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O tratamento percutâneo da ruptura do tendão calcâneo tem sido amplamente empregado. Estudos biomecânicos permitem a análise da resistência das suturas e a reprodutibilidade clínica. Nosso trabalho analisou, 36 tendões calcâneos bovinos, submetidos a reparo de ruptura produzida a 4cm da inserção e divididos em três grupos: simples sholeace(SS), Triplo Shoelace(TP) e Carmont & Mafulli(CM), avaliados biomecanicamente quanto: alongamento, rigidez, força máxima força e tipo de falha do sistema. Os resultados do alongamento,foram de 5,9mm no grupo1(SS), 3,0 mm para o grupo2(TS) e 3,8mm no grupo3(CM), significância estatística entre o grupo2 e os grupos1(p0,003767) e 3(p0,0005). Com relação a rigidez do sistema; grupo1 apresentou 23,2N/mm, grupo2 -30,3N/mm e grupo3 -28,6N/mm, significância estatística dos grupos2(p≈0) e 3(p0,0075) em relação grupo1. Os resultados de força máxima foram de 158,2N grupo1, 346,5N no grupo2 e146,1N para o grupo3, tendo significância estatística a entre o grupo 2 aos grupos 1(p≈0) e 3(p≈0). O tipo de falha na ruptura apresentou significância estatística entre todos os grupos analisados. O aumento do número de fios de suturas diminuiu o alongamento e aumentou a rigidez do construto, significância estatística dos grupos2 e 3 sobre o grupo1. A sutura simétrica em ambos os cotos e maior número de passada no tendão são demonstrados pela maior resistência no grupo2 (346,5N) até a falha, corroborado pela falha por arrancamento em todos os casos no grupo3.

Abstract Passion fruit scab (PFS), which is caused by species of the fungal complex Cladosporium cladosporioides, occurs both in protected environments and in the field. In view of the importance of the passion fruit scab, this study aimed to evaluate the effect of different intervals and doses of potassium phosphite in the greenhouse and in the field on the incidence of the disease. To evaluate the best dose of potassium phosphite, three experiments were carried out, two in a greenhouse and one in the field. The best application interval was evaluated in another experiment in a greenhouse. The variables evaluated were the incidence of plants with PFS symptoms (%) and the incidence of defoliated plants (%) in all experiments. The harvested fruits were evaluated for their mass (g), diameter (cm), soluble solids, acidity and chlorophyll content. The present work allowed to conclude that the dose of 0.1% of potassium phosphite was the best to control the passion fruit scab in a greenhouse, the treatment with an interval of 28 days of application showed a lower incidence of scab in seedlings at 35 days after inoculation and that potassium phosphite did not interfere in the quality parameters of fruits and leaves of passion fruit evaluated.

Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias when the standard therapy strategy failed. Methods: All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in two cardiology divisions between January 2010 and January 2020 were enrolled. Patients were divided into group A (oral procainamide) and group B (mexiletine) and the two groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All events that occurred during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when a ≥80% reduction of the sustained ventricular arrhythmias burden recorded by the ICD was achieved. Results: A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the VA burden. After multivariable adjustment, therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06–6.14, p = 0.03). Only three patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy compared with six patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p = 0.47). Conclusions: Compared to mexiletine, oral procainamide had a higher efficacy for the treatment of recurrent and refractory VAs, and showed a good profile of tolerability. [ABSTRACT FROM AUTHOR]

Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias in patients who have undergone catheter ablation, and in whom amiodarone and/or beta-blockers were ineffective or contraindicated, is a controversial issue. Objective: The present study sought to evaluate the efficacy and tolerability of oral procainamide in patients with recurrent ventricular arrhythmias when the standard therapy strategy had failed. Methods: All patients treated with procainamide for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in our institution between January 2010 and May 2019 were enrolled. The primary endpoint was the total number of implantable cardioverter-defibrillator (ICD) interventions after the beginning of procainamide therapy. Secondary endpoints were the total number of VTs and VFs recorded on the ICDs’ controls and discontinuation of therapy. The events occurring during procainamide treatment were compared with a matched-duration period before the initiation of therapy with procainamide. Patients therefore served as self-controls. Results: A total of 34 consecutive patients (32 male, 94.1%; mean age 74.4 ± 9.7 years) were included in the retrospective analysis. The mean time of procainamide treatment was 12.9 ± 13.7 months (median 9 [2–20] months). The mean dose of procainamide was 1207 ± 487 mg/day. Procainamide therapy significantly decreased ICD interventions (median 5 [0–22.5] vs 15.5 [3–32.25], P < .05). Procainamide also decreased the total number of VT/VF episodes (median 5.5 [0.75–30] vs 19 [7.5–30], P < .05). Only 3 patients (8.8%) presented severe side effects (dyspnea or hypotension), requiring discontinuation of therapy. Conclusion: Oral procainamide was associated with a significant decrease in ICD therapies and ventricular arrhythmias, showing an acceptable profile of tolerability.

This study aimed at analyzing the applicability of commercially pure titanium grade 2 (Cp) in cranial implants produced by incremental sheet forming (ISF) subjected to photofunctionalization via UV LED. ISF and heat treatment were used to meet the expected implant dimensions and3D scanning to determine the best result between the 3D model and the final prosthesis. Scanning Electron Microscopy (SEM) analysis to understand the behavior of samples before and after photofunctionalization. The wettability angle was used to assess the effectiveness of photofunctionalization. X-ray photoelectron spectroscopy (XPS) was applied to verify the chemical behavior of the sample. The prosthesis can be obtained in the best possible manner to meet the requirements of the patient's model. UV irradiation was effective in wettability tests while XPS and SEM analysis showed a considerable decline in the number of hydrocarbons and an increase in TiOH and TiO2 groups. Photofunctionalization has proved to be a valid method in reducing contamination, with different results in dental implants. The objective here was to amplify this process, lowering the costs by developing a photofunctionalization device that can be expanded to cranial implant applications.

This article has systematized the current scientific literature comprising the use of essential oils for acne treatment. The methods for essential oils obtention and their chemical constitution have been presented. The pharmaceutical formulations and advanced technologies used for essential oil topical application have been addressed. The concentration of use, main biological activities and reported adverse effects of essential oils regarding the topical treatment of acne have been presented. The methods for in vitro activity evaluation and the in vivo studies have been discussed. A search in different databases was conducted using the keywords 'essential oil' AND 'acne'. Seventy species of essential oils were identified, demonstrating anti-inflammatory, antibacterial and antioxidant activities. The essential oils of Melaleuca alternifolia Cheel, Cinnamomum zeylanicum Blume, Thymus vulgaris L., Fortunella japonica (Thunb.) Swingle, Copaiba langsdorfii (Desf.) Kuntze and Trachyspermum ammi (L.) Sprague showed the best results. Nonetheless, more in vivo studies should be carried out to confirm efficiency and fully determine adverse reactions and toxicity. [ABSTRACT FROM AUTHOR]

Background: Non-sustained ventricular tachycardia (NSVT) can occur asymptomatically and can be incidentally detected in the internal records of pacemakers (PM). The clinical value of NSVT in the population of PM patients is still uncertain.Our aim was to assess the prevalence of NSVT detected by remote PM control, to describe the clinical and demographic characteristics of patients with NSVT, and to assess the prognostic significance of NSVT in terms of both overall and cardiovascular mortality. Methods: Consecutive patients followed with PM remote interrogations from September 2010 to December 2015 were included. The transmissions pertaining to the first 12 months of remote control were analysed and the patients were divided by those presenting NSVT and those without NSVT. The two groups were compared in terms of total mortality and cardiovascular mortality based on the administrative data provided by the regional administration of the Italian National Health System. Results: The prevalence of NSVT in 408 patients (62% males, mean age 75.6; SD 10.6 years old) was 21% in a year. During a mean follow-up duration of 44 months, NSVT did not emerge as independently associated with overall mortality, but was associated with cardiovascular mortality in a competing risk regression model with older age, male gender, diabetes, chronic renal insufficiency, ischemic cardiomyopathy and chronic obstructive pulmonary disease. Conclusions: We show that NSVT episodes recorded by remote control in a PM population are independently associated with cardiovascular mortality with possible implications for risk stratification and therapeutic options. Keywords: Pacemaker, Remote interrogation, Non-sustained ventricular tachycardia, Cardiovascular mortality

Abstract This study aimed to analyze the wettability characteristics applied to the surface of heat-treated pure titanium grade 2. Titanium is widely used for applications in implants produced by incremental sheet forming (ISF), where the 3D model resulting from tomography was used to produce the part. Since the ISF process creates residual stresses in the sheet, heat treatments were applied to relieve them. Also analyzed were roughness, researching what the literature recommends to enable surface wettability. Tests were conducted to assess geometric discrepancy using 3D scanning. The results obtained prove the efficacy of the experiment in assessing wettability as a characteristic of bioactivity, which is necessary for applications involving the human body. In addition, geometric discrepancy analysis enables the prosthesis to be used with the best esthetic and functional comfort possible.

Problem-based learning (PBL) approaches are well-accepted and disseminated and have been intensively employed in several engineering programs. This article aims to present a teaching experience in which PBL was applied in one course of a mechanical engineering graduation program. The PBL approach applied is described step-by-step as well as the goals and constraints related to Computer-Aided Design, Engineering and Manufacturing (CAD/CAE/CAM) technologies employed in this particular case. The evaluation process is described, as well as the quantitative results, and also the results obtained from questionnaires answered by the students at the end of the PBL experience. Additionally, the team’s technical success in solving the proposed CAD/CAE/CAM problems was also taken into account. This PBL approach provided the students with the required autonomy to develop their argumentative skills within the team, defending their ideas, and at the same time, promoting self-criticism and ethical and impartial judgment among the other team members.

Objective: to examine how a group resonated in the lives of women attending a mental health service in Mato Grosso state. Method: a descriptive, qualitative approach was applied through semi-structured interviews of five women, from April to June 2012, after approval by the research ethics committee. The theoretical framework was based on operative groups and psychosocial care. Results: the women’s group assisted in social reintegration, autonomy-building, and reestablishing social and family ties. The group’s gender homogeneity helped participants identify, and develop and maintain interpersonal ties, and encouraged them to remain in the service. Conclusion: the study confirmed the operative group’s importance as a working tool in mental health care, where its repercussions aligned with psychosocial care and women’s needs. RESUMO Objetivo: analisar as ressonâncias de um grupo na vida das mulheres de um serviço de saúde mental de Mato Grosso. Método: pesquisa descritiva de abordagem qualitativa, realizada com cinco mulheres no período de abril a junho de 2012, por meio de entrevista semiestruturada realizada após a aprovação do Comitê de Ética em Pesquisa. O referencial teórico baseou-se em grupos operativos e na Atenção Psicossocial. Resultados: o grupo de mulheres auxiliou na reinserção social, construção de autonomia e restabelecimento de vínculos sociais e familiares. O grupo homogêneo, quanto ao gênero, facilitou a identificação entre as participantes, desenvolvendo e mantendo vínculos interpessoais, e estimulou a permanência delas no serviço. Conclusão: confirma-se a importância do grupo operativo como instrumento de trabalho na assistência em saúde mental, repercutindo em resultados condizentes com a atenção psicossocial e necessidades do universo feminino. RESUMEN Objetivo: analizar las resonancias de un grupo en la vida de las mujeres de un servicio de salud mental de Mato Grosso. Método: investigación descriptiva de enfoque cualitativo, realizada junto a cinco mujeres en el período de abril a junio de 2012, por medio de entrevista semiestructurada realizada tras la aprobación del Comité de Ética en Investigación. El referencial teórico se basó en grupos operativos y en la Atención Psicosocial. Resultados: el grupo de mujeres auxilió en la reinserción social, construcción de autonomía y restablecimiento de vínculos sociales y familiares. El grupo homogéneo, en cuanto al género, facilitó la identificación entre las participantes, desarrollando y manteniendo vínculos interpersonales, y estimuló su permanencia en el servicio. Conclusión: se confirma la importancia del grupo operativo como instrumento de trabajo en la asistencia en salud mental, repercutiendo en resultados acordes con la atención psicosocial y necesidades del universo femenino.

The aim of this work is to fabricate physical models of skulls fractured by 3D printing and customized pre-surgical implant in pure titanium sheets. The early manufacturing of model and implant allows the surgeon to plan surgery and reduce the runtime; the personalization contributes to the aesthetic and functional outcome of the implant, since it considers the anatomy of each patient. Methodology: from DICOM images generated by computed tomography of defective skull, both defective and repaired parts are reconstructed digitally in CAD. The fabrication of the physical model of the defective part is made by 3D printing. The manufacture of the implant in titanium sheet grade 2 is performed by incremental sheet forming - low-cost process that uses simple tooling and allows the fabrication of custom implants. The final dimensions of the implant and its assembly achieved satisfactory results, indicating the efficiency of the resources and parameters used.

Background: The ablation of arrhythmias arising near the His‐bundle region in the non‐coronary aortic cusp (NCAC) is challenging. Among the aortic sinuses of Valsalva, the NCAC is located between the right atrium and the left atrium. For this reason, pacing from the NCAC should result in atrial capture while pacing from the right and left coronary cusps (LCC) may result in ventricular capture. The objective of this study is to prove that atrial capture during pacing from the sinuses of Valsalva may be used to confirm a correct position in the non‐coronary cusp. Methods: A total of 30 patients with structurally normal heart undergoing left sided ablation procedures, underwent electrophysiological study of the aortic cusps. Each of the aortic valve cusps was paced with increasing outputs and analyzed offline to determine their unique electrocardiographic characteristics. Results: In the NCAC, we obtained an atrial capture in 29 out of 30 patients (96.6%). The atrial capture was highly specific for a position in the NCAC (p <.001). The median output required to capture from the cusp was 10 mA (range 5–25 mA) at a pulse width of 2 ms. In the right coronary cusp (RCC) and LCC, we obtained ventricular capture in all patients (100%). The median output required to capture from the cusp was 10 mA (range 10–25 mA) in RCC and 25 mA (range 10–25 mA) in LCC at a pulse width of 2 ms. Conclusions: Atrial capture during a pacemapping from the aortic cusps can be considered proof of a correct position in NCAC. [ABSTRACT FROM AUTHOR]

A região Oeste do estado de São Paulo, caracterizava-se por apresentar poços explorando o Grupo Bauru ou o Aqüífero Guarani. Com a execução de poços para abastecimento público executados recentemente, a possibilidade de exploração da Formação Serra Geral mostrou-se uma excelente fonte de recursos hídricos, ampliando o horizonte de oferta de água potável para consumo na região.

O Aqüífero Caiuá, localizado no extremo sudoeste do Estado de São Paulo apresenta-se contínuo e uniforme, possuindo Permeabilidade Aparente de até 3 m/dia e Transmissividade Aparente de até 300 m2/dia. Estes parâmetros indicam condições favoráveis para a exploração de águas subterrâneas, no entanto, existem limites para a sua exploração. Tais limites podem levar a região da Gleba XV de Novembro, onde já existem mais de 100 (cem) poços perfurados, a se tornar uma região de conflito de uso, em função da quantidade de poços que foram perfurados na região e da demanda reprimida que ainda existe. Este trabalho avalia a solicitação de outorga de 96 poços localizados em uma área de 150 Km2 e os limites que deverão ser considerados para a emissão de outorga de novos poços.

Introduction: The recently developed second‐generation subcutaneous implantable cardioverter defibrillator (S‐ICD) and the intermuscular two‐incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking. The aim of this multicentre prospective study was to evaluate the safety and outcome of second‐generation S‐ICD using the intermuscular two‐incision technique in a large population study. Methods and Results: The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second‐generation S‐ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular two‐incision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure‐related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments. During a median follow‐up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device‐related infections were observed. Ten patients (9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications. Conclusions: According to our multicentre study, second‐generation S‐ICD implanted with the intermuscular two‐incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks. [ABSTRACT FROM AUTHOR]

Aims: The aim of this prospective multicentre study is to evaluate safety and efficacy of the new bidirectional rotational mechanical lead extraction (LE) sheath (Evolution RL, Cook Medical, USA) in chronically implanted leads (>1-year-old leads).Methods and results: Between September 2013 and June 2016, a total of 238 leads in 124 consecutive patients were removed by using the new Evolution RL rotational mechanical sheath. Indications for LE were cardiac device infection in 63 (50.8%) cases, lead malfunction in 41 (33.1%), upgrade in 1 (0.8%) case and for other reasons in the remaining 19 cases (15.3%). Ninety-one leads (38.2%) were implantable cardioverter defibrillator leads (81 dual coil vs. 10 single coil), 38 (16%) right ventricular leads, 86 (36.1%) right atrial leads, and 23 (9.7%) coronary sinus leads. The mean implant duration was 92.2 ± 52.9 months (range 12-336). 91.6% of the leads (218/238) were extracted completely with the Evolution RL alone, with the complete success rate rising to 98.7% (235/238 leads) with combined use of a snare. Overall clinical success rate was 100%. No Evolution sheath-related complications were noted. There were no deaths or major complications. Five minor complications (4%) were encountered. In cases of companion leads no wrapping or lead damage were observed.Conclusion: On the basis of our prospective multicentre study, the new hand-powered bidirectional rotational mechanical LE sheath is an effective and safe tool for the extraction of chronically implanted leads without major complications and lead wrapping or lead damage. [ABSTRACT FROM AUTHOR]

Aims: Implantable cardioverter defibrillators improve survival of patients at risk for ventricular arrhythmias, but inappropriate shocks occur in up to 30% of patients and have been associated with worse quality of life and prognosis. In heart failure patients with cardiac resynchronization therapy defibrillators (CRT-Ds), we evaluated whether a new generation of detection and discrimination algorithms reduces inappropriate shocks.Methods and Results: We analysed 1983 Medtronic CRT-D patients (80% male, 67 ± 10 years), 1368 with standard devices (Control CRT-D) and 615 with new generation devices (New CRT-D). Expert electrophysiologists reviewed and classified the electrograms of all device-detected ventricular tachycardia/fibrillation episodes. Total follow-up was 3751 patients-years. Incidence of inappropriate shocks at 1 year was 2.8% [95% confidence interval (CI) = 2.0-3.5] in Control CRT-D and 0.9% (CI = 0.4-2.2) in New CRT-D (hazard ratio = 0.37, CI = 0.21-0.66, P < 0.001). In New CRT-D, inappropriate shocks were reduced by 77% [incidence rate ratio (IRR) = 0.23, CI = 0.16-0.35, P < 0.001] and inappropriate anti-tachycardia pacing by 81% (IRR = 0.19, CI = 0.11-0.335, P < 0.001). Annual rate per 100 patient-years for appropriate VF detections was 3.0 (CI = 2.1-4.2) in New CRT-D and 3.2 (CI = 2.1-5.0) in Control CRT-D (P = 0.68), for syncope was 0.4 (CI = 0.2-0.9) in New CRT-D and 0.7 (CI = 0.5-1.0) in Control CRT-D (P = 0.266), and for death was 1.0 (CI = 0.6-1.6) in New CRT-D and 3.5 (CI = 3.0-4.1) in Control CRT-D (P < 0.001).Conclusion: Detection and discrimination algorithms used in new generation CRT-D significantly reduced inappropriate shocks when compared with standard CRT-D. This result, with no compromise on VF sensitivity or risk of syncope, has important implications for patients' quality of life and prognosis. [ABSTRACT FROM AUTHOR]

The aim of this work is to fabricate physical models of skulls fractured by 3D printing and customized pre-surgical implant in pure titanium sheets. The early manufacturing of model and implant allows the surgeon to plan surgery and reduce the runtime; the personalization contributes to the aesthetic and functional outcome of the implant, since it considers the anatomy of each patient. Methodology: from DICOM images generated by computed tomography of defective skull, both defective and repaired parts are reconstructed digitally in CAD. The fabrication of the physical model of the defective part is made by 3D printing. The manufacture of the implant in titanium sheet grade 2 is performed by incremental sheet forming - low-cost process that uses simple tooling and allows the fabrication of custom implants. The final dimensions of the implant and its assembly achieved satisfactory results, indicating the efficiency of the resources and parameters used. [ABSTRACT FROM AUTHOR]

Introduction: This work aims to pre-operatively manufacture custom-made low-cost implants and physical models ('biomodels') of fractured skulls. The pre-operative manufacturing of biomodels and implants allows physicians to study and plan surgery with a greater possibility of achieving the expected result. Customization contributes to both the esthetic and functional outcome of the implant because it considers the anatomy of each patient, while the low cost allows a greater number of people to potentially benefit. Methods: From CT images of a fractured skull, a CAD model of the skull (biomodel) and a restorative implant were constructed digitally. The biomodel was then physically constructed with 3D Printing, and Incremental Sheet Forming (ISF) was used to manufacture the implant from a sheet of pure grade 2 titanium. Before cutting the implant's final shape from a pre-formed sheet, heat treatment was performed to avoid deformations caused by residual stresses generated during the ISF process. Results: A comparison of the dimensions of the implant and its respective CAD biomodel revealed geometric discrepancies that can affect both functional and aesthetic efficiency. Nevertheless, the final shape preserved symmetry between the right and left sides of the skull. Electron microscopy analysis did not indicate the presence of elements other than pure titanium. Conclusions: Dimensional variability can be decreased with changes in the manufacturing process (i.e., forming and cutting) and the heating ramp. Despite biomedical characteristics, there was no contamination of the implant by harmful chemical elements. 3D Printing was effective in making the biomodel, enabling pre-operative planning and improving physician-patient communication. Current results indicate that ISF is a process that can be used to obtain custom-made implants. [ABSTRACT FROM AUTHOR]