A new piezoelectric actuator induces bone formation in vivo: a preliminary study.

This in vivo study presents the preliminary results of the use of a novel piezoelectric actuator for orthopedic application. The innovative use of the converse piezoelectric effect to mechanically stimulate bone was achieved with polyvinylidene fluoride actuators implanted in osteotomy cuts in sheep femur and tibia. The biological response around the osteotomies was assessed through histology and histomorphometry in nondecalcified sections and histochemistry and immunohistochemistry in decalcified sections, namely, through Masson's trichrome, and labeling of osteopontin, proliferating cell nuclear antigen, and tartrate-resistant acid phosphatase. After one-month implantation, total bone area and new bone area were significantly higher around actuators when compared to static controls. Bone deposition rate was also significantly higher in the mechanically stimulated areas. In these areas, osteopontin increased expression was observed. The present in vivo study suggests that piezoelectric materials and the converse piezoelectric effect may be used to effectively stimulate bone growth.

Correlation between api 50 ch and multiplex polymerase chain reaction for the identification of vaginal lactobacilli in isolates.

UNLABELLED: Identification of Lactobacillus sp. strains by phenotypic methods may lead to doubtful results possibly interfering in the reliability of the epidemiological and probiotics studies. Therefore this study aimed to determine the best methodology for the identification of the large diversity of lactobacilli species found in the vagina by comparing two techniques, one based on their biochemical profile and other employing molecular biology. A carbohydrate fermentation test (API 50 CH) was compared with multiplex polymerase chain reaction (PCR) for the identification of species of vaginal lactobacilli from 135 healthy women. The kappa index was used to evaluate agreement between the methods. Using the molecular technique, L. crispatus (32.6%), L. jensenii (25%) and L. gasseri (20.6%) were the most frequent species. However, using the biochemical technique, the most frequent species were: L. acidophilus (34.8%), L. crispatus (27.2%) and L. fermentum (13%). Although L. acidophilus was the most frequent specie found by biochemical tests, no strain of this microorganism was detected by PCR. Agreement between the methods was low for identification of all the most common species. Although rates of L. crispatus detected were similar using both methods (32.6% and 27.2%), agreement between them was relatively low (kappa = 0.52). CONCLUSIONS: Our results confirmed the limitation of the biochemical method and the applicability of a previously published molecular method (Multiplex PCR) for the identification of lactobacilli in the vaginal tract, focusing on further necessity of its improvement for also targeting L. vaginalis and L. iners.

Recovery of DNA for the detection and genotyping of human papillomavirus from clinical cervical specimens stored for up to 2 years in a universal collection medium with denaturing reagent.

The recovery and stability of DNA for the detection and genotyping of HPV in UCM-containing specimens, after exposure to denaturing reagents and stored for up to 2 years were evaluated. Samples were collected from 60 women who had cervical cytology specimens harboring cervical intraepithelial neoplasia (CIN) 2 or 3. All samples were stored in UCM and had been frozen at -20 degrees C following the addition of the denaturing reagent (sodium hydroxide) and the removal of the aliquot required for Hybrid Capture 2 testing for the identification of HPV DNA. The samples had been stored for 6, 12 and 24 months (20 samples for each storage time). HPV DNA extraction was performed according to a protocol designed specifically and the presence and quality of DNA was confirmed by human beta-globin detection using the consensus primers G73 and G74. HPV DNA was amplified using the consensus primers PGMY09 and PGMY11, and reverse line-blot hybridization was used to detect type-specific amplicons for 37 HPV types. The DNA extracted from the denatured specimen was recovered in 57/60 (95%) of the samples. HPV DNA was detected in 56/57 (98%) of the recovered samples. Twenty-six of the 56 samples recovered (48%) were genotyped successfully.

Phenotypical characteristics of group B streptococcus in parturients.

Colonization by Group B Streptococcus (GBS) is highly prevalent among pregnant women, with prevalence rates ranging between 4% and 30%. The infection may be transmitted vertically and may result in serious neonatal consequences. In the period from November 2003 to May 2004, a cross-sectional study was carried out among 316 parturients at the Jundiaí Teaching Hospital to establish the prevalence of genital GBS colonization, to identify the factors associated with colonization and the characteristic phenotypes of these streptococci. Samples from rectal and vaginal areas were collected for selective culture in Todd-Hewitt broth. Susceptibility to 7 antimicrobial agents was tested using the antibiotic diffusion disk technique, and the isolated strains were classified using specific antisera. The prevalence of GBS colonization was 14.6%. No strain was resistant to penicillin, ampicillin, erythromycin or nitrofurantoin. The majority of strains were sensitive to cephalothin. Greatest resistance was to gentamicin (76.1%), followed by clindamycin (17.4%). The most frequent serotype was Ib (23.9%), followed by serotypes II and Ia (19.6% and 17.4%, respectively). There was no correlation between serotype and greater antimicrobial resistance. In conclusion, the prevalence of GBS in parturients was high and penicillin continues to be the drug of choice for intrapartum prophylaxis. The most frequent serotype (Ib) found in this study differs from those found in the majority of studies carried out in other countries, revealing the need to identify prevalent serotypes in each region so that specific vaccines can be designed.

Impact of treatment for bacterial vaginosis on prematurity among Brazilian pregnant women: a retrospective cohort study.

CONTEXT AND OBJECTIVE: Bacterial vaginosis has been associated with prematurity and other perinatal complications. However, the efficacy of the treatment for preventing such complications has not yet been well established. The objective of this study was to evaluate the impact of treatment for bacterial vaginosis on a low-risk population of Brazilian pregnant women, in order to prevent prematurity and other perinatal complications. DESIGN AND SETTING: Observational retrospective cohort study, at the Obstetric and Gynecology Department, Universidade Estadual de Campinas (Unicamp). METHODS: Vaginal bacterioscopy results from 785 low-risk pregnant women were studied. Three different groups of women were identified: 580 without bacterial vaginosis during pregnancy, 134 with bacterial vaginosis treated using imidazoles (metronidazole, tinidazole, or secnidazole) during pregnancy, and 71 with bacterial vaginosis not treated during pregnancy. The diagnosis of bacterial vaginosis was based on Nugent's criteria, from the vaginal bacterioscopy performed during the first prenatal care visit. RESULTS: The frequency of prematurity was 5.5% among the women without bacterial vaginosis, 22.5% among those with untreated bacterial vaginosis and 3.7% among those with treated bacterial vaginosis. The risk ratios for perinatal complications were significantly higher in the group with untreated bacterial vaginosis: premature rupture of membranes, 7.5 (95% CI: 1.9-34.9); preterm labor, 3.4 (95% CI: 1.4-8.1); preterm birth, 6.0 (95% CI: 1.9-19.7); and low birth weight, 4.2 (95% CI: 1.2-14.3). CONCLUSION: The treatment of bacterial vaginosis significantly reduced the rates of prematurity and other perinatal complications among these low-risk Brazilian pregnant women, regardless of the history of previous preterm delivery.

HIV infection in women: impact on contraception.

A study was performed to evaluate the impact of knowledge of HIV infection (diagnosis) on contraception information and choices for HIV infected women. A questionnaire was given to 140 HIV infected women. Most of the studied population included young women with a low educational level. A significant increase in the knowledge of contraceptive methods was observed after diagnosis of being HIV infected. The data suggested that the women who received information had never received it before, or that the diagnosis created a stronger motivation to listen to the counseling offered. A significant increase in the use of contraceptive methods was also found, especially male condoms and tubal ligation. Total number of children had a strong impact on contraceptive method at the time of interview. Only 5 of 23 HIV infected women who had no children used hormonal contraceptives, while 15 of 23 preferred condom use, and 3 of 23 chose not to use any contraceptive method. Tubal ligation was performed in approximately 9% of the women who had only one child. However, 12.4% of the sexually active HIV infected women were still not using any contraceptive method at the time of the interview. A combined method (male condom plus another contraceptive) was used by only 27% of sexually active HIV infected women, despite health service counseling. In conclusion, the realization of being HIV infected had a strong impact on contraceptive practice among these women. It is expected that HIV and family planning clinics will address HIV infected women's needs and be prepared to integrate contraception and gynecological care.

From conventional sensors to fibre optic sensors for strain and force measurements in biomechanics applications: a review.

In vivo measurement, not only in animals but also in humans, is a demanding task and is the ultimate goal in experimental biomechanics. For that purpose, measurements in vivo must be performed, under physiological conditions, to obtain a database and contribute for the development of analytical models, used to describe human biomechanics. The knowledge and control of the mechanisms involved in biomechanics will allow the optimization of the performance in different topics like in clinical procedures and rehabilitation, medical devices and sports, among others. Strain gages were first applied to bone in a live animal in 40's and in 80's for the first time were applied fibre optic sensors to perform in vivo measurements of Achilles tendon forces in man. Fibre optic sensors proven to have advantages compare to conventional sensors and a great potential for biomechanical and biomedical applications. Compared to them, they are smaller, easier to implement, minimally invasive, with lower risk of infection, highly accurate, well correlated, inexpensive and multiplexable. The aim of this review article is to give an overview about the evolution of the experimental techniques applied in biomechanics, from conventional to fibre optic sensors. In the next sections the most relevant contributions of these sensors, for strain and force in biomechanical applications, will be presented. Emphasis was given to report of in vivo experiments and clinical applications.

In vivo measurement of the pressure signal in the intervertebral disc of an anesthetized sheep.

The purpose of the present study was to measure the intradiscal pressure signal of an anesthetized sheep under spontaneous breathing. An ultra-miniature fiber optic high-pressure sensor was implanted into the nucleus pulposus of the fifth lumbar intervertebral using a dorsolateral transforaminal approach. Results suggested the periodicity of the intradiscal pressure signal was similar to the mean respiratory rate of the animal. The average resting intradiscal pressure was also calculated and compared to available data.

Use of a lactic acid plus lactoserum intimate liquid soap for external hygiene in the prevention of bacterial vaginosis recurrence after metronidazole oral treatment.

OBJECTIVE: To determine the recurrence of bacterial vaginosis (BV) after the use of a lactic acid plus lactoserum liquid soap starting immediately after the treatment with oral metronidazole and the quality of life of the participants. METHODS: A total of 123 women with diagnosis of BV with at least three of the following criteria: 1) homogeneous vaginal discharge without inflammation of the vagina or vulva; 2) vaginal pH ≥ 4.5; 3) positive Whiff test; and 4) "clue cells" in more than 20% of the epithelial cells in the vagina. A Nugent score ≥ 4 in the vaginal bacterioscopy was also used. After BV diagnosis, metronidazole 500 mg was administered orally bid during 7 days. Patients cured of BV were then instructed to use 7.5 to 10 mL of a lactic acid plus lactoserum liquid soap once-a-day for hygiene of the external genital region. Three subsequent control visits after starting the hygiene treatment (30, 60, and 90 days; ± 5 days) were scheduled. A questionnaire was applied in the form of visual analogue scale (VAS) in all the visits regarding: 1) level of comfort at the genital region; 2) malodorous external genitalia; 3) comfort in sexual intercourse; 4) satisfaction with intimate hygiene; and 5) self-esteem. RESULTS: Ninety two (74.8%) women initiated the use of a lactic acid plus lactoserum liquid soap at visit 1. At visit 2, 3, and 4 there were 84, 62 and 42 women available for evaluation, respectively. The rate of recurrence of BV was 19.0%, 24.2% and 7.1%, respectively in the three visits and vaginal candidiasis was observed in five treated women. Quality of life was evaluated in the 42 women who completed the four visits schedule and there were significant improvement in the five domains assessed. CONCLUSION: A lactic acid plus lactoserum liquid soap for external intimate hygiene may be an option for the prevention of BV recurrence after treatment and cure with oral metronidazole.

RAPID MANUFACTURING SYSTEM OF ORTHOPEDIC IMPLANTS.

This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane) which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD/CAM system. After sterilization, the implant is able to be placed on the patient. The concept was developed using low cost technology and commercially available. The system has been tested in an in vivo hip arthroplasty performed on a sheep. The time increase of surgery was 80 minutes being 40 minutes the time of implant manufacturing. The system developed has been tested and the goals defined of the study achieved enabling the rapid manufacture of an implant in a time period compatible with the surgery time.

[Prevalence and characterization of vaginal lactobacillus species in women at reproductive age without vulvovaginitis]. / Prevalência e caracterização de espécies de lactobacilos vaginais em mulheres em idade reprodutiva sem vulvovaginites.

PURPOSE: to identify species of lactobacillus isolated from the vaginal contents of healthy and asymptomatic women, determining the most prevalent species and characterizing them phenotypically. METHODS: lactobacillus have been isolated in selective milieu from samples of the vaginal contents of 135 women without complaints of vaginal secretion, and with negative laboratorial diagnosis of vaginal infection, followed up at an outpatient clinic. After being identified by multiplex PCR, the isolates have been submitted to RNAr 16S gene sequencing, when necessary. They have also been evaluated concerning the production of lactic acid, H2O2, bacteriocins and the ability to adhere to epithelial cells. RESULTS: eight-three lactobacillus strains were isolated and identified, L. crispatus (30.1%), L. jensenii (26.5%), L. gasseri (22.9%) e L. vaginalis (8.4%), being the prevalent species. Only 20 of those isolates did not present H2O2 production, in detectable amounts. From the 37 strains selected for the test of adhesion to the epithelial cells, 12 presented 50 to 69% of adhesion, 10 presented 70% or more, and the remaining, little or no adhesion at all. None of the tested strains produced bacteriocins. CONCLUSIONS: the lactobacillus species more prevalent in women without vulvovaginitis, isolated in selective culture milieu and identified by molecular methods were L. crispatus, L. jensenii and L. gasseri. Besides the fact of being more prevalent, these strains also presented better production of H2O2, and reached lower pH values in the culture milieu.

[Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy]. / Tinidazol versus cefazolina na antibioticoprofilaxia de histerectomia vaginal e abdominal.

PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The chi2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-beta) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy. The high ratio of BV at the immediate pre-surgery period among the women submitted to vaginal hysterectomy suggests that this infection must be better investigated and properly treated before the surgery.

Increased detection of clue cells in smears from cervical intraepithelial lesions with reduced expression of COX-2.

The relation between the detection of clue cells in cervical smears of women with CIN and the expression of COX-2 in these lesions were determined. Samples from 228 women, treated due to CIN and who underwent cervical conization, were obtained. Hybrid Capture II and Pap smear samples were collected immediately before performing conization. Pathological diagnoses were 11 (5%) normal cervix, 35 (15%) CIN1, 31 (14%) CIN2, and 151 (66%) CIN3. COX-2 immunoreactivity grading on the pathological specimens was based on the German ImmunoReactive score. In cervical smears, 20 fields (40x) were examined, each of them with a minimum count of 10 epithelial cells. When 20% or more of clue cells were detected the sample was considered positive for clue cells. The prevalence of clue cells was similar across histological strata (P = 0.42). Although the expression of COX-2 did not differ in lesions with varying severities (P = 0.24), there was a negative association between the expression of COX-2 and the presence of clue cells in Pap smear (OR = 0.4; 95% CI = 0.2-0.9): only 12% of women with moderate and strong expression of COX-2 had clue cells in their smears, contrasted to 22% of those with negative and weak expression of COX-2. HPV infection was associated in a borderline manner to the expression of COX-2 (P = 0.04; OR = 2.3 95% CI = 1.0-5.4). The reduced expression of COX-2 in CIN specimens may suggest that clue cells interfere with the inflammatory component of the carcinogenic process that lead to CIN.

Use of a lactic acid plus lactoserum intimate liquid soap for external hygiene in the prevention of bacterial vaginosis recurrence after metronidazole oral treatment / Uso do ácido láctico com lactoserum em sabonete líquido íntimo para higiene externa na prevenção da recorrência de vaginose bacteriana após tratamento oral com metronidazol

OBJECTIVE: To determine the recurrence of bacterial vaginosis (BV) after the use of a lactic acid plus lactoserum liquid soap starting immediately after the treatment with oral metronidazole and the quality of life of the participants. METHODS: A total of 123 women with diagnosis of BV with at least three of the following criteria: 1) homogeneous vaginal discharge without inflammation of the vagina or vulva; 2) vaginal pH ≥ 4.5; 3) positive Whiff test; and 4) "clue cells" in more than 20 percent of the epithelial cells in the vagina. A Nugent score ≥ 4 in the vaginal bacterioscopy was also used. After BV diagnosis, metronidazole 500 mg was administered orally bid during 7 days. Patients cured of BV were then instructed to use 7.5 to 10 mL of a lactic acid plus lactoserum liquid soap once-a-day for hygiene of the external genital region. Three subsequent control visits after starting the hygiene treatment (30, 60, and 90 days; ± 5 days) were scheduled. A questionnaire was applied in the form of visual analogue scale (VAS) in all the visits regarding: 1) level of comfort at the genital region; 2) malodorous external genitalia; 3) comfort in sexual intercourse; 4) satisfaction with intimate hygiene; and 5) self-esteem. RESULTS: Ninety two (74.8 percent) women initiated the use of a lactic acid plus lactoserum liquid soap at visit 1. At visit 2, 3, and 4 there were 84, 62 and 42 women available for evaluation, respectively. The rate of recurrence of BV was 19.0 percent, 24.2 percent and 7.1 percent, respectively in the three visits and vaginal candidiasis was observed in five treated women. Quality of life was evaluated in the 42 women who completed the four visits schedule and there were significant improvement in the five domains assessed. CONCLUSION: A lactic acid plus lactoserum liquid soap for external intimate hygiene may be an option for the prevention of BV recurrence after treatment and cure with oral metronidazole.

OBJETIVO: Determinar a ocorrência de vaginose bacteriana (VB) após o uso de acido láctico com lactoserum em sabonete líquido iniciado imediatamente após o tratamento com metronidazol oral e qualidade de vida das participantes. MÉTODOS: Um total de 123 mulheres com dianóstico de VB com ao menos três dos seguintes critérios: 1) leucorreia vaginal homogênea sem inflamação de vagina ou vulva; 2) pH vaginal ≥ 4,5; 3) teste positivo de Whiff; e 4) "clue cells" em mais de 20 por cento das células epiteliais na vagina. O escore de Nugent ≥ 4 na bacterioscopia vaginal também foi usado. Após o diagnóstico de VB, metronidazol 500 mg oral foi ministrado durante 7 dias. Pacientes curados da VB foram instruídos a usar 7,5 a 10 mL de acido láctico com lactoserum em sabonete líquido uma vez ao dia para higiene da genitália externa. Três visitas de controle foram agendadas (30, 60 e 90 dias; ± 5 dias). Um questionário foi aplicado na forma de escala visual análoga (EVA) em todas as visitas sobre: 1) nível de conforto na região genital; 2) mau odor na genitália; 3) conforto na relação sexual; 4) satisfação com higiene íntima; e 5) autoestima. RESULTADOS: Noventa e duas (74,8 por cento) mulheres iniciaram o uso de ácido láctico com lactoserum líquido na visita 1. Na visita 2, 3 e 4 foram 84, 62 e 42 mulheres para avaliação, respectivamente. A taxa de recorrência da VB foi 19,0 por cento, 24,2 por cento e 7,1 por cento, respectivamente nas três visitas e candidíase vaginal foi observada em cinco mulheres. Qualidade de vida foi avaliada em 42 mulheres que completaram as quatro visitas agendadas e houve uma melhora significativa nos cinco domínios avaliados. CONCLUSÃO: O uso de acido láctico com lactoserum em sabonete líquido para higiene externa intima pode ser uma opção para a prevenção da recorrência de VB após tratamento e cura com metronidazol oral.

Correlation between API 50 CH and multiplex polymerase chain reaction for the identification of vaginal lactobacilli in isolates

Identification of Lactobacillus sp. strains by phenotypic methods may lead to doubtful results possibly interfering in the reliability of the epidemiological and probiotics studies. Therefore this study aimed to determine the best methodology for the identification of the large diversity of lactobacilli species found in the vagina by comparing two techniques, one based on their biochemical profile and other employing molecular biology. A carbohydrate fermentation test (API 50 CH) was compared with multiplex polymerase chain reaction (PCR) for the identification of species of vaginal lactobacilli from 135 healthy women. The kappa index was used to evaluate agreement between the methods. Using the molecular technique, L. crispatus (32.6 percent), L. jensenii (25 percent) and L. gasseri (20.6 percent) were the most frequent species. However, using the biochemical technique, the most frequent species were: L. acidophilus (34.8 percent), L. crispatus (27.2 percent) and L. fermentum (13 percent). Although L. acidophilus was the most frequent specie found by biochemical tests, no strain of this microorganism was detected by PCR. Agreement between the methods was low for identification of all the most common species. Although rates of L. crispatus detected were similar using both methods (32.6 percent and 27.2 percent), agreement between them was relatively low (kappa = 0.52). Conclusions: Our results confirmed the limitation of the biochemical method and the applicability of a previously published molecular method (Multiplex PCR) for the identification of lactobacilli in the vaginal tract, focusing on further necessity of its improvement for also targeting L. vaginalis and L. iners.

Sistema de fabrico rápido de implantes ortopédicos / Rapid manufacturing system of orthopedics implants

Este estudo teve como objectivo o desenvolvimento uma metodologia de fabrico rápido de implantes ortopédicos, em simultaneidade com a intervenção cirúrgica, considerando duas potenciais aplicações na área ortopédica: o fabrico de implantes anatomicamente adaptados e o fabrico de implantes para substituição de perdas ósseas. A inovação do trabalho desenvolvido consiste na obtenção in situ da geometria do implante, através da impressão directa de um material elastomérico (polivinilsiloxano) que permite obter com grande exactidão a geometria pretendida. Após digitalização do modelo obtido em material elastomérico, o implante final é fabricado por maquinagem recorrendo a um sistema de CAD/CAM dedicado. O implante após esterilização, pode ser colocado no paciente. O conceito foi desenvolvido com recurso a tecnologias disponíveis comercialmente e de baixo custo. O mesmo foi testado sob a forma de uma artroplastia da anca realizada in vivo numa ovelha. O acréscimo de tempo de cirurgia foi de 80 minutos sendo 40 directamente resultantes do processo de fabrico do implante. O sistema desenvolvido revelou-se eficiente no alcance dos objectivos propostos, possibilitando o fabrico de um implante durante um período de tempo perfeitamente compatível com o tempo de cirurgia.

This study, aimed the development of a methodology for rapid manufacture of orthopedic implants simultaneously with the surgical intervention, considering two potential applications in the fields of orthopedics: the manufacture of anatomically adapted implants and implants for bone loss replacement. This work innovation consists on the capitation of the in situ geometry of the implant by direct capture of the shape using an elastomeric material (polyvinylsiloxane) which allows fine detail and great accuracy of the geometry. After scanning the elastomeric specimen, the implant is obtained by machining using a CNC milling machine programmed with a dedicated CAD/CAM system. After sterilization, the implant is able to be placed on the patient. The concept was developed using low cost technology and commercially available. The system has been tested in an in vivo hip arthroplasty performed on a sheep. The time increase of surgery was 80 minutes being 40 minutes the time of implant manufacturing. The system developed has been tested and the goals defined of the study achieved enabling the rapid manufacture of an implant in a time period compatible with the surgery time.

Prevalência e caracterização de espécies de lactobacilos vaginais em mulheres em idade reprodutiva sem vulvovaginites / Prevalence and characterization of vaginal lactobacillus species in women at reproductive age without vulvovaginitis

OBJETIVO: identificar espécies de lactobacilos isolados do conteúdo vaginal de mulheres saudáveis e assintomáticas; determinar as espécies mais prevalentes e caracterizá-las fenotipicamente. MÉTODOS: lactobacilos foram isolados em meio seletivo a partir de amostras de conteúdo vaginal de 135 mulheres, sem queixa de corrimento e com diagnóstico laboratorial negativo para infecções vaginais, acompanhadas em um ambulatório de Planejamento Familiar. Os isolados foram identificados por PCR multiplex e, quando necessário, submetidos ao sequenciamento do gene RNAr 16S. Foram também avaliados quanto à acidificação do meio de cultura, à produção de ácido láctico, de H2O2, bacteriocinas e a capacidade de adesão às células epiteliais. RESULTADOS: oitenta e três cepas de lactobacilos foram isoladas e identificadas, sendo as espécies predominantes L. crispatus (30,1%), L. jensenii (26,5%), L. gasseri (22,9%) e L. vaginalis (8,4%). Apenas 20 destes isolados não produziram H2O2 em quantidades detectáveis. Das 37 linhagens selecionadas para teste de adesão a células epiteliais, 12 apresentaram adesão entre 50 a 69%, 10 apresentaram 70% ou mais, e as restantes pouca ou nenhuma adesão. Nenhum dos isolados produziu bacteriocinas. CONCLUSÕES: as espécies de lactobacilos mais prevalentes em mulheres sem vulvovaginites, isoladas em meio de cultura seletivo e identificadas por métodos moleculares, foram L. crispatus, L. jensenii e L. gasseri. Além de mais frequentes, tais linhagens também apresentaram melhor produção de H2O2 e atingiram menores valores de pH em meio de cultura.

PURPOSE: to identify species of lactobacillus isolated from the vaginal contents of healthy and asymptomatic women, determining the most prevalent species and characterizing them phenotypically. METHODS: lactobacillus have been isolated in selective milieu from samples of the vaginal contents of 135 women without complaints of vaginal secretion, and with negative laboratorial diagnosis of vaginal infection, followed up at an outpatient clinic. After being identified by multiplex PCR, the isolates have been submitted to RNAr 16S gene sequencing, when necessary. They have also been evaluated concerning the production of lactic acid, H2O2, bacteriocins and the ability to adhere to epithelial cells. RESULTS: eight-three lactobacillus strains were isolated and identified, L. crispatus (30.1%), L. jensenii (26.5%), L. gasseri (22.9%) e L. vaginalis (8.4%), being the prevalent species. Only 20 of those isolates did not present H2O2 production, in detectable amounts. From the 37 strains selected for the test of adhesion to the epithelial cells, 12 presented 50 to 69% of adhesion, 10 presented 70% or more, and the remaining, little or no adhesion at all. None of the tested strains produced bacteriocins. CONCLUSIONS: the lactobacillus species more prevalent in women without vulvovaginitis, isolated in selective culture milieu and identified by molecular methods were L. crispatus, L. jensenii and L. gasseri. Besides the fact of being more prevalent, these strains also presented better production of H2O2, and reached lower pH values in the culture milieu.

Tinidazol versus cefazolina na antibioticoprofilaxia de histerectomia vaginal e abdominal / Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy

OBJETIVO: comparar a eficácia do tinidazol e da cefazolina na antibioticoprofilaxia da morbidade febril e infecciosa pós-histerectomia vaginal e abdominal. MÉTODOS: estudo clínico randomizado, no qual as mulheres internadas para histerectomia foram aleatorizadas para um dos seguintes grupos de antibioticoprofilaxia: Grupo C (2 g de cefazolina EV na indução anestésica); Grupo T (2 g de tinidazol VO 12 horas antes da cirurgia); ou Grupo C+T (2 g de tinidazol VO 12 horas antes da cirurgia e 2 g de cefazolina EV na indução anestésica). Amostras cervicovaginais foram coletadas para culturas específicas e o diagnóstico de vaginose bacteriana (VB) foi baseado nos critérios de Amsel e Nugent. As pacientes foram reavaliadas sete e 30 dias após a cirurgia para sinais de morbidade febril e/ou infecciosa. Para avaliar as diferenças entre os três grupos, realizaram-se os testes do χ2 ou exato de Fisher com nível de significância de 5%. Calulou-se o poder da amostra (1-β) através do programa SAS. RESULTADOS: morbidade infecciosa sete dias após a histerectomia foi diagnosticada em 6,6% das mulheres, mas não houve diferença significativa na distribuição entre os três grupos estudados (p=0,12). Não diagnosticou-se morbidade febril ou infecciosa no pós-operatório imediato ou após 30 dias da cirurgia. A freqüência de VB no pré-operatório foi significativamente maior entre as mulheres submetidas à histerectomia vaginal do que naquelas submetidas à histerectomia abdominal (27 versus 7%, p=0,02). Também se observou freqüência maior de VB após 30 dias entre as mulheres submetidas à histerectomia vaginal (20 versus 8%), porém sem significância estatística (p=0,19). CONCLUSÕES: o uso do tinizadol, isoladamente ou em associação com cefazolina, não apresentou maior eficácia que o uso de apenas cefazolina na prevenção de morbidade febril ou infecciosa pós-histerectomia...

PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction); Group T (2 g of tinidazole orally, 12 hours before the surgery); or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction). Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV) was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β) was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12). There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02). BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%), though without statistical significance (p=0.19). CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post hysterectomy...

Qualidade de vida em mulheres após tratamento da incontinência urinária de esforço com fisioterapia / Women's life quality after physical therapy treatment for stress urinary incontinence

OBJETVO: comparar a qualidade de vida (QV) antes e após tratamento fisioterápico de mulheres com incontinência urinária de esforço (IUE). MÉTODOS: ensaio clínico não controlado com 26 mulheres com queixa clínica predominantemente de IUE. Foram excluídas mulheres na pós-menopausa, com hiperatividade do detrusor, com cistocele grau II ou maior e tratamento cirúrgico/conservador anterior. O tratamento fisioterápico constituiu-se em 12 sessões individuais de cinesioterapia do assoalho pélvico associadas ao biofeedback eletromiográfico, e as mesmas realizavam 200 contrações divididas entre fásicas (rápidas) e tônicas (lentas). Para avaliar a QV, todas responderam ao King's Health Questionnaire (KHQ), antes e após o tratamento. Os dados foram descritos em freqüências, médias e desvios-padrões, medianas, mínimos e máximos. Os escores do KHQ foram comparados pelo teste de Wilcoxon para amostras pareadas, com nível de significância de 0,05. RESULTADOS: houve uma diminuição dos sintomas urinários, particularmente da freqüência urinária, noctúria, urgência miccional e perdas urinárias aos esforços. Observou-se uma melhora significativa nos escores dos domínios do KHQ: percepção da saúde (49,0±24,0 versus 26,9±15,7; p=0,0015), impacto da incontinência (78,2±28,2 versus 32,1±30,5; p=0,001), limitações das atividades diárias (75,0±28,2 versus 13,5±22,6; p<0,001), limitações físicas (72,4±29,4 versus 15,4±24,5; p<0,001), limitações sociais (38,3±28,6 versus 6,4±14,5; p<0,001), emoções (59,0±33,8 versus 14,1±24,7; p=0,0001), sono/energia (34,0±23,8 versus 6,4±16,4; p=0,001) e as medidas de gravidade (66,9±19,6 versus 22,3±24,2; p<0,001), exceto das relações pessoais (60,5±33,9 versus 41,7±16,7; p=0,0679). CONCLUSÕES: a QV de mulheres com IUE tratadas com fisioterapia pode melhorar em diversos aspectos, quando avaliada com um instrumento...

PURPOSE: to compare women's quality of life (QoL) before and after physical therapy treatment for stress urinary incontinence (SUI). METHODS: an uncontrolled clinical trial of 26 women, who had mainly complaints of SUI. Post-menopausal women with overactive bladder, cystocele >grade II and previous surgical/conservative treatments were excluded from the study. The physiotherapy treatment relied on 12 individual pelvic floor exercises assisted by electromyographyc-biofeedback sessions. A total of 200 contractions were carried out, divided in phasic (quick) and tonic (slow). The tool used to evaluate QoL was the King's Health Questionnaire (KHQ), before and after the treatment. RESULTS: there was a decrease in the urinary symptoms, particularly in urinary frequency, nocturia, urgency and urinary incontinence. Regarding the QoL, there was a significant improvement in the following domain scores: general health perception (49.0±24.0 versus 26.9±15.7; p=0.0015), incontinence impact (78.2±28.2 versus 32.1±30.5; p=0.001), activity limitation (75.0±28.2 versus 13.5±22.6; p<0.001), physical limitation (72.4±29.4 versus 15.4±24.5; p<0.001), social limitations (38.3±28.6 versus 6.4±14.5; p<0.001), emotions (59.0±33.8 versus 14.1±24.7; p=0.0001, sleep/energy (34.0±23.8 versus 6.4±16.4; p=0.001) and severity measures (66.9±19.6 versus 22.3±24.2; p<0.001), except for personal relationships (60.5±33.9 versus 41.7±16.7; p=0.0679). CONCLUSIONS: there was an improvement in several aspects of women's QoL treated by physiotherapy, when evaluated with a specific tool, the KHQ.