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A female patient in her late 70s underwent uncomplicated non-penetrating deep sclerectomy surgery. Three years after surgery, she presented with a sudden decrease in visual acuity, intraocular pressure (IOP) of 2 mmHg, macular folding and significant macular subretinal fluid. Assuming hypotony as the cause, topical dexamethasone was started, with complete functional and imagological improvement. Two months after withdrawal, she returned with the same symptoms and imagological findings. The same topical treatment was re-established, with progressive and complete improvement. After 14 months of follow-up and a maintenance dose of topical dexamethasone (1id), the patient remained stable with an IOP of 16 mm Hg. Hypotony maculopathy can, in rare cases, lead to subretinal fluid and neurosensory detachment. Topical corticosteroids can reverse and prevent hypotony in patients who are corticosteroid responsive. In advanced glaucoma, extremely low IOP may be as dangerous as high IOP. Timely normalisation of IOP may restore normal retinal architecture with associated functional improvement.

Assets deteriorate over time, as well as being covered, corroded, or becoming old in less obvious ways. Maintenance can extend the remaining useful life (RUL) of an asset system, but sooner or later it must surely be replaced. In this study, we propose a new RUL estimation methodology to assist in decision making for the maintenance and replacement of assets from prioritizing equipment in a renovation plan. Our methodology uses advanced data analysis techniques that consider multiple competing criteria with the goal of maximizing values of the asset throughout its life cycle, while considering the rules of remuneration and service quality of the current regulation, as well as the values at risk according to the decisions and actions taken. Experimental results with real datasets show the efficiency of the proposed approach. Finally, this work also presents the development of an analytical tool to optimize asset renewal decisions applying the RUL estimation methodology proposed and its application to the Brazilian electric sector.

An anterior cruciate ligament (ACL) tear is a severe sports injury that often occurs in young athletes. Besides the strong cumulative evidence on noncontact ACL tears, the injury mechanism (especially the contribution of external rotation) is still not well understood. The present work aims to evaluate which knee kinetics result in higher ACL stress and strain. A finite element model of the ACL was developed with a detailed geometry; the two distinct bundles (anteromedial and posterolateral) and the surrounding connective tissue were modelled based on medical anatomic measures and images. The model was validated using computational and cadaveric external data. Sixteen simulations were performed using different combinations of moments and axial loads applied to the knee model as boundary conditions. The results demonstrated that the peak stress (11.00 MPa) and strain (0.048) occurred at the midportion of the anteromedial bundle with the higher values being obtained under a combined knee valgus, flexion, tibial external rotation and high axial load. Anterior load showed low sensitivity in ACL stress and strain peaks. The tibial external rotation showed a higher contribution to the peak ACL stress and strain as compared to internal rotation. These results reinforce the role of axial load and highlight the importance of external rotation on ACL stress and strain, which may be suggestive of the ACL tear mechanism. The role of external rotation is often neglected and should be further explored in future cadaveric and experimental studies. The findings of this study provide data-driven insights to optimize the indications for prevention, diagnosis and treatment of ACL injuries in clinical practice and contribute to raising awareness of the injury mechanism among all relevant stakeholders.

‘Numerous operations have been described for correction of recurrent dislocation of the patella. The number in itself predicates that the problem has not been solved'. This classic discusses the original publication ‘Diagnosis and treatment of recurrent dislocations of the patella' from Trillat A, Dejour H, Couette A. Published in 1964 at the Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur, where the authors described a surgical procedure modifying Elmslie's original surgery for patients with objective patellar dislocations and also for patients with anterior knee pain who had the sign of the ‘baionnette'. Medialisation of the anterior tibial tubercle (ATT) has been known worldwide as the Elmslie-Trillat procedure, but the history of procedure has its roots going back to 1888. The history of the publications of the Elmslie-Trillat technique is really something special. Cesar Roux published in 1888 the original technique that is similar to Elmislie's procedure. In 1944 in London, Trillat met Selddon and became aware about Elmslie's procedure for the ATT medialisation. Back to France, Trillat published and named it as the Elmslie's technique. Later, after the ‘Journees du Genou', the technique was disseminated as ‘The Elmslie-Trillat' procedure. Nowadays, isolated ATT medialisation, the ‘true' Elmslie-Trillat operation, is still occasionally performed. Too few surgeons use these elegant operations largely because the details of the techniques are not taught routinely. This classic section has the objective to encourage young surgeons to learn tibial tubercle transfer operations and the benefits they bring to patients when performed for proper indications.

Objective Investigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders. Methods Fifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness. Results The force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant shallower trochlear groove and increased lateral tilt. More than half of the PPI and OPI population presented with at least one classic risk factor (patella alta, trochlear dysplasia, increased quadriceps vector, lateral tilt). In the PPI group, at least two risk factors were found in 37% of patients, whereas at least 33% of patients in the OPI group had three risk factors present. None of the patients presented with all four anatomical risk factors. Conclusion Patients presenting with patellofemoral instability (PPI and OPI) display similar ligament stiffness patterns (force-displacement curve). Patients with PFP and PPI showed higher ligament stiffness as compared with patients with OPI. Level of evidence Level V, case series.

Purpose This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery. Methods This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality. Results Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes. Conclusion Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics. Level of evidence Level IV, systematic review of level II to IV studies.

A ABORDAGEM CTSA SE PREOCUPA EM ESTABELECER CONEXÕES ENTE O CONHECIMENTO CIENTÍFICO E AS SITUAÇÕES DO COTIDIANO DOS ALUNOS. UMA OPÇÃO ADEQUADA PARA TRABALHAR QUESTÕES AMBIENTAIS NESTE ÂMBITO, NO ENSINO DE CIÊNCIAS E BIOLOGIA, ESTÁ ASSOCIADA À IMPLEMENTAÇÃO DE COMPONENTES DE GESTÃO AMBIENTAL NO AMBIENTE EDUCACIONAL. SELECIONOU-SE COMO OBJETO DESTE ESTUDO A METODOLOGIA DA PRODUÇÃO MAIS LIMPA (PML), A FIM DE ANALISAR A POTENCIALIDADE DE SE EMPREGAR DELA EM ESCOLAS E UNIVERSIDADES. OBSERVOU-SE QUE POUCOS TRABALHOS VÊM SENDO DESENVOLVIDOS EM TORNO DA METODOLOGIA EM AMBIENTE EDUCACIONAL. NO ENTANTO, AS PESQUISAS QUE JÁ FORAM DESENVOLVIDAS MOSTRAM UM GRANDE POTENCIAL DE FORMAÇÃO DOS ESTUDANTES PARA A CIDADANIA, COM EMPENHO DAS INSTITUIÇÕES DE ENSINO EM TORNO DE SUA RESPONSABILIDADE SOCIAL E EDUCATIVA. SUGERE-SE A NECESSIDADE DE SE DESENVOLVEREM MAIS TRABALHOS EM TORNO DA IMPLEMENTAÇÃO DA PML EM AMBIENTE EDUCACIONAL NA PERSPECTIVA CTSA.

Ramzi Lakhdar,1 Dagmara McGuinness,2 Ellen M Drost,1 Paul G Shiels,2 Ricardo Bastos,3 William MacNee,1,4 Roberto A Rabinovich1,4 1ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK; 2Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; 3IDIBAPS, University of Barcelona, Barcelona, Spain; 4Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK Purpose: Skeletal muscle wasting is an independent predictor of health-related quality of life and survival in patients with COPD, but the complexity of molecular mechanisms associated with this process has not been fully elucidated. We aimed to determine whether an impaired ability to repair DNA damage contributes to muscle wasting and the accelerated aging phenotype in patients with COPD. Patients and methods: The levels of phosphorylated H2AX (γH2AX), a molecule that promotes DNA repair, were assessed in vastus lateralis biopsies from 10 COPD patients with low fat-free mass index (FFMI; COPDL), 10 with preserved FFMI and 10 age- and gender-matched healthy controls. A panel of selected markers for cellular aging processes (CDKN2A/p16ink4a, SIRT1, SIRT6, and telomere length) were also assessed. Markers of oxidative stress and cell damage and a panel of pro-inflammatory and anti-inflammatory cytokines were evaluated. Markers of muscle regeneration and apoptosis were also measured. Results: We observed a decrease in γH2AX expression in COPDL, which occurred in association with a tendency to increase in CDKN2A/p16ink4a, and a significant decrease in SIRT1 and SIRT6 protein levels. Cellular damage and muscle inflammatory markers were also increased in COPDL. Conclusion: These data are in keeping with an accelerated aging phenotype as a result of impaired DNA repair and dysregulation of cellular homeostasis in the muscle of COPDL. These data indicate cellular degeneration via stress-induced premature senescence and associated inflammatory responses abetted by the senescence-associated secretory phenotype and reflect an increased expression of markers of oxidative stress and inflammation. Keywords: COPD, skeletal muscle wasting, aging, inflammation, apoptosis

O objetivo deste estudo consiste em avaliar os aspectos emocionais e experienciais que influenciam a ida e a intenção do torcedor de retornar aos estádios de futebol de Belo Horizonte. Foi realizada uma pesquisa, de cunho quantitativo, com 353 torcedores de futebol na cidade. Como principais resultados, constatou-se que as emoções positivas e a socialização do torcedor no estádio impactam positivamente a satisfação do torcedor, que há forte relação entre identificação com o time e lealdade ao time e que a satisfação do torcedor tem uma relação forte e direta com intenção de retornar ao estádio. De outro lado, é possível inferir que as emoções vivenciadas durante o campeonato ou durante os jogos não representam impacto significativo no comparecimento ao estádio. No mesmo aspecto, lealdade ao time também não apresentou relação significativa com intenção de retornar ao estádio, indicando que o retorno, ou não, ao estádio, independe da lealdade dos torcedores., The objective of this study was to assess the emotional and behavioral aspects that significantly influence attendance and intention to return to soccer stadiums in Belo Horizonte, Brazil. A quantitative survey (N=353) was realized with football fans in the city of Belo Horizonte-MG. As main results, one verified that positive emotions and socialization of the supporter in the stadium positively impact the satisfaction of the supporter. Besides, one also verified that there is a strong relation between identification with the team and loyalty to the team and that supporters’ satisfaction has a strong direct relation with intention to come back to the stadium. On the other hand, it is possible to infer that emotions experienced during the championship or during the games do not specifically represent a significant impact on stadium attendance. In the same aspect, loyalty to the team did not present a significant relation with intention to come back to the stadium either, indicating that whether they come back or not is independent from supporters’ loyalty.

The purpose of this study was to investigate the influence of the knee lateral compartment bony morphology and morphometry on risk of sustaining an anterior cruciate ligament (ACL) injury. A total of 400 age and sex-matched patients (200 ACL-ruptured and 200 ACL-intact) were included. The lateral femoral and tibial bone morphology and morphometric parameters were measured on knee lateral radiographs, taken at 30° of knee flexion with overlapping of the femoral condyles. Radiographic measurements included: anteroposterior-flattened surface of the femur’s lateral condyle (XY); femur’s diaphysis anteroposterior distance (A); anteroposterior distance of the femur’s lateral condyle (B); height of the femur’s lateral condyle (C); anteroposterior distance of the tibial plateaus (AB); tibial slope. In addition, three morphological ratios were calculated: B/AB; B/XY; XY/AB (Porto ratio). Most of bone morphological parameters were different between genders (P

"Article in press" ; "Published online: November 27, 2017", Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through the tunnel and rents in a U-shaped form. The graft is sutured along the length of the patellar tendon on both margins in tension at 30 of knee flexion. Fluoroscopy imaging is performed to assess the patella height. This technique provides a significant augmentation of patellar tendon, avoiding the potential patella bone tunnel complications., info:eu-repo/semantics/publishedVersion

[Epub ahead of print], PURPOSE:To compare the clinical and laboratory outcomes of intra-articular injections of culture-expanded bone-derived mesenchymal stem cells (MSCs) with or without platelet-rich plasma (PRP) to intra-articular corticosteroid injections for the treatment of knee osteoarthritis (OA). METHODS:Forty-seven patients with radiographic and symptomatic knee OA were randomized into three groups for intra-articular injections: autologous bone marrow-derived culture-expanded MSCs (nâ =â 16); autologous bone marrow-derived culture-expanded MSCsâ +â PRP (nâ =â 14); and corticosteroid (nâ =â 17). The outcomes were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and range of motion (ROM) at baseline, 1, 2, 3, 6, 9 and 12Â months and intra-articular cytokines analysis at baseline, 6 and 12Â months postoperatively. RESULTS:The three groups showed significant improvement in most KOOS domains and global score at 1st month and all domains and global score at 12-month follow-up (pâ

Knee osteoarthritis (OA) is a common condition in the older population and is characterized by several articular dysfunctions with consequent anatomic abnormalities including osteochondral degenerative changes and meniscal extrusion. Meniscal damage with extrusion is one of the strongest identified risk factors for the development and progression of knee OA and represents an important factor in the long-term health of the joint. Meniscal extrusion can alter normal knee biomechanics and dramatically inhibit meniscal function. We present a surgical technique for the treatment of early knee OA in association with an extruded meniscus to restore the meniscal anatomic position and preserve its native physiological function related to cartilage preservation. Meniscal retensioning, or a "meniscal autotransplant," can increase meniscal coverage in the compromised compartment, prevent cartilage degeneration, decrease subchondral bone exposure, and restore the compartmental space and, consequently, can relieve patients' symptoms related to early OA., The experimental work (arthroscopy laboratory) and surgical equipment were financially supported by Arthrex. Video 1 was edited by Arthrex. J.E-M. received support for travel-related expenses and laboratory equipment from Arthrex for this study. R.B. received support for travel-related expenses and laboratory equipment from Arthrex for this study. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Patellar dislocation is a major orthopaedic concern in pediatric and adult populations, with both conservative and surgical options available. Several surgical techniques of the combined or isolated reconstruction of the medial patellofemoral ligament are described in the literature using different grafts, locations, and types of fixations, providing different advantages and disadvantages. New recent developments in cadaveric dissection studies have unveiled the importance of structures that were neglected until recently, such as the medial quadriceps tendon–femoral ligament, which provides a connection between the medial femur and the quadriceps tendon component of the knee extensor mechanism. Hence, we present a surgical technique with combined reconstruction of the medial patellofemoral ligament and medial quadriceps tendon–femoral ligament without the use of hardware and with no need for patellar or femoral drilling (no physis compromise or risk of patellar fracture), which can be used concomitantly with other bony procedures.

A água é um recurso finito que representa a fonte principal de manutenção de vida. Partilhando desta concepção e reconhecendo a importância da preservação ambiental alinhada ao desenvolvimento econômico e social das organizações, os quais devem ser a cerne na atuação de um profissional de Engenharia de produção, o presente trabalho teve como objetivo analisar as perdas de água no sistema de abastecimento de uma empresa situada na região sul do Estado do Rio de Janeiro, que possui como atividade secundária a distribuição de água potável. O objeto de estudo foi uma das quatro vilas onde os funcionários da empresa residem. Para alcançar os objetivos propostos, a pesquisa utilizou os dados referentes à distribuição de água, e ainda, baseou-se em outros estudos sobre a determinação dos indicadores de perdas. Os resultados evidenciam um alto índice de perdas, relacionado à deficiência operacional, bem como ausência de um setor específico que trabalhe na redução das perdas no sistema de distribuição. Com o objetivo de propor melhorias para os problemas encontrados, este trabalho utilizou o ciclo PDCA em conjunto com algumas ferramentas de qualidade.

This study aimed at evaluating the association between the volume of the bone bruises and the magnitude of knee sagittal laxity and presence of meniscal injury in patients with anterior cruciate ligament (ACL) rupture. It was hypothesized that higher volumes of bone bruises will be associated with increased knee laxity and the presence of meniscal injury. Patients with clinical diagnosis of ACL injury were referred for magnetic resonance imaging (MRI) and knee sagittal laxity measurement with a mechanical instrumented device (Porto-Knee Testing Device). The femoral and tibial bone bruises were assessed by MRI and the volume measured by manually contouring the bone bruise using a computerized software and computed by a mathematical algorithm combining all measured areas. The ACL rupture type (partial or total), meniscal tear (medial or lateral), and the localization of bone bruise were also analyzed. Seventy-six ACL-ruptured participants were included and 34 patients displayed bone bruises. Tibiofemoral sagittal laxity was higher in participants with complete ACL rupture (p

Purpose Analyze the return to sports rate and timing after conservative and surgical treatment in athletes with spondylolysis. Methods Comprehensive search using Pubmed, Cochrane Library and SPORTDiscus databases to identify English language studies that assessed the return to sports after conservative or surgical treatment of symptomatic spondylolysis in athletes. The main outcome of interest was the return to sports rate and timing, as well as, the follow-up clinical and functional outcomes. Results A total of 14 trials (592 participants) were included. Eight and seven studies reported the outcomes of conservative and surgical approach, respectively. A total of 92% (n = 492) and 88% (n = 100) of athletes return to sports at any level, and 89% (n = 185) and 81% (n = 103) returned to their pre-injury level of sports for conservative and surgical approaches, respectively. The time to return to sports was 4.6 and 6.8 months for conservative and surgical approaches, respectively. Conclusions Conservative management (bracing, sports modification and physiotherapy) of athletes with spondylolysis show excellent return to sports rates at any level and at the pre-injury level at a mean of 4.6 months. Those who fail the conservative treatment can be successfully managed with surgical treatment with a high rate of return to sports at 6.8 months. Level of Evidence Level IV, Systematic review of level IV studies

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

O projeto, operação e descomissionamento de uma unidade de tratamento e armazenamento de rejeitos requerem que sejam observados os requisitos regulatórios referentes à garantia da qualidade nuclear, conforme o Regulamento CNENNN1.16 \"Garantia da Qualidade para a Segurança de Usinas Nucleoelétricas e Outras Instalações\", da Comissão Nacional de Energia Nuclear (CNEN). Entretanto, embora a aplicação do regulamento seja obrigatória, o documento da CNEN apresenta requisitos para qualquer tipo de instalação nuclear, sendo por isso genérico e pouco detalhado em relação às ações necessárias para garantir que os requisitos mais específicos de uma unidade de tratamento e armazenamento de rejeitos sejam observados. Além disso, não existem comercialmente ferramentas informatizadas já prontas para utilização, mas somente programas para gestão de qualidade que requerem uma adaptação através da inclusão de conjuntos de dados específicos do programa de controle da qualidade de uma instalação de gestão de rejeitos, ou então o desenvolvimento de uma ferramenta personalizada. Desta forma, o objetivo deste trabalho é buscar informações que permitam o desenvolvimento de bases para um sistema informatizado de garantia da qualidade que esteja em conformidade com o regulamento da CNEN NN-1.16, e que possa vir a englobar os procedimentos específicos para uma instalação de tratamento e gestão de rejeitos radioativos. The design, operation and decommissioning of a radioactive waste treatment and storage unit requires the compliance with the regulatory requirements for nuclear quality assurance, in accordance with the CNEN-NN.1.16 - \"Quality Assurance for the Safety of Nuclear Power Plants and Other Installations\", of the National Nuclear Energy Commission (CNEN). However, although the regulation is mandatory, the CNEN document presents requirements for any type of nuclear facility, therefore it is generic and not detailed in relation to the actions necessary to ensure that the more specific requirements of a radioactive waste treatment and storage unit are met. In addition, there are no commercially available ready-to-use computer tools, but only quality management programs that require adaptation through the inclusion of specific data sets from the quality control program of a radioactive waste management facility, or the development of a customized tool. Therefore, the objective of this work is to gather information that allows the development of bases for a computerized quality assurance system that is in compliance with the CNEN NN-1.16 regulation, and which may include the specific procedures for an facility of treatment and management of radioactive waste.

Football (soccer) is the most played sport worldwide, practiced by more than 300 million people [1]. It is a high-impact contact sport, and with the increasing competitive level, it often results in sports-related damage of the knee structures, including articular cartilage injuries [2â 4]. These articular cartilage injuries can also be caused by forceful and repetitive mechanical stresses on the knee joint during the football practice [5â 8]. When the cartilage damage reaches the subchondral bone, it often results in knee complaints [9], including pain, swelling, catching, and locking [3, 10, 11]. Nonetheless, articular cartilage injuries may be present in asymptomatic athletes which, if not treated properly, may lead to an early onset of knee osteoarthritis [12â 14]., (undefined), info:eu-repo/semantics/publishedVersion

Articular cartilage lesions of the knee are complex injuries, posing a serious threat to the handball player competitive career. Returning to competition at the pre-injury sports activity level as early and as safe as possible is the ultimate goal to be achieved. There is no consensus on the best surgical technique, and clinical algorithms have been proposed to manage the different articular cartilage defects. The chapter will also overview and summarize the available conservative and surgical management options and stepwise criteria-based rehabilitation strategy and return to play considerations in handball players with focal cartilage defects and osteochondral lesions.

The objective measurement of knee sagittal and rotation laxity upon the anterior cruciate ligament (ACL) lesion has an essential role in the knee stability assessment. These measurements can further be evaluated through magnetic resonance imaging (MRI), which in combination with instrumented assessment and physical examination can correlate both the “anatomy” and “function” of the ligament. The Porto-Knee Testing Device (PKTD) is a knee laxity testing device compatible with MRI that is capable of measuring the posterior-anterior tibial translation and tibial internal and external rotation. In this sense, the PKTD is a useful tool for the assessment of knee sagittal and rotatory laxity in the follow-up of football players that underwent ACL reconstruction. Hence, this tool may allow to identify individuals presenting residual knee laxity with increased risk of sustaining secondary ACL injuries and assist in the planning of secondary prevention programs.

Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.

Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity., info:eu-repo/semantics/publishedVersion

Single Point Incremental Forming (SPIF) is a promising manufacturing technology concerning the production of customized products, low batches or prototyping of ready-to-use parts, given its easy implementation and absence of dedicated tooling. The range of application is wide, covering many materials and virtually unlimited geometries. Indeed, nowadays’ process downsides are more related to high forming times and dimensional inaccuracy. There are many processing parameters that can be optimized to circumvent such problems. In this work, focus is given on the effect of increasing tool feed rate. To this end, a dedicated SPIF machine is employed. After forming steel and aluminum sheets, parameters like forming force, maximum wall angle and formability are assessed for a range of velocities from 1500 to 12,000 mm/min. Parameters like step down or tool diameters are kept constant for a clear comparison. It will be shown how the process can be fastened up without seriously compromising its feasibility.

Single Point Incremental Forming (SPIF) is a promising manufacturing technology concerning the production of customized products, low batches or prototyping of ready-to-use parts, given its easy implementation and absence of dedicated tooling. The range of application is wide, covering many materials and virtually unlimited geometries. Indeed, nowadays’ boundaries of the process are more related to the machines limitations than to the process itself. The SPIFA machine [1] developed at the University of Aveiro allies high payload capacity to flexibility driven by a kinematics based on a Stewart Platform. In this work, it will discussed the effects of employing five degrees of freedom toolpaths to produce aluminium and high strength steel parts.

Over the past few years, Single Point Incremental Forming (SPIF) has been mainly studied regarding formability, forming forces involved and the dimensional accuracy achieved in the final product. As in any other metal forming process, the choice of the lubricant depends on the deformation mechanisms that characterize the process, the roughness of the material involved and on the process parameters. Despite the recent developments on SPIF, little attention has been paid to the influence of lubricants used during the process. This study intends to evaluate the influence of the type of lubricant used in SPIF process, particularly on aluminum 1050 and DP780 steel sheets, in what concerns the surface quality of final parts. To do so, tests were performed employing a range of distinct lubricants. Roughness tests were conducted to evaluate surface quality. Results show opposite trends for aluminum and steel in the sense that lubricants that guarantee better results in aluminum proved to have worse results in steel and vice-versa.

To compare the effectiveness and safety of intra-articular injections of autologous expanded mesenchymal stromal stem cells alone (MSCs), or in combination with platelet-rich plasma (MSCs + PRP), in patients with knee osteoarthritis. Eighteen patients (57.6 ± 9.6 years) with radiographic symptomatic knee osteoarthritis (Dejour grades II–IV) were randomized to receive intra-articular injections of MSCs (n = 9) or MSCs + PRP (n = 9). Injections were performed 2–3 weeks after bone marrow aspiration (± 80–100 ml) which was obtained from both posterior iliac crests. The Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly throughout the 12 months for both groups (p

Background Chronic obstructive pulmonary disease (COPD) is associated with several extra-pulmonary effects of which skeletal muscle wasting is one of the most common and contributes to reduced quality of life, increased morbidity and mortality. The molecular mechanisms leading to muscle wasting are not fully understood. Proteomic analysis of human skeletal muscle is a useful approach for gaining insight into the molecular basis for normal and pathophysiological conditions. Methods To identify proteins involved in the process of muscle wasting in COPD, we searched differentially expressed proteins in the vastus lateralis of COPD patients with low fat free mass index (FFMI), as a surrogate of muscle mass (COPDL, n = 10) (FEV1 33 ± 4.3% predicted, FFMI 15 ± 0.2 Kg.m−2), in comparison to patients with COPD and normal FFMI (COPDN, n = 8) and a group of age, smoking history, and sex matched healthy controls (C, n = 9) using two-dimensional fluorescence difference in gel electrophoresis (2D-DIGE) technology, combined with mass spectrometry (MS). The effect of silencing DOT1L protein expression on markers of cell arrest was analyzed in skeletal muscle satellite cells (HSkMSCs) in vitro and assessed by qPCR and Western blotting. Results A subset of 7 proteins was differentially expressed in COPDL compared to both COPDN and C. We found an increased expression of proteins associated with muscle homeostasis and protection against oxidative stress, and a decreased expression of structural muscle proteins and proteins involved in myofibrillogenesis, cell proliferation, cell cycle arrest and energy production. Among these was a decreased expression of the histone methyltransferase DOT1L. In addition, silencing of the DOT1L gene in human skeletal muscle satellite cells in vitro was significantly related to up regulation of p21 WAF1/Cip1/CDKN1A, a marker of cell arrest and ageing. Conclusions 2D-DIGE coupled with MS identified differences in the expression of several proteins in the wasted vastus lateralis that are relevant to the disease process. Down regulation of DOT1L in the vastus lateralis of COPDL patients may mediate the muscle wasting process through up regulation of markers of cell arrest and senescence. Electronic supplementary material The online version of this article (doi:10.1186/s12931-017-0525-x) contains supplementary material, which is available to authorized users.

This research analyzes organizational links of professors with a private Superior Education Institution in Belo Horizonte, Minas Gerais, Brazil. The study comprises a quantitative and qualitative descriptive study that was carried out with 82 professors who teach in Engineering and IT courses. The most relevant links to the professors were the feelings of belongingness and autonomy. The age above 40 years old was correlated to links of autonomy and idealization of the institution, whereas schooling was correlated to the link cooperation during activities and the length of teaching experience was associated with the integration among the members. Academic experience and the brand of the institution are amongst the elements that justify those associations. The qualitative results suggest that belongingness denotes a congruence of the professors with the philosophy of the institution and that autonomy results from the freedom they have to express ideas and to plan and perform their own work.

Dissertação de Mestrado em Engenharia Informática apresentada à Faculdade de Ciências e Tecnologia Hoje em dia são cada vez mais as pessoas que têm um dispositivo móvel, sejapara navegar na Internet, para consultar o mail, para utilizar aplicações ou para a enorme diversidade de coisas que este permite. O dispositivo móvel tem se tornado um objeto tecnológico gradualmente mais essencial no dia a dia de cada um de nós, e existem aplicações que se têm vindo a revelar imprescindíveis simplesmente pela sua utilidade. Para serem produzidas estas tão faladas "apps", existem três grandes sistemas operativos que devem ser considerados para atingir uma maior cota de mercado - são eles o Android, o iOS e o Windows Mobile. Através destas apps conseguimos chegar cada vez a mais pessoas das varias faixas etárias. Posto isto e necessário escolher um dos diversos panoramas de desenvolvimento de aplicações móveis - se optamos por desenvolvimento nativo especificamente para um sistema operativo ou por outro lado uma alternativa cross-platform, onde desenvolvemos aplicações para os diversos sistemas operativos atingindo, consequentemente, um maior número de utilizadores. O objetivo desta tese é o desenvolvimento de uma aplicação mobile para uso interno dos colaboradores da empresa Xpand IT, com o intuito de facilitar as suas tarefas do dia-a-dia, recorrendo a frameworks - mais especificamente utilizando Xamarin - analisando também as restantes propostas de desenvolvimento multiplataforma que o mercado disponibiliza, entre elas, o Cordova / PhoneGap, Appcelerator Titanium e Sencha Touch. Nowadays, more and more people have a mobile device, either to browse the Internet, to consult the mail, to use applications, to check the calendar, to send messages or to the enormous diversity of things that it allows. The mobile device has become a technological object gradually more essential in the day to day of each one of us, and there are applications that are proving indispensable simply for its usefulness. To produce these so-called "apps", there are three major operating systems that must be considered to achieve a higher market share - they are Android, iOS and Windows Mobile. Through these apps we can reach more and more people of various age groups. Given this, it is necessary to choose one of the several scenarios of mobile application development - whether we choose native development specifically for an operating system, with advantages and disadvantages underlying this, or alternatively a cross-platform alternative, where we develop applications for the various operating systems and, consequently, a larger number of users. The purpose of this thesis is to develop a mobile application for the internal use of Xpand IT employees, with the aim of facilitating their day-to-day tasks, using frameworks - more specifically using Xamarin - and also analyzing the others multiplatform development proposals that the market offers, among otheres, Cordova / Phone Gap, Appcelerator Titanium and Sencha Touch, considering that each of these alternatives has its underlying advantages and disadvantages (each alternative should be chosen according to the purpose that we need).

Background Tibiofemoral bone morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) rupture, with recent increasing interest in the lateral femoral condyle. Objective Investigate several tibiofemoral bone morphology measurements as risk factors for rupturing the ACL. Design Retrospective case–control study. Setting Clinical setting. Patients (or Participants) 200 ACL-ruptured patients and 200 normal subjects without history of previous knee injuries, with a mean age of 24 years old. Main Outcome Measurements Presence or not of ACL rupture. Assessment of Risk Factors Radiographic measurements of the distal epiphysis/diaphysis of the femur and proximal epiphysis of the tibia were performed, including: anteroposterior-flattened surface of the femur's lateral condyle; femur's diaphysis anteroposterior distance; anteroposterior distance of the femur's lateral condyle; height of the femur's lateral condyle; anteroposterior distance of the tibial plateaus; tibial slope. In addition, three morphological ratios were calculated. Results Most of the bone morphological parameters were different between genders (P, info:eu-repo/semantics/publishedVersion

Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries. Herein, we discuss the main injuries involving the elbow and wrist encountered in football players.

Purpose To identify the normal and injured magnetic resonance imaging appearance of the anterolateral ligament (ALL). Methods A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic databases were used to search for studies that reported the imaging outcomes of the appearance of the ALL. Two authors performed the searches in duplicate up to April 30, 2018, and interobserver agreement was calculated. The methodologic quality of included articles was assessed using an adaptation of the Arrive methodologic quality scale for clinical studies of radiologic examinations. Results From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0 for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions. The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9. Conclusions High variability was found in the identification of normal and injured ALL definition methods and the respective magnetic resonance imaging findings. Reliability rates varied considerably, and the entire portion of the ligament was often not seen. Level of Evidence Level IV, systematic review of Level II to IV studies.

A sobrevivência e a prosperidade das empresas estão relacionadas com a adoção de modelos de gerenciamento que possibilitem melhorar os resultados de suas operações. O sistema de gestão proposto pelo padrão ISO 9001:2008 se constitui num forte mecanismo para as empresas alcançarem seus objetivos. O presente artigo tem por objetivo analisar o processo de implementação do sistema de gestão pela qualidade e certificação segundo a norma ISO 9001:2008 de uma empresa mecânica de pequeno porte, como também relatar as dificuldades encontradas durante este processo e os benefícios decorrentes do mesmo.

O aumento da competitividade entre as empresas, a globalização dos mercados, a constante necessidade de estar se adaptando a novas tecnologias, o maior nível de exigência dos clientes e a menor disponibilidade de recursos financeiros estão fazendo com que o setor da construção civil venha sofrendo várias alterações nos últimos anos, de tal forma que as empresas passaram a sentir necessidade de implantar e aprimorar os sistemas de planejamento e gerenciamento dos processos existentes. O presente trabalho tem o propósito de apresentar como a Teoria da Corrente Crítica pode ser utilizada no planejamento e gestão de obras de construção civil. Diante disso, foi realizado um estudo de caso em uma obra localizada na cidade de Fortaleza – CE, sendo abordado o processo de planejamento e monitoramento da respectiva obra, com foco no planejamento de médio prazo realizado e na utilização da Teoria da Corrente Crítica. As principais contribuições deste trabalho estão relacionadas às melhorias que podem ser proporcionadas ao gerenciamento de processos do setor da construção civil a partir da aplicação dos conceitos da Teoria da Corrente Crítica e do planejamento de médio prazo, resultando em um aumento da produtividade, uma redução do retrabalho e da multitarefa, uma maior integração e comprometimento por parte das equipes envolvidas no projeto, dentre outros benefícios.

O câncer de próstata (CaP) é uma doença maligna que está comumente ligada ao avanço da idade dos homens. Trata-se de uma doença que não se restringe somente a próstata, mas que toca sua identidade, construída sob o modelo hegemônico de masculinidade, e abrange aspectos culturais, simbólicos, sociais e econômicos. Abordar a saúde do homem implica falar em sexualidade masculina e masculinidades. Este estudo tem por objetivo analisar as contribuições da produção científica sobre as repercussões do tratamento do CaP na sexualidade masculina publicadas entre os anos de 2006 e 2015, disponível em periódicos on-line. Para tanto, foi realizada uma revisão integrativa de literatura nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Library Online (SCIELO), utilizando os descritores Neoplasia de próstata e Sexualidade, publicados em português. Conclui-se que o adoecimento do homem pelo CaP representa uma ameaça a sexualidade e ao modelo hegemônico de masculinidade devido a “simbologia” atribuída a próstata.

Esta dissertação apresenta a análise de eficiência energética predial feita no edifício do Ceamazon, laboratório de pesquisas vinculado à Universidade Federal do Pará. Para este estudo foi utilizada a metodologia prescritiva do Regulamento Técnico da Qualidade para o Nível de Eficiência Energética de Edificações Comerciais, de Serviços e Públicas – RTQ-C. A análise energética do RTQ-C envolve três parâmetros distintos: a envoltória da edificação, o sistema de iluminação artificial e o sistema de condicionamento de ar. O estudo dos dados de cada um destes sistemas fornece material para os cálculos necessários no método, que resultarão em um equivalente numérico para cada um, representando a eficiência de cada sistema. A análise desta dissertação foi efetuada principalmente nos sistemas de iluminação artificial e condicionamento de ar, visto que uma análise prévia dos dados de envoltória do prédio já havia coletado bons resultados. O objetivo primário da dissertação foi de enquadrar a edificação em questão no nível A de eficiência energética proposto pelo regulamento. Desta forma, foram feitas as adequações necessárias ao projeto do ponto de vista energético, especificamente nos sistemas de iluminação e refrigeração artificial, visando tanto a classificação máxima de acordo com o RTQ-C como também a economia de energia e consequentemente, a redução de custos. Assim sendo, serão apresentadas também propostas de inclusão de alternativas energéticas para o edifício, visando uma eficiência energética ainda maior, bem como análises de viabilidade econômica e simulações energéticas das alterações propostas ao projeto da edificação, através dos softwares RetScreen e EnergyPlus. This dissertation presents the analysis of energy efficiency of the Ceamazon building, a research laboratory bounded to the Federal University of Pará. For this study it was utilized the prescriptive method of the “Regulamento Técnico da Qualidade para o Nível de Eficiência Energética de Edificações Comerciais, de Serviços e Públicas – RTQ-C”. RTQ-C’s energy analysis involves three distinct parameters: the building envelope, the artificial illumination system and the air-conditioning system. The study of the characteristics of each one of these systems provides material for the necessary calculations of the method, which will result in a numeric equivalent for each one, representing the efficiency of each system. This dissertation’s analysis was done mainly at the artificial illumination system and the air-conditioning system, since one previous analysis of the building’s envelope had already collected good results. The primary goal of this dissertation was to fit the building studied in the level A of energy efficiency proposed by the regulation. Thus, adjustments were made to the project from the energetic point of view, specifically on the artificial illumination and air-conditioning systems, aiming not only the maximum classification according to RTQ-C but also energy savings and the consequent reduction of costs. Therefore, proposals of inclusion of energetic alternatives to the building will also be presented, aiming at a higher energy efficiency, as well as economic viability analysis and energetic simulations of the alterations proposed to the building project, utilizing the softwares RetScreen and EnergyPlus.

An overview of several candidate architectures for 100 Gb/s capable optical access networks is presented. Considerations for their system requirements are outlined in regards to performance, cost and energy efficiency, towards addressing the design issues for the next generation EPON.

There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of MSC proliferation. On the other hand, PRP obtained in SC presented the higher platelet recovery after the blood first centrifugation step and a minimal change in MSC gene expression. Therefore, we suggest the use of SC as the anticoagulant for PRP obtaining.