Customized palatal guide and splint for maxillary expansion.

Customization in orthognathic surgery allows better precision and a reduced surgical time. In Le Fort I osteotomy surgery, the maxillary segmentation is considered one of the most unstable procedures due to transverse instability. Various different types of palatal device have been proposed to address this instability. This note describes a customized bone-borne palatal guide and splint that may help surgeons shorten the surgical time and achieve better three-dimensional repositioning, with more postoperative comfort for the patient and occlusal control for the surgeon.

Does rassi score caracterize patients with chagas disease with complex ventricular arrhythmias?

INTRODUCTION: Rassi score (NYHA functional class III/IV HF [5 points], cardiomegaly [5 points], contractions abnormalities [3 points], non-sustained ventricular tachycardia [3 points], low amplitude QRS [2 points] and male sex [2 points]) is used in the clinic for risk stratification due to cardiovascular death in patients with Chagas disease (P-CD). Whether this score has any role in identifying patients at risk of complex ventricular arrhythmias has not been determined. OBJECTIVE: Assess whether there is an association between Rassi score and the presence of potentially malignant complex ventricular arrhythmias in P-CD. METHODS: 79 P-CD (34 men, age 61±11 years-old), consecutively referred for 24h-Holter were divided into 2 groups: low risk Rassi score (57 P, 0-6 points) and medium-high risk (22 P, 7-20 points). The amount and complexity of ventricular arrhythmia (> 30/ h, ventricular tachycardia [VT]), LVEF, heart rate turbulence (HRT) indexes (turbulence onset [TO] and turbulence slope [TS]) and HRT category (0 [without disautonomy], 1 and/or 2 [presence of disautonomy]) were evaluated. RESULTS: Compared to P-CD with low risk score, those with medium-high risk had more ventricular arrhythmias, lower LVEF, worse HRT indexes and more HRT categories 1 and/or 2 (see table below). CONCLUSIONS: 1) P-CD and Rassi score of medium to high risk have a greater amount of ventricular arrhythmias; 2) These findings can be explained by the presence of greater degree of disautonomy, assessed by HRT, and by the lower LVEF; 3) Prospective studies are necessary to confirm these findings in clinical practice.

Energy balance for forced two-dimensional incompressible ideal fluid flow.

Cheskidov et al. (2016 Commun. Math. Phys. 348, 129-143. (doi:10.1007/s00220-016-2730-8)) proved that physically realizable weak solutions of the incompressible two-dimensional Euler equations on a torus conserve kinetic energy. Physically realizable weak solutions are those that can be obtained as limits of vanishing viscosity. The key hypothesis was boundedness of the initial vorticity in [Formula: see text], [Formula: see text]. In this work, we extend their result, by adding forcing to the flow. This article is part of the theme issue 'Scaling the turbulence edifice (part 2)'.

Production of thermoplastic starch and poly (butylene adipate-co-terephthalate) films assisted by solid-state shear pulverization.

A novel processing technique involving Solid-State Shear Pulverization (SSSP) was used to produce thermoplastic starch (TPS) and Poly (Butylene Adipate-co-Terephthalate) (PBAT) films to improve processability and produce well-dispersed blends. Four different compositions (50-80 wt% TPS content) were processed using two different production routes. In one instance, the compositions were pre-treated by SSSP before melt extrusion (SSSPE). Secondly, starch was initially plasticized and thereafter blended with PBAT by melt extrusion (EXT) method. Flat films were produced using both routes and processability, visual and tactical aspects, mechanical and optical properties, crystallinity, and water absorption behavior were evaluated. High starch content films (70 and 80 wt%) prepared based on SSSP incorporation showed easier processability, and better visual aspect and mechanical integrity than EXT ones. However, EXT films with 50 and 60 wt% of starch presented higher elongation at break and lower water absorption due to finer dispersion of TPS and better starch plasticization.

Bending, buckling and torsional resistance of rotary and reciprocating glide path instruments.

AIM: To evaluate the bending, buckling and torsional resistance of ProGlider (PG) (Dentsply Sirona, Ballaigues, Switzerland), R-Pilot (RP) (VDW, Munich, Germany) and WaveOne Gold Glider (WOGG) (Dentsply Sirona). METHODOLOGY: Ninety instruments were used: 30 PG (size 0.16, .02v taper), 30 RP (size 0.125, .04 taper) and 30 WOGG (size 0.15, .02v taper). The bending resistance test was performed on 10 randomly selected instruments of each system according to ISO 3630-1 specifications. For the buckling resistance test, a loading was applied in the axial direction of each instrument using a universal test machine, with a 20 N cell and 15 mm min-1 speed, in the axial direction. When a lateral elastic displacement of 1 mm occurred, the force was registered. The torsional resistance test was performed according to ISO 3630-1 specifications. Statistical analysis was performed using one-way anova and post hoc Student-Newman-Keuls test (P < 0.05). RESULTS: WOGG had the lowest bending resistance, whilst RP had the highest bending resistance (P < 0.05). RP also had the highest buckling resistance, and WOGG had the lowest (P < 0.05). PG had intermediate results regarding bending and buckling resistance, with significant differences to RP and WOGG (P < 0.05). RP had the highest torsional strength and the lowest angular deflection when compared to PG and WOGG (P < 0.05). No differences in the torsional strength and angular deflection were observed between WOGG and PG (P> 0.05). CONCLUSION: The glide path instruments had different behaviours in term of bending, buckling and torsional resistance.

Mechanical behavior of ropes based on polypropylene (PP) and poly(ethylene terephthalate) (PET) multifilament yarns for Achilles tendon partial substitution.

In some clinical cases, attending to the type and extension of the Achilles tendon injury, a partial replacement of the tissue may be needed. Driven by this, the authors developed different structures based on polypropylene (PP) or poly (ethylene terephthalate) (PET) multifilament yarns, using a textile technology-based technique, in order to mimic the fibrous structure of tendons. Those structures are based on a core/shell system, being the core composed by several sub-components (braids) and the shell based on braided yarns enclosing the core. It was observed that the load at failure of ropes is mainly defined by the number of yarns that compose it, but the strain level is mostly influenced by the production take-up rate of the core braids and consequently by the braid angle. The ropes stiffness level results from a combination of the yarns number and braid angle of the core braids. The structure based on PET yarns revealed a non-linear force-strain curve similar to a typical curve of a natural Achilles tendon (AT), presenting a load at failure, strain to failure and stiffness levels very promising for AT replacement. Moreover, the PET rope also revealed a very promising fatigue and appropriate creep resistance for the final application, being in accordance with what has been reported for native AT.

Spatial Accessibility and Social Inclusion: The Impact of Portugal's Last Health Reform.

Health policies seek to promote access to health care and should provide appropriate geographical accessibility to each demographical functional group. The dispersal demand of health-care services and the provision for such services at fixed locations contribute to the growth of inequality in their access. Therefore, the optimal distribution of health facilities over the space/area can lead to accessibility improvements and to the mitigation of the social exclusion of the groups considered most vulnerable. Requiring for such, the use of planning practices joined with accessibility measures. However, the capacities of Geographic Information Systems in determining and evaluating spatial accessibility in health system planning have not yet been fully exploited. This paper focuses on health-care services planning based on accessibility measures grounded on the network analysis. The case study hinges on mainland Portugal. Different scenarios were developed to measure and compare impact on the population's accessibility. It distinguishes itself from other studies of accessibility measures by integrating network data in a spatial accessibility measure: the enhanced two-step floating catchment area. The convenient location for health-care facilities can increase the accessibility standards of the population and consequently reduce the economic and social costs incurred. Recently, the Portuguese government implemented a reform that aimed to improve, namely, the access and equity in meeting with the most urgent patients. It envisaged, in terms of equity, the allocation of 89 emergency network points that ensured more than 90% of the population be within 30 min from any one point in the network. Consequently, several emergency services were closed, namely, in rural areas. This reform highlighted the need to improve the quality of the emergency care, accessibility to each care facility, and equity in their access. Hence, accessibility measures become an efficient decision-making tool, despite its absence in effective practice planning. According to an application of this type of measure, it was possible to verify which levels of accessibility were decreased, including the most disadvantaged people, with a larger time of dislocation of 12 min between 2001 and 2011.

A RAPD-PCR-based genetic diversity analysis of Helicoverpa armigera and H. zea populations in Brazil.

Helicoverpa armigera is the most significant pest of agriculture in Asia, Europe, Africa, and Australasia, causing damage to crops greater than US$2 billion annually and until 2013 it was not detected in Brazil. Helicoverpa zea is restricted to the American continent and is important to corn and a secondary pest of cotton and tomatoes. The wide range of crops exploited by H. armigera (mainly cotton, soybeans, chickpea, and corn), the possible mating between these species can promote population shifts, that could be assessed by RAPD-PCR technique. Therefore, the aim of this study was to determine the genetic diversity of H. armigera and H. zea populations by RAPD-PCR analysis. The most important result was the clustering of one H. armigera population in a group predominantly formed by H. zea. It could indicate a possible occurrence of an interspecific cross between these species. This is a concern to Brazilian agriculture due to the possibility of selection of hybrids well adapted to the American environment, which would be inherited from H. zea. The other noxious fact is the possible development of new biotypes resistant to insectides or Bt toxins expressed in transgenic crops, came from H. armigera gene pool.

Adding value to gasification and co-pyrolysis chars as removal agents of Cr3.

The present work aims to assess the efficiency of chars, obtained from the gasification and co-pyrolysis of rice wastes, as adsorbents of Cr3+ from aqueous solution. GC and PC chars, produced in the gasification and co-pyrolysis, respectively, of rice husk and polyethylene were studied. Cr3+ removal assays were optimised for the initial pH value, adsorbent mass, contact time and Cr3+ initial concentration. GC showed a better performance than PC with about 100% Cr3+ removal, due to the pH increase that caused Cr precipitation. Under pH conditions in which the adsorption prevailed (pH<5.5), GC presented the highest uptake capacity (21.1mg Cr3+ g-1 char) for the following initial conditions: 50mg Cr3+ L-1; pH 5; contact time: 24h;L/S ratio: 1000mLg-1. The pseudo-second order kinetic model showed the best adjustment to GC experimental data. Both the first and second order kinetic models fitted well to PC experimental data. The ion exchange was the dominant phenomenon on the Cr3+ adsorption by GC sample. Also, this char significantly reduced the ecotoxicity of Cr3+ solutions for the bacterium Vibrio fischeri. GC char proved to be an efficient material to remove Cr3+ from aqueous solution, without the need for further activation.

Leaching behaviour and ecotoxicity evaluation of chars from the pyrolysis of forestry biomass and polymeric materials.

The main objective of this study was to assess the environmental risk of chars derived from the pyrolysis of mixtures of pine, plastics, and scrap tires, by studying their leaching potential and ecotoxicity. Relationships between chemical composition and ecotoxicity were established to identify contaminants responsible for toxicity. Since metallic contaminants were the focus of the present study, an EDTA washing step was applied to the chars to selectively remove metals that can be responsible for the observed toxicity. The results indicated that the introduction of biomass to the pyrolysis feedstock enhanced the acidity of chars and promote the mobilisation of inorganic compounds. Chars resulting from the pyrolysis of blends of pine and plastics did not produce ecotoxic eluates. A relationship between zinc concentrations in eluates and their ecotoxicity was found for chars obtained from mixtures with tires. A significant reduction in ecotoxicity was found when the chars were treated with EDTA, which was due to a significant reduction in zinc in chars after EDTA washing.

Removal of phosphorus from wastewaters by biomass ashes.

Removal batch assays of phosphates from a synthetic wastewater (SWW) and a pulp and paper mill wastewater (PPWW) with two forestry biomass ashes were performed. The supernatants were not only chemically characterized but also the ecotoxicity was determined using two organisms: Vibrio fischeri and Artemia franciscana. The addition of fly ash and bottom ash to the SWW in solid/liquid (S/L) ratios of 3.35 and 9.05 g L(-1), respectively, achieved removal percentages of phosphates >97% for both ashes. The addition of fly ash and bottom ash to the PPWW in S/L ratios of 34.45 and 46.59 g L(-1), respectively, yield removal percentages of phosphates >90% for both ashes. According to the results of the Langmuir and Freundlich isotherms, the removal of phosphates from the SWW was mainly explained by surface removal mechanisms, while the removal from the PPWW was partially explained by multi-layer mechanisms. The supernatants resulting from the treatment of SWW and PPWW with both biomass ashes did not present acute ecotoxicity.

Physico-chemical properties of chars obtained in the co-pyrolysis of waste mixtures.

The present work aims to perform a multistep upgrading of chars obtained in the co-pyrolysis of PE, PP and PS plastic wastes, pine biomass and used tires. The quality of the upgraded chars was evaluated by measuring some of their physico-chemical properties in order to assess their valorisation as adsorbents' precursors. The crude chars were submitted to a sequential solvent extraction with organic solvents of increasing polarity (hexane, mixture 1:1 v/v hexane:acetone and acetone) followed by an acidic demineralization procedure with 1M HCl solution. The results obtained showed that the upgrading treatment allow the recovery of 63-81% of the pyrolysis oils trapped in the crude chars and a reduction in the char's ash content in the range of 64-86%. The textural and adsorption properties of the upgraded chars were evaluated and the results indicate that the chars are mainly mesoporous and macroporous materials, with adsorption capacities in the range of 3.59-22.2 mg/g for the methylene blue dye. The upgrading treatment allowed to obtain carbonaceous materials with quality to be reused as adsorbents or as precursors for activated carbon.

[Methotrexate to treat SAPHO syndrome with keloidal scars]. / Metotrexato no tratamento da síndrome SAPHO complicadas por quelóides.

SAPHO syndrome is an uncommon clinical entity, recently described in literature, which usually affects children, young adults and middle-aged people. It is defined by the association of skin lesions (severe acne, palmo-plantar pustulosis, supurative hidradenitis), synovitis, hiperosthosis and osteitis; however, not all manifestations are required for correct diagnosis. We report a currently forty-two year-old man who initiated follow-up in 1992 for severe acne. His diagnosis changed along the years and has been treated with antibiotics many times to control pustule formation and hidrosadenitis, which evolved to keloidal scars, requiring neck zethaplasty due to limitation of mobility. In 1996 isotretinoin was started, with good response to treatment but recurrence after its completion. Ten years later, isotretinoin was being used again due to worsening clinical picture when the patient developed polyarthritis, lost 11kg in 3 months and was found to have an elevated erythrocyte sedimentation rate. SAPHO syndrome was then diagnosed by the Rheumatology clinic, which started methotrexate at 10mg per week to a good clinical response. Several cutaneous and articular flares have occurred since, however he is now clinically stable with methotrexate 20mg per week and finasteride 5mg per day. SAPHO syndrome is a rare disease and its diagnosis is often late and difficult. In this case, skin lesions preceded arthritis in several years and have been resistant to other common treatments. The patient had a better improve after initiation of methotrexate. Although the skin disease has evolved to keloids, the patient has had excellent treatment response.

Extended cyclic fatigue life of F2 ProTaper instruments used in reciprocating movement.

AIM: To evaluate the cyclic fatigue fracture resistance of engine-driven F2 ProTaper instruments under reciprocating movement. METHODOLOGY: A sample of 30 NiTi ProTaper F2 instruments was used. An artificial canal was made from a stainless steel tube, allowing the instruments to rotate freely. During mechanical testing, different movement kinematics and speeds were used, which resulted in three experimental groups (n = 10). The instruments from the first group (G1) were rotated at a nominal speed of 250 rpm until fracture, whilst the instruments from the second group (G2) were rotated at 400 rpm. In the third instrument group (G3), the files were driven under reciprocating movement. The time of fracture for each instrument was measured, and statistical analysis was performed using parametric methods. RESULTS: Reciprocating movement resulted in a significantly longer cyclic fatigue life (P < 0.05). Moreover, operating rpm was a significant factor affecting cyclic fatigue life (P < 0.05); instruments used at a rotational speed of 400 rpm (approximately 95 s) failed more rapidly than those used at 250 rpm (approximately 25 s). CONCLUSIONS: Movement kinematics is amongst the factors determining the resistance of rotary NiTi instruments to cyclic fracture. Moreover, the reciprocating movement promoted an extended cyclic fatigue life of the F2 ProTaper instrument in comparison with conventional rotation.

Estimating the prevalence of inflammatory bowel disease in Portugal using a pharmaco-epidemiological approach.

PURPOSE: To estimate inflammatory bowel disease (IBD) prevalence in Portugal from 2003 to 2007, and to obtain disease, sex and age specific estimates. METHODS: A pharmaco-epidemiological approach based on intestinal anti-inflammatory (IAI) drugs consumption was used. Proportion of patients taking IAI drugs and mean prescribed daily dose (PDD) were estimated from a sample of 513 IBD patients. Assumptions were made about unknown parameters and sensitivity analysis performed: drug compliance (80% in base case; range 70-85%) and proportion of sulphasalazine used in IBD (52%; range 40-80%). Sex and age specific estimates were based on a proposed methodological extension and results from a nationwide (n = 5893) cross-sectional study. RESULTS: IBD prevalence increased from 86 patients per 100 000 in 2003 to 146 in 2007. Regions more affected were Lisboa and Porto (173 and 163 per 100 000 in 2007, respectively). Prevalence increased from 42 and 43 per 100 000 in 2003 to 71 and 73 in 2007, respectively for ulcerative colitis (UC) and Crohn's disease (CD). In 2007, prevalence was higher in the 40-64 age stratum for UC (99 per 100 000) and in the 17-39 stratum for CD (121). Prevalence was consistently higher in females. CONCLUSIONS: Portugal is half way between countries with the highest and lowest IBD prevalence, but is steeply making the road to the highest-level group. Despite limitations of the proposed methods, assumptions were reasonable and estimates seem to be valid. Feasibility and comparability of this methodology makes it an interesting tool for future studies on IBD epidemiology.

Critical analysis of autoregressive and fast Fourier transform markers of cardiovascular variability in rats and humans

The autonomic nervous system plays an important role in physiological and pathological conditions, and has been extensively evaluated by parametric and non-parametric spectral analysis. To compare the results obtained with fast Fourier transform (FFT) and the autoregressive (AR) method, we performed a comprehensive comparative study using data from humans and rats during pharmacological blockade (in rats), a postural test (in humans), and in the hypertensive state (in both humans and rats). Although postural hypotension in humans induced an increase in normalized low-frequency (LFnu) of systolic blood pressure, the increase in the ratio was detected only by AR. In rats, AR and FFT analysis did not agree for LFnu and high frequency (HFnu) under basal conditions and after vagal blockade. The increase in the LF/HF ratio of the pulse interval, induced by methylatropine, was detected only by FFT. In hypertensive patients, changes in LF and HF for systolic blood pressure were observed only by AR; FFT was able to detect the reduction in both blood pressure variance and total power. In hypertensive rats, AR presented different values of variance and total power for systolic blood pressure. Moreover, AR and FFT presented discordant results for LF, LFnu, HF, LF/HF ratio, and total power for pulse interval. We provide evidence for disagreement in 23 percent of the indices of blood pressure and heart rate variability in humans and 67 percent discordance in rats when these variables are evaluated by AR and FFT under physiological and pathological conditions. The overall disagreement between AR and FFT in this study was 43 percent.

Critical analysis of autoregressive and fast Fourier transform markers of cardiovascular variability in rats and humans.

The autonomic nervous system plays an important role in physiological and pathological conditions, and has been extensively evaluated by parametric and non-parametric spectral analysis. To compare the results obtained with fast Fourier transform (FFT) and the autoregressive (AR) method, we performed a comprehensive comparative study using data from humans and rats during pharmacological blockade (in rats), a postural test (in humans), and in the hypertensive state (in both humans and rats). Although postural hypotension in humans induced an increase in normalized low-frequency (LFnu) of systolic blood pressure, the increase in the ratio was detected only by AR. In rats, AR and FFT analysis did not agree for LFnu and high frequency (HFnu) under basal conditions and after vagal blockade. The increase in the LF/HF ratio of the pulse interval, induced by methylatropine, was detected only by FFT. In hypertensive patients, changes in LF and HF for systolic blood pressure were observed only by AR; FFT was able to detect the reduction in both blood pressure variance and total power. In hypertensive rats, AR presented different values of variance and total power for systolic blood pressure. Moreover, AR and FFT presented discordant results for LF, LFnu, HF, LF/HF ratio, and total power for pulse interval. We provide evidence for disagreement in 23% of the indices of blood pressure and heart rate variability in humans and 67% discordance in rats when these variables are evaluated by AR and FFT under physiological and pathological conditions. The overall disagreement between AR and FFT in this study was 43%.

Inflammatory bowel disease: a patient's and caregiver's perspective.

The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients' and their caregivers' daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn's disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N=324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care.