, para la sección ensayada, la capacidad resistente del tirante bruto se reduce todavía más, llegando al 6%.

Unexpected Complication of a Multinodular Goitre

Multinodular goitre is the most common thyroid gland disorder. It can cause hyperthyroidism and mechanical complaints such as tracheal compression or dysphagia. We report a unique case of a patient with a toxic multinodular goitre presenting with a deep venous thrombosis of the left arm due to direct local compression of blood flow.

Cardiovascular response during trigeminal ganglion compression for trigeminal neuralgia according to the use of local anesthetics

There are controversies about the use of local anesthetics during balloon compression for trigeminal neuralgia (TN) as a protective factor for cardiovascular events. The objective of this study was to investigate cardiovascular parameters (blood pressure and heart rate [HR]) of patients that underwent trigeminal balloon compression with local anesthetics compared to a control group (placebo). This is a randomized controlled study; 55 patients were randomized into two groups: study (deep sedation and trigeminal block with 0.8-mL lidocaine 2%) and control group (deep sedation and trigeminal injection of 0.8-mL saline). Blood pressure and HR were measured in five distinct moments: preoperative, during puncture for local anesthesia/placebo, during puncture with the catheter, during balloon compression, and final evaluation. Statistical analysis was performed with Pearson`s chi (2) and McNemar tests and the analysis of variance for repetitive measures. The means of systolic and diastolic blood pressures (SBP and DBP, respectively) were higher in the control group when compared to the study group at the evaluation during puncture with the catheter (p < 0.001) and balloon compression (p < 0.001 and p = 0.018 for DBP and SBP, respectively). There was an increase in the HR in the control group during the procedure (p = 0.017). The use of local anesthetics during the trigeminal balloon compression for TN can have a preventive role for the risk of cardiovascular events.

Ulnar nerve transposition at the elbow : local anesthesia should be preferred to general anesthesia

Après la compression du nerf médian au niveau du tunnel carpien, la compression du nerf ulnaire au niveau du coude est le deuxième syndrome compressif le plus fréquent des nerfs périphériques. La chirurgie des nerfs périphériques consiste dans une décompression nerveuse et est caractérisée par un suivi post¬opératoire parfois très douloureux avec des douleurs qui peuvent chroniciser si insuffisamment traitées. Le traitement chirurgical de décompression nerveuse se fait traditionnellement sous anesthésie générale ou régionale. Une analgésie post-opératoire plus efficace et durable avec moindre risque de chronicisation avait justifié ce choix jusqu'à ce jour. Grâce au développement de la chirurgie ambulatoire ces dernières années, un grand nombre d'interventions chirurgicales au niveau de la main sont effectués sous anesthésie locale. Au vu d'une meilleure connaissance de cette technique d'anesthésie, son rôle dans la chirurgie des nerfs périphériques a été remis en question. Alors que plusieurs études ont démontré que l'anesthésie locale est aussi efficace que l'anesthésie générale et régionale au sujet de la chirurgie du tunnel carpien, son utilisation pour la chirurgie du nerf ulnaire reste peu connue. La raison de l'hésitation à l'utilisation de l'anesthésie locale pour le traitement du tunnel ulnaire est due au fait que dans plus de la moitié des cas, une simple décompression n'est pas suffisante et qu'il est souvent nécessaire de transposer le nerf ulnaire devant l'épicondyle ulnaire. La seule publication disponible au sujet de l'utilisation de l'anesthésie locale dans le traitement du tunnel ulnaire considère comme irréalisable d'utiliser cette méthode dans le cas d'une transposition. Malgré cette mise en garde, nous avons, depuis plusieurs années, des excellents résultats avec la transposition du nerf ulnaire sous anesthésie locale. Avec le but d'objectiver notre expérience dans ce domaine nous avons souhaité analyser nos résultats de façon rétrospective avec particulière attention aux douleurs post-opératoires et à la satisfaction des patients. Les dossiers de cinquante patients Consécutifs (26F, 24M) opérés par le même chirurgien dans notre service de 2002 à 2012 ont été analysés rétrospectivement. Les critères suivants ont été récoltés: l'âge du patient, la profession, la main dominante, les détails des techniques opératoires utilisées, le type d'anesthésie, l'intensité du suivi ainsi que les complications, le niveau de douleur dans l'immédiat post-opératorie ainsi que à une année de l'intervention. Les patients ont été divisés en 4 groupes: les opérés sous anesthésie générale avec transposition du nerf (n=17) ou sans transposition (n=10) et les opérés sous anesthésie locale avec transposition (n=12) ou sans transposition (n=11). Au premier jour la douleur était comparable dans tous les groupes. A une semaine, elle était deux fois plus importante lorsque la transposition avait été réalisée sous anesthésie générale par rapport à si une anesthésie locale avait été effectuée (p=0.03). La satisfaction s'est révélée plus élevée mais non significative chez les patients opérés sous anesthésie locale. Ces derniers étaient significativement plus enclins à répéter la chirurgie comparé a ceux opérés sous anesthésie générale (p=0.04). En conclusion, les résultats de cette étude suggèrent que l'anesthésie locale est au moins autant efficace que l'anesthésie générale en termes de complications et de douleurs post-opératoires indépendamment du fait qu'une transposition nerveuse soit effectuée ou pas. Un meilleur contrôle des douleurs à une semaine post-opératoire a contribué à une haute satisfaction des patients de notre étude.

New Distance Transforms for Gray Level Image Compression

This thesis deals with distance transforms which are a fundamental issue in image processing and computer vision. In this thesis, two new distance transforms for gray level images are presented. As a new application for distance transforms, they are applied to gray level image compression. The new distance transforms are both new extensions of the well known distance transform algorithm developed by Rosenfeld, Pfaltz and Lay. With some modification their algorithm which calculates a distance transform on binary images with a chosen kernel has been made to calculate a chessboard like distance transform with integer numbers (DTOCS) and a real value distance transform (EDTOCS) on gray level images. Both distance transforms, the DTOCS and EDTOCS, require only two passes over the graylevel image and are extremely simple to implement. Only two image buffers are needed: The original gray level image and the binary image which defines the region(s) of calculation. No other image buffers are needed even if more than one iteration round is performed. For large neighborhoods and complicated images the two pass distance algorithm has to be applied to the image more than once, typically 3 10 times. Different types of kernels can be adopted. It is important to notice that no other existing transform calculates the same kind of distance map as the DTOCS. All the other gray weighted distance function, GRAYMAT etc. algorithms find the minimum path joining two points by the smallest sum of gray levels or weighting the distance values directly by the gray levels in some manner. The DTOCS does not weight them that way. The DTOCS gives a weighted version of the chessboard distance map. The weights are not constant, but gray value differences of the original image. The difference between the DTOCS map and other distance transforms for gray level images is shown. The difference between the DTOCS and EDTOCS is that the EDTOCS calculates these gray level differences in a different way. It propagates local Euclidean distances inside a kernel. Analytical derivations of some results concerning the DTOCS and the EDTOCS are presented. Commonly distance transforms are used for feature extraction in pattern recognition and learning. Their use in image compression is very rare. This thesis introduces a new application area for distance transforms. Three new image compression algorithms based on the DTOCS and one based on the EDTOCS are presented. Control points, i.e. points that are considered fundamental for the reconstruction of the image, are selected from the gray level image using the DTOCS and the EDTOCS. The first group of methods select the maximas of the distance image to new control points and the second group of methods compare the DTOCS distance to binary image chessboard distance. The effect of applying threshold masks of different sizes along the threshold boundaries is studied. The time complexity of the compression algorithms is analyzed both analytically and experimentally. It is shown that the time complexity of the algorithms is independent of the number of control points, i.e. the compression ratio. Also a new morphological image decompression scheme is presented, the 8 kernels' method. Several decompressed images are presented. The best results are obtained using the Delaunay triangulation. The obtained image quality equals that of the DCT images with a 4 x 4

Cation Distribution and Local Order in Mixed Sodium Metaphosphate Glasses

Two structural properties in mixed alkali metal phosphate glasses that seem to be crucial to the development of the mixed ion effect in dc conductivity were systematically analyzed in Na mixed metaphosphates: the local order around the mobile species, and their distribution and mixing in the glass network. The set of glasses considered here, Na1-xMxPO3 with M = Li, Ag, K, Rb, and Cs and 0 <= x <= 1, encompass a broad degree of size mismatch between the mixed cation species. A comprehensive solid-state nuclear magnetic resonance study was carried out using P-31 MAS, Na-23 triple quantum MAS, Rb-87 QCPMG, P-31-Na-23 REDOR, Na-23-Li-7 and Li-7-Li-6 SEDOR, and Na-23 spin echo decay. It was observed that the arrangement of P atoms around Na in the mixed glasses was indistinguishable from that observed in the NaPO3 glass. However, systematic distortions in the local structure of the 0 environments around Na were observed, related to the presence of the second cation. The average Na-O distances show an expansion/compression When Na+ ions are replaced by cations with respectively smaller/bigger radii. The behavior of the nuclear electric quadrupole coupling. constants indicates that this expansion reduces the local symmetry, while the compression produces the opposite effect These effects become marginally small when the site mismatch between the cations is small, as in Na-Ag mixed glasses. The present study confirms the intimate mixing of cation species at the atomic scale, but clear deviations from random mixing were detected in systems with larger alkali metal ions (Cs-Na, K-Na, Rb-Na). In contrast, no deviations from the statistical ion mixture were found in the systems Ag-Na and Li-Na, where mixed cations are either of radii comparable to (Ag+) or smaller than (Li+) Na+. The set of results supports two fundamental structural features of the models proposed to explain the mixed ion effect: the. structural specificity of the sites occupied by each cation species and their mixing at the atomic scale.

High resolution study of local stress inside alumina - micro mechanical analysis using laser scanning confocal microscope

The aim of this work is to measure the stress inside a hard micro object under extreme compression. To measure the internal stress, we compressed ruby spheres (a-Al2O3: Cr3+, 150 µm diameter) between two sapphire plates. Ruby fluorescence spectrum shifts to longer wavelengths under compression and can be related to the internal stress by a conversion coefficient. A confocal laser scanning microscope was used to excite and collect fluorescence at desired local spots inside the ruby sphere with spatial resolution of about 1 µm3. Under static external loads, the stress distribution within the center plane of the ruby sphere was measured directly for the first time. The result agreed to Hertz’s law. The stress across the contact area showed a hemispherical profile. The measured contact radius was in accord with the calculation by Hertz’s equation. Stress-load curves showed spike-like decrease after entering non-elastic phase, indicating the formation and coalescence of microcracks, which led to relaxing of stress. In the vicinity of the contact area luminescence spectra with multiple peaks were observed. This indicated the presence of domains of different stress, which were mechanically decoupled. Repeated loading cycles were applied to study the fatigue of ruby at the contact region. Progressive fatigue was observed when the load exceeded 1 N. As long as the load did not exceed 2 N stress-load curves were still continuous and could be described by Hertz’s law with a reduced Young’s modulus. Once the load exceeded 2 N, periodical spike-like decreases of the stress could be observed, implying a “memory effect” under repeated loading cycles. Vibration loading with higher frequencies was applied by a piezo. Redistributions of intensity on the fluorescence spectra were observed and it was attributed to the repopulation of the micro domains of different elasticity. Two stages of under vibration loading were suggested. In the first stage continuous damage carried on until certain limit, by which the second stage, e.g. breakage, followed in a discontinuous manner.

Integrity of venoarteriolar reflex determines level of microvascular skin flow enhancement with intermittent pneumatic compression

OBJECTIVE: To investigate whether intermittent pneumatic compression (IPC) augments skin blood flow through transient suspension of local vasoregulation, the veno-arteriolar response (VAR), in healthy controls and in patients with peripheral arterial disease (PAD). METHODS: Nineteen healthy limbs and twenty-two limbs with PAD were examined. To assess VAR, skin blood flow (SBF) was measured using laser Doppler fluxmetry in the horizontal and sitting positions and was defined as percentage change with postural alteration [(horizontal SBF--sitting SBF)/horizontal SBF x 100]. On IPC application to the foot, the calf, or both, SBF was measured with laser Doppler fluxmetry, the probe being attached to the pulp of the big toe. RESULTS: Baseline VAR was higher in the controls 63.8 +/- 6.4% than in patients with PAD (31.7 +/- 13.4%, P = .0162). In both groups SBF was significantly higher with IPC than at rest (P < .0001). A higher percentage increase with IPC was demonstrated in the controls (242 +/- 85% to 788 +/- 318%) than in subjects with PAD, for each one of the three different IPC modes investigated (98 +/- 33% to 275 +/- 72%) with IPC was demonstrated. The SBF enhancement with IPC correlated with VAR for all three compression modes (r = 0.58, P = .002 for calf compression, r = 0.65, P < .0001 for foot compression alone, and r = 0.64, P = .0002 for combined foot and calf compression). CONCLUSION: The integrity of the veno-arteriolar response correlates with the level of skin blood flow augmentation generated with intermittent pneumatic compression, indicating that this may be associated with a transient suspension of the autoregulatory vasoconstriction both in healthy controls and in patients with PAD.

Automation of shear-wave splitting parameter determination of local earthquakes at Yellowstone : application as indicator of crustal stress and temporal variation

Shear-wave splitting can be a useful technique for determining crustal stress fields in volcanic settings and temporal variations associated with activity. Splitting parameters were determined for a subset of local earthquakes recorded from 2000-2010 at Yellowstone. Analysis was automated using an unsupervised cluster analysis technique to determine optimum splitting parameters from 270 analysis windows for each event. Six stations clearly exhibit preferential fast polarization values sub-orthogonal to the direction of minimum horizontal compression. Yellowstone deformation results in a local crustal stress field differing from the regional field dominated by NE-SW extension, and fast directions reflect this difference rotating around the caldera maintaining perpendicularity to the rim. One station exhibits temporal variations concordant with identified periods of caldera subsidence and uplift. From splitting measurements, we calculated a crustal anisotropy of ~17-23% and crack density ~0.12-0.17 possibly resulting from stress-aligned fluid filled microcracks in the upper crust and an active hydrothermal system.

Predictive-DCT Coding for 3D Mesh Sequences Compression

This paper proposes a new compression algorithm for dynamic 3d meshes. In such a sequence of meshes, neighboring vertices have a strong tendency to behave similarly and the degree of dependencies between their locations in two successive frames is very large which can be efficiently exploited using a combination of Predictive and DCT coders (PDCT). Our strategy gathers mesh vertices of similar motions into clusters, establish a local coordinate frame (LCF) for each cluster and encodes frame by frame and each cluster separately. The vertices of each cluster have small variation over a time relative to the LCF. Therefore, the location of each new vertex is well predicted from its location in the previous frame relative to the LCF of its cluster. The difference between the original and the predicted local coordinates are then transformed into frequency domain using DCT. The resulting DCT coefficients are quantized and compressed with entropy coding. The original sequence of meshes can be reconstructed from only a few non-zero DCT coefficients without significant loss in visual quality. Experimental results show that our strategy outperforms or comes close to other coders.

Vibration frequency measurement using a local multithreshold technique

In this paper, we demonstrate the use of a video camera for measuring the frequency of small-amplitude vibration movements. The method is based on image acquisition and multilevel thresholding and it only requires a video camera with high enough acquisition rate, not being necessary the use of targets or auxiliary laser beams. Our proposal is accurate and robust. We demonstrate the technique with a pocket camera recording low-resolution videos with AVI-JPEG compression and measuring different objects that vibrate in parallel or perpendicular direction to the optical sensor. Despite the low resolution and the noise, we are able to measure the main vibration modes of a tuning fork, a loudspeaker and a bridge. Results are successfully compared with design parameters and measurements with alternative devices.

On the distributed compression of quantum information

The problem of distributed compression for correlated quantum sources is considered. The classical version of this problem was solved by Slepian and Wolf, who showed that distributed compression could take full advantage of redundancy in the local sources created by the presence of correlations. Here it is shown that, in general, this is not the case for quantum sources, by proving a lower bound on the rate sum for irreducible sources of product states which is stronger than the one given by a naive application of Slepian-Wolf. Nonetheless, strategies taking advantage of correlation do exist for some special classes of quantum sources. For example, Devetak and Winter demonstrated the existence of such a strategy when one of the sources is classical. Optimal nontrivial strategies for a different extreme, sources of Bell states, are presented here. In addition, it is explained how distributed compression is connected to other problems in quantum information theory, including information-disturbance questions, entanglement distillation and quantum error correction.

Omnigen:providing electricity, food preparation, cold storage and pure water using a variety of local fuels

We describe a polygeneration system that can run on neat plant oils, such as Jatropha and Pongamia, or standard diesel fuel. A prototype has been constructed using a compression ignition engine of 9.9 kW shaft output. It consumes 3 L/h of fuel and will produce 40 kg/h of ice by means of an adsorption refrigerator powered from the engine jacket heat. Steaming of rice, deep and shallow frying, and other types of food preparation heated by the exhaust gas have been demonstrated. In addition, the feasibility of producing distilled water by means of multiple-effect distillation powered by the engine waste heat is shown. Overall plant efficiency and potential savings in greenhouse gas emissions are discussed. © 2012 Elsevier Ltd.

Gonadal Hormones Modulate The Responsiveness To Local β-blocker-induced Antinociception In The Temporomandibular Joint Of Male And Female Rats.

We have previously demonstrated that blockade of β-adrenoreceptors (β-AR) located in the temporomandibular joint (TMJ) of rats suppresses formalin-induced TMJ nociceptive behaviour in both male and female rats, but female rats are more responsive. In this study, we investigated whether gonadal hormones modulate the responsiveness to local β-blocker-induced antinociception in the TMJ of rats. Co-administration of each of the selective β1 (atenolol), β2 (ICI 118.551) and β3 (SR59230A)-AR antagonists with equi-nociceptive concentrations of formalin in the TMJ of intact, gonadectomized and hormone-treated gonadectomized male and female rats. Atenolol, ICI 118.551 and SR59230A significantly reduced formalin-induced TMJ nociception in a dose response fashion in all groups tested. However, a lower dose of each β-AR antagonist was sufficient to significantly reduce nociceptive responses in gonadectomized but not in intact and testosterone-treated gonadectomized male rats. In the female groups, a lower dose of β1 -AR antagonist was sufficient to significantly reduce nociceptive responses in gonadectomized but not in intact or gonadectomized rats treated with progesterone or a high dose of oestradiol; a lower dose of β2 -AR antagonist was sufficient to significantly reduce nociceptive responses in gonadectomized but not in intact and gonadectomized rats treated with low or high dose of oestradiol. Gonadal hormones may reduce the responsiveness to local β-blocker-induced antinociception in the TMJ of male and female rats. However, their effect depends upon their plasma level, the subtype of β-AR and the dose of β-blockers used.