Efectos de la mastectomía en los parámetros baropodométricos de pacientes con cáncer de seno / The effect of mastectomy on baropodometric parameters for breast cancer patients / Efeitos da mastectomia nos parâmetros baropodometricos de pacientes com câncer de mama

Objetivo: la mastectomía posterior al cáncer de seno produce diversas alteraciones posturales y biomecánicas en el plano frontal y sagital. Dichos cambios conducen a una cinemática alterada de la columna vertebral, desequilibrio muscular y alteración del soporte del peso del pie. Este estudio pretende describir las alteraciones de la baropodometría después de la mastectomía, con base en análisis baropodométricos de la presión media y la carga estática. Metodología: se realizó un estudio descriptivo correlacional. Las propiedades de carga del pie se identificaron en 17 mujeres mastectomizadas. Se utilizó una placa de presión Ecosanit Foot para medir la carga del pie en posición anatómica y con los pies juntos. Resultados: en el estudio participaron 17 mujeres mastectomizadas con una edad media de 54.16 años. Las pacientes reportaron una presión media significativamente mayor en la posición anatómica del lado dominante mastectomizado en comparación con el lado no dominante mastectomizado (227.2 ± 22.16 vs. 175.6 ± 14.95, p =0.05). No hubo diferencia significativa para la carga estática entre el lado dominante mastectomizado y el lado no dominante mastectomizado en la posición anatómica (52.43±4.069 vs. 49.69 ± 4.094, de forma respectiva). Conclusión: los resultados actuales de nuestro estudio evidenciaron la distribución desequilibrada del peso (vector carga en el pie) en pacientes después de la mastectomía. Por tanto, en este texto se describen las alteraciones posturales, musculares, y el desequilibrio estático y dinámico en pacientes con cáncer de seno.

Objective: mastectomy after breast cancer produces several postural and biomechanical alterations in the frontal and sagittal plane. Such changes lead to disturbed kinematics of the spine, muscle imbalance and altered foot weight bearing. This study aims to describe body balance alterations after mastectomy based on the baropodometric analysis of their mean pressure and static load. Methodology: a descriptive correlational research was carried out. Foot weight-bearing properties were identified in 17 patients who have undergone a mastectomy. An Ecosanit Foot pressure plate was used to measure foot load at anatomical position and keeping the feet together. Results: 17 female patients who had undergo mastectomy with a mean age of 54.16 years took part on the research. Patients who have had a dominant-side mastectomy demonstrated significant greater mean pressure at anatomical position when compared to those patients who have had a non-dominant side mastectomy (227.2 ± 22.16 versus 175.6 ± 14.95, p =0.05). There was no significant difference for static load between the patients who have had a dominant side mastectomy and patients who have had a non dominant side mastectomy at anatomical position (52.43 ± 4.069 versus 49.69 ± 4.094, respectively). Conclusion: the current results of our research showed the unbalanced weight distribution in patients after mastectomy. Consequently, it describes the postural and muscular alterations, and the static and dynamic imbalance in breast cancer patients.

Objetivo: A mastectomia após câncer de mama produz diversas alterações posturais e biomecânicas nos planos frontal e sagital. Tais mudanças levam a alteração da cinemática da coluna, desequilíbrio muscular e alteração do suporte de peso do pé. Este estudo tem como objetivo descrever as alterações baropodométricas após mastectomia, com base em análises baropodométricas de pressão média e carga estática. Metodologia: foi realizado estudo correlacional descritivo. Propriedades de carga nos pés foram identificadas em 17 mulheres mastectomizadas. Uma placa de pressão Ecosanit Foot foi usada para medir a carga do pé em posição anatômica e com os pés juntos. Resultados: participaram do estudo 17 mulheres mastectomizadas com idade média de 54,16 anos. Os pacientes relataram uma pressão média significativamente maior na posição anatômica do lado mastectomizado dominante em comparação ao lado mastectomizado não dominante (227,2 ± 22,16 vs. 175,6 ± 14,95, p =0,05). Não houve diferença significativa para a carga estática entre o lado mastectomizado dominante e o lado mastectomizado não dominante na posição anatômica (52,43 ± 4,069 vs. 49,69 ± 4,094, respectivamente). Conclusão: Os resultados atuais do nosso estudo mostraram distribuição de peso desequilibrada (carga vetorial no pé) em pacientes após mastectomia. Portanto, este texto descreve alterações posturais, musculares e desequilíbrio estático e dinâmico em pacientes com câncer de mama.

Stress distribution in peri-implant bone, implants, and prostheses: 3D-FEA of marginal bone loss and prosthetic design / Distribuição de estresse no osso peri-implantar, implantes e próteses: análise 3D-FEA de perda óssea marginal e design protético

Objective: In response to the demand for dental implants, extensive research has been conducted on methods for transferring load to the surrounding bone. This study aimed to evaluate the stresses on the peripheral bone, implants, and prostheses under scenarios involving of the following variables: prosthesis designs, vertical bone heights, load angles, and restorative materials. Material and Methods: Three implants were inserted in the premolar and molar regions (5-6-7) of the two mandibular models. Model 1 represented 0 mm marginal bone loss and Model 2 simulated 3 mm bone loss. CAD/CAM-supported materials, hybrid ceramic (HC), resin-nano ceramic (RNC), lithium disilicate (LiSi), zirconia (Zr), and two prosthesis designs (splinted and non-splinted) were used for the implant-supported crowns. Forces were applied vertically (90°) to the central fossa and buccal cusps and obliquely (30°) to the buccal cusps only. The stresses were evaluated using a three-dimensional Finite Element Analysis. Results: Oblique loading resulted in the highest stress values. Of the four materials, RNC showed the low stress in the restoration, particularly in the marginal area. The use of different restorative materials did not affect stress distribution in the surrounding bone. The splinted prostheses generated lower stress magnitude on the bone, and while more stress on the implants were observed. Conclusion: In terms of the stress distribution on the peri-implant bone and implants, the use of different restorative materials is not important. Oblique loading resulted in higher stress values, and the splinted prosthesis design resulted in lower stress (AU)

Objetivo: Em resposta à demanda por implantes dentários, extensa pesquisa foi realizada sobre métodos para transferir carga ao osso circundante. Este estudo buscou avaliar os estresses no osso periférico, implantes e próteses em cenários que envolvem as seguintes variáveis: designs de próteses, alturas ósseas verticais, ângulos de carga e materiais restauradores. Material e Métodos: Três implantes foram inseridos nas regiões dos pré-molares e molares (5-6-7) de dois modelos de mandíbula. O Modelo 1 representou perda óssea marginal de 0 mm e o Modelo 2 simulou perda óssea de 3 mm. Materiais suportados por CAD/CAM, cerâmica híbrida (HC), cerâmica nano-resina (RNC), dissilicato de lítio (LiSi), zircônia (Zr) e dois designs de próteses (sintetizadas e não-sintetizadas) foram utilizados para as coroas suportadas por implantes. Forças foram aplicadas verticalmente (90°) à fossa central e cúspides bucais e obliquamente (30°) apenas às cúspides bucais. Os estresses foram avaliados usando Análise de Elementos Finitos tridimensional. Resultados: Cargas oblíquas resultaram nos valores mais altos de estresse. Entre os quatro materiais, RNC mostrou baixo estresse na restauração, especialmente na área marginal. O uso de diferentes materiais restauradores não afetou a distribuição de estresse no osso circundante. Próteses sintetizadas geraram menor magnitude de estresse no osso, enquanto mais estresse nos implantes foi observado. Conclusão: Em termos de distribuição de estresse no osso peri-implantar e implantes, o uso de diferentes materiais restauradores não é crucial. Cargas oblíquas resultaram em valores mais altos de estresse, e o design de prótese sintetizada resultou em menor estresse. (AU)

Importance and use of corneal biomechanics and its diagnostic utility.

The study of corneal biomechanics has become relevant in recent years due to its possible applications in the diagnosis, management, and treatment of various diseases such as glaucoma, keratorefractive surgery and different corneal diseases. The clinical biomechanical investigation has become of great importance in the setting of refractive surgery to identify patients at higher risk of developing iatrogenic ectasia. This review focuses on two of the technologies available for clinical use, the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, USA) and the Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Germany). Both are non-contact tonometers that provided a clinical evaluation of corneal biomechanics. The fundamentals and main parameters of each device are described, as well as their use in eye surgery and the corneal biomechanical behavior in eye diseases. Finally, we will discuss the more recent Brillouin microscopy biomechanical analysis, and the integration Scheimpflug-based corneal tomography and biomechanical data with artificial intelligence to increase accuracy to detect risk of ectasia.

El estudio de la biomecánica corneal ha cobrado relevancia en los últimos años debido a sus posibles aplicaciones en el diagnóstico, el manejo y el tratamiento de diversas enfermedades, como glaucoma, cirugía queratorrefractiva y diferentes enfermedades corneales. La investigación de la biomecánica corneal es de mucha importancia en el contexto de cirugía refractiva, pues podría identificar pacientes en riesgo de desarrollar una ectasia corneal iatrogénica. Esta revisión se centra en dos de las tecnologías disponibles para uso clínico: el Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, EE. UU.) y el Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Alemania). Ambos son tonómetros de no contacto que proporcionan una evaluación clínica de la biomecánica corneal. Se describen los fundamentos y los principales parámetros de cada dispositivo, así como su uso en cirugía ocular y el comportamiento biomecánico corneal en las enfermedades oculares. Finalmente, se mencionan los dispositivos más recientes de análisis biomecánico, como la microscopía de Brillouin, así como la integración de los datos biomecánicos y topográficos basados en Scheimpflug con la inteligencia artificial para aumentar la precisión en la detección del riesgo de ectasias.

La biomecánica aplicada a la técnica de pitcheo en lanzadores de béisbol

El deporte como fenómeno social, se desarrolla en la actualidad simultáneamente con los adelantos de la ciencia y la tecnología; en este contexto, juega un papel importante la biomecánica que asegura las bases para un verdadero entrenamiento técnico, de ahí que el trabajo está dirigido al uso de la biomecánica en la técnica de pitcheo. Para dar respuesta a esta temática se concibe como objetivo aplicar estudios biomecánicos a la técnica de pitcheo en los lanzadores del equipo de béisbol La Isla de la Juventud. Se utilizaron como métodos el análisis de documentos, la revisión bibliográfica, la observación científica, la entrevista y la técnica del análisis de video con ayuda de un Dron; ello permitió medir magnitudes y valorar el comportamiento de las características que poseen los movimientos ejecutados por los lanzadores objeto de estudio. También, se emplearon dos técnicas de mediciones, una a través de la filmación y otra por procesamiento cinemático con el uso de los softwares como Tracker y Kinovea. La muestra estuvo conformada por ocho sujetos, distribuidos en tres atletas, dos entrenadores y tres investigadores; esto permitió determinar las características de la distancia de paso, ángulo que forma el brazo de lanzar con respecto a la cabeza, altura de la pelota y la velocidad de la pelota ejecutados por los lanzadores investigados.

O esporte, como fenômeno social, está se desenvolvendo simultaneamente com os avanços da ciência e da tecnologia; nesse contexto, a biomecânica desempenha um papel importante para garantir a base de um verdadeiro treinamento técnico, portanto, o trabalho visa ao uso da biomecânica na técnica de arremesso. Para responder a essa questão, o objetivo foi aplicar estudos biomecânicos à técnica de arremesso nos arremessadores do time de beisebol La Isla de la Juventud. Os métodos utilizados foram a análise de documentos, a revisão bibliográfica, a observação científica, a entrevista e a técnica de análise de vídeo com a ajuda de um drone, o que permitiu medir as magnitudes e avaliar o comportamento das características dos movimentos executados pelos arremessadores em estudo. Além disso, foram utilizadas duas técnicas de medição, uma por meio de filmagem e outra por meio de processamento cinemático com o uso de softwares como o Tracker e o Kinovea. A amostra foi composta por oito sujeitos, distribuídos em três atletas, dois técnicos e três pesquisadores, o que nos permitiu determinar as características da distância de arremesso, do ângulo do braço de arremesso em relação à cabeça, da altura da bola e da velocidade da bola executada pelos arremessadores investigados.

Sport as a social phenomenon, currently develops simultaneously with the advances of science and technology; in this context, biomechanics plays an important role that ensures the bases for true technical training; hence the work is directed to the use of biomechanics in throwing technique. To respond to this issue, the objective is to apply biomechanical studies to the throwing technique in the throwers of the La Isla de la Juventud baseball team. Document analysis, bibliographic review, scientific observation, interview and the technique of video analysis with the help of a drone were used as methods; this made it possible to measure magnitudes and assess the behavior of the characteristics of the movements executed by the throwers under study. Also, two measurement techniques were used, one through filming and the other by kinematic processing with the use of software such as Tracker and Kinovea. The sample consisted of eight subjects, divided into three athletes, two coaches and three researchers; this allowed to determine the characteristics of the throw distance, the angle formed by the throwing arm with respect to the head, the height of the ball, and the speed of the ball executed by the investigated throwers.

Effect of fried sunflower oil intake on mandibular biomechanical competence of growing rats / Efecto del consumo de aceite de girasol termooxidado sobre la competencia biomecánica de la mandíbula, en animales en crecimiento

ABSTRACT Previous studies by us demonstrated that the consumption of thermally oxidized oil diet adversely affects body growth, lipid metabolism, bone mass and femur biomechanical competence. Aim: The aim of this study was to evaluate the effects of a diet containing fried sunflower oil on the mandible of growing rats. Materials and Method: Male Wistar rats (21±1 day old) (n=21) were assigned at weaning to one of three diets for 8 weeks: a control diet (C), a diet containing sunflower oil (SFO) or a diet containing sunflower oil that had been repeatedly heated (SFOx); both SFO and SFOx were mixed with commercial rat chow at 13% (w/w). The consistency and viscosity of the 3 diets were similar. Zoometrics and food intake were recorded weekly. At wk=8, mandibular growth was assessed by measurements of anatomical points of cleaned bones, and mandible biomechanical competence was assessed to estimate the structural properties of the bone. Statistical analysis was performed by SPSS v. 20.0. Results: Rats fed SFOx diet attained the lowest final body weight (P=0.0074), mandibular weight (P=0.0001) and mandibular /length (P=0.0002). Load bearing capacity (Wf;N), load of yielding (Wy;N) and stiffness (Wy/dy;N/mm) of the mandible were negatively affected by both sunflower oil diets (fresh and fried) (P=0.001; P=0.002; P=0.003, respectively) though SFOx induced the most significant reduction in Wy/dy (C:44.4(5.4) > SFO:36.1(2.1) > SFOx: 26.3(3.7) N/ mm; P=0.003). The deleterious effect of SFOx on mandibular growth was more accentuated on the posterior part of the bone (C:11.4(0.3)=SFO:11.2(0.2)>SFOx: 10.7(0.2) mm; p=0.0005); the anterior/ posterior ratio (C:1.25(0.02)=SFO:1.27(0.02)<SFOx:1.32(0.03); p=0.0001) indicated that SFOx induced mandibular deformation. Conclusion: Consumption of SFOx diet during growth could affect mandibular morphometric properties and biomechanical competence, in terms of bone stiffness.

RESUMEN En estudios previos hemos demostrado los efectos adversos del consumo de una dieta rica en aceite termooxidado sobre el crecimiento corporal, el metabolismo de los lípidos, la masa ósea y la competencia biomecánica del fémur. Objetivo: El objetivo de este trabajo fue investigar el efecto de una dieta rica en aceite de girasol termooxidado (AGX) sobre los parámetros morfométricos y biomecánicos de la mandíbula de rata en crecimiento. Materiales y Método: Ratas macho Wistar de 22±1 días de edad (n=21) recibieron durante 8 semanas una de 3 dietas: control (C); dieta comercial, una dieta suplementada con aceite de girasol (AG) y una dieta suplementada con AGX. La consistencia y la viscosidad de las dietas fueron similares. Los parámetros zoométricos y el consumo de dieta se registraron semanalmente. A T=8, los animales se eutanasiaron y se obtuvieron las hemimandíbulas. El crecimiento mandibular se estimó por medidas morfométricas entre puntos anatómicos y las propiedades estructurales por biomecánica. El análisis estadístico se realizó por SPSS v. 20.0. Resultados: Las ratas alimentadas con AGX presentaron menor peso corporal final (p=0.0074), peso mandibular (p=0.0001) y longitud mandibular (p=0.0002). Las propiedades estructurales de la mandíbula, Wf (p=0.001), Wy (p=0.002) y Wy/dy (p=0.003), se vieron afectadas negativamente en ratas alimentadas con AG o AGX, respecto a C; pero la rigidez ósea (Wy/dy) en AGX fue significativamente menor (C:44.4(5.4) > SFO:36.1(2.1) > SFOx: 26.3(3.7) N/mm; p=0.003). El efecto deletéreo del AGX sobre el crecimiento mandibular fue más acentuado en la región posterior (C:11.4(0.3)=SFO:11.2(0.2)>SFOx: 10.7(0.2) mm; p=0.0005). La relación anterior/posterior (C=1.25 (0.02); AG= 1.27(0.02) y AGX=1.32(0.03), p=0.001) indica que AGX indujo deformación mandibular. Conclusiones: El efecto adverso del consumo de una dieta rica en AGX durante el crecimiento podría afectar los parámetros morfométricos y la biomecánica ósea en términos de rigidez ósea.

Optimal posterior screw placement configuration in Sanders 2B calcaneal fractures: A biomechanical study / Configuración y localización óptima de los tornillos posteriores en las fracturas de calcáneo Sanders 2B: estudio biomecánico

Background: Calcaneal fractures can be high energy intra-articular injuries associated with joint depression. Challenges to fracture reduction include lateral wall blow out, medial wall overlap, comminution and central bone loss. Secondary deformity such as hindfoot varus alters foot biomechanics. Minimally invasive approaches with indirect reduction of the calcaneal tuberosity to maintain the reduction using posterior screws is routinely being used in the treatment of joint depression fractures. Biomechanically, optimum screw numbers and configuration is not known. Biomechanical studies have evaluated and proposed different screw configurations, however, it is not clear which configuration best controls varus deformity. This study aims to determine the optimum screw configuration to control varus deformity in Sanders 2B calcaneal fractures. Methods: Sawbone models were prepared to replicate Sanders type 2-B fracture, with central bone loss and comminution. 0.5cm medial wedge of the calcaneal tuberosity was removed to create varus instability. After stabilising posterior facet with a single 4mm partial threaded screw, and applied an 8 hole contoured plate to stabilise the angle of Gissane, inserted one or two 7mm cannulated partially threaded Charlotte™ (Wright Medical Technology, Inc. 5677 Airline Road Arlington, TN) Headless Multi-use Compression (under image guidance) extra screws to control varus and subsidence deformity of the fracture. Coronal plane displacement of the dissociated calcaneal tuberosity fragment relative to the body when applying 5N, 10N and 20N force was measured in millimetres (mm). Results: 2 screws inserted (one medial screw into the sustentaculum talus from inferior to superior and, one lateral screw into the long axis anterior process) provides the least displacement (0.88±0.390 at 5N and 1.7±1.251 at 20N) and the most stable construct (p<0.05) when compared to other configurations...(AU)

Introducción: Las fracturas de calcáneo suelen ser lesiones intraarticulares de alta energía asociadas con hundimiento articular. Además, se añade con frecuencia el estallido de la pared lateral, la superposición de la pared medial, la conminución y la pérdida de hueso bajo la carilla articular. La deformidad secundaria, como el varo del retropié, altera la biomecánica del pie. Nuestra comunidad utiliza cada vez más abordajes mínimamente invasivos con reducción indirecta de la tuberosidad del calcáneo para mantener la reducción mediante tornillos posteriores. Hay estudios que proponen diferentes configuraciones de tornillos, tras experimentación biomecánica, pero aún no es bien conocido qué configuración controla mejor la deformidad en varo. Este estudio tiene como objetivo determinar la configuración óptima del tornillo para controlar la deformidad en varo en las fracturas de calcáneo Sanders 2B. Método: Se prepararon modelos en Sawbone para replicar la fractura de Sanders tipo 2B, con pérdida de hueso central y con conminución. Se eliminó una cuña medial de 0,5cm de la tuberosidad calcánea para crear inestabilidad en varo. Tras estabilizar el ángulo de Gissane con un tornillo aislado parcialmente roscado de 4mm y una placa moldeada, se utilizaron tornillos de compresión multiuso Charlotte (Wright Medical Technology, Inc. 5677 Airline Road Arlington, TN) sin cabeza, canulados y parcialmente roscados de 7mm insertados sobre una AK bajo escopia. El desplazamiento del plano sagital del fragmento de tuberosidad fracturado en comparación con el cuerpo al aplicar una fuerza de 5N, 10N y 20N se midió en milímetros (mm). Resultados: Dos tornillos insertados (un tornillo medial en el sustenaculum tali de inferior a superior y un tornillo lateral en el eje largo del astrágalo) proporciona el menor desplazamiento (0,88±0,390 a 5N y 1,7±1,251 a 20N) y resulta la construcción más estable (p<0,05) en comparación con otras configuraciones...(AU)

[Artículo traducido] Configuración y localización óptima de los tornillos posteriores en las fracturas de calcáneo Sanders 2B: estudio biomecánico / Optimal posterior screw placement configuration in Sanders 2B calcaneal fractures: A biomechanical study

Background: Calcaneal fractures can be high energy intra-articular injuries associated with joint depression. Challenges to fracture reduction include lateral wall blow out, medial wall overlap, comminution and central bone loss. Secondary deformity such as hindfoot varus alters foot biomechanics. Minimally invasive approaches with indirect reduction of the calcaneal tuberosity to maintain the reduction using posterior screws is routinely being used in the treatment of joint depression fractures. Biomechanically, optimum screw numbers and configuration is not known. Biomechanical studies have evaluated and proposed different screw configurations, however, it is not clear which configuration best controls varus deformity. This study aims to determine the optimum screw configuration to control varus deformity in Sanders 2B calcaneal fractures. Methods: Sawbone models were prepared to replicate Sanders type 2-B fracture, with central bone loss and comminution. 0.5cm medial wedge of the calcaneal tuberosity was removed to create varus instability. After stabilising posterior facet with a single 4mm partial threaded screw, and applied an 8 hole contoured plate to stabilise the angle of Gissane, inserted one or two 7mm cannulated partially threaded Charlotte™ (Wright Medical Technology, Inc. 5677 Airline Road Arlington, TN) Headless Multi-use Compression (under image guidance) extra screws to control varus and subsidence deformity of the fracture. Coronal plane displacement of the dissociated calcaneal tuberosity fragment relative to the body when applying 5N, 10N and 20N force was measured in millimetres (mm). Results: 2 screws inserted (one medial screw into the sustentaculum talus from inferior to superior and, one lateral screw into the long axis anterior process) provides the least displacement (0.88±0.390 at 5N and 1.7±1.251 at 20N) and the most stable construct (p<0.05) when compared to other configurations...(AU)

Introducción: Las fracturas de calcáneo suelen ser lesiones intraarticulares de alta energía asociadas con hundimiento articular. Además, se añade con frecuencia el estallido de la pared lateral, la superposición de la pared medial, la conminución y la pérdida de hueso bajo la carilla articular. La deformidad secundaria, como el varo del retropié, altera la biomecánica del pie. Nuestra comunidad utiliza cada vez más abordajes mínimamente invasivos con reducción indirecta de la tuberosidad del calcáneo para mantener la reducción mediante tornillos posteriores. Hay estudios que proponen diferentes configuraciones de tornillos, tras experimentación biomecánica, pero aún no es bien conocido qué configuración controla mejor la deformidad en varo. Este estudio tiene como objetivo determinar la configuración óptima del tornillo para controlar la deformidad en varo en las fracturas de calcáneo Sanders 2B. Método: Se prepararon modelos en Sawbone para replicar la fractura de Sanders tipo 2B, con pérdida de hueso central y con conminución. Se eliminó una cuña medial de 0,5cm de la tuberosidad calcánea para crear inestabilidad en varo. Tras estabilizar el ángulo de Gissane con un tornillo aislado parcialmente roscado de 4mm y una placa moldeada, se utilizaron tornillos de compresión multiuso Charlotte (Wright Medical Technology, Inc. 5677 Airline Road Arlington, TN) sin cabeza, canulados y parcialmente roscados de 7mm insertados sobre una AK bajo escopia. El desplazamiento del plano sagital del fragmento de tuberosidad fracturado en comparación con el cuerpo al aplicar una fuerza de 5N, 10N y 20N se midió en milímetros (mm). Resultados: Dos tornillos insertados (un tornillo medial en el sustenaculum tali de inferior a superior y un tornillo lateral en el eje largo del astrágalo) proporciona el menor desplazamiento (0,88±0,390 a 5N y 1,7±1,251 a 20N) y resulta la construcción más estable (p<0,05) en comparación con otras configuraciones...(AU)

[Translated article] Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures.

INTRODUCTION AND OBJECTIVES: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Does fatigue affect the kinematics of endurance running? / ¿Afecta la fatiga a la cinemática de la carrera de resistencia?

The purpose of this study was to determine the foot strike pattern (FSP), inversion (INV) and spatial-temporal variables in a large sample of recreational runners during a long-distance competition, according to sex and changes in the classification race. A total of 368 men and 67 women, who participated in the XVII International Half Marathon of Cordoba (Spain) were analysed. It was recorded at km 5 and km 15, where high-speed camcorder and 2D-photogrammetric techniques were used to measure FSP, INV, contact time (CT) and flight time (FT). The group that worsened their classification at km 15 increase RFS prevalence and INV asymmetry. A Pearson analysis indicates that variation of the classification in the race between the marks km 5 and km 15 is related with CT (r=0.429, p<0.001) and FT (r=-0.360, p<0.001). RFS prevalence and spatial-temporal parameters showed different patterns depending on whether the runners improved or worsened their ranking. (AU)

El objetivo de este estudio fue determinar el patrón de pisada, inversión y variables espaciotemporales para una amplia muestra de corredores amateurs, durante una carrera de larga distancia, según sexo y posición de clasificación. Se analizaron 368 hombres y 67 mujeres, que participaron en la XVII Media Maratón Internacional de Córdoba (España). Se registró el km 5 y km 15, utilizando técnicas de fotogrametría 2D de alta velocidad para medir la pisada, la inversión, el tiempo de contacto (TC) y el tiempo de vuelo (TV). El grupo que empeoró su clasificación en el km 15 aumentó la prevalencia de FSP y la asimetría del INV. Un análisis de Pearson indica que la variación de la clasificación en la carrera está relacionada con TC (r=0,429, p<0,001) y TV (r=-0,360, p<0,001). La prevalencia de retropié y los parámetros espaciotemporales mostraron diferentes patrones dependiendo de si los corredores mejoraron o empeoraron su clasificación. (AU)

Comparative clinical and biomechanical study of different types of osteosynthesis in the treatment of distal femur fractures. / Estudio comparativo clínico y biomecánico de distintos tipos de osteosíntesis en el tratamiento de fracturas distales de fémur.

INTRODUCTION AND OBJECTIVES: Distal femoral fractures represent a problem due to their high number of complications. The aim was to compare the results, complications and stability achieved with retrograde intramedullary nailing and the angular stable plate in the treatment of distal femoral diaphyseal fractures. MATERIAL AND METHOD: A clinical and experimental biomechanical study was carried out using finite elements. The results of the simulations allowed us to obtain the main results related to the stability of osteosynthesis. For clinical follow-up data, frequencies were used for qualitative variables, and Fisher's exact test and χ2 test were used to evaluate the significance of the different factors, with the condition of P<.05. RESULTS: In the biomechanical study, the retrograde intramedullar nails demonstrated superiority, obtaining lower values in terms of global displacement, maximum tension, torsion resistance, and bending resistance. In the clinical study, the rate of consolidation of the plates was lower than nails (77% vs. 96%, P=.02). The factor that most influenced the healing of fractures treated with plate were the central cortical thickness (P=.019). The factor that most influenced the healing of nail-treated fractures was the difference between the diameter of the medullary canal and the nail. CONCLUSIONS: Our biomechanical study shows that both osteosynthesis provide sufficient stability, but biomechanically behaves differently. Nails provide greater overall stability being preferable the use of long nails adjusted to the diameter of the canal. Plates form less rigid osteosynthesis, with little resistance to bending.

Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico / Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study

Antecedentes y objetivo: Las fracturas de falange proximal (FP) son las fracturas más frecuentes de la mano. En los últimos años, se ha descrito el uso de tornillos endomedulares sin cabeza (TESC) para las fracturas inestables transversas u oblicuas de la FP. A pesar de que tanto la técnica anterógrada como retrógrada con TESC han mostrado buenos resultados, no se ha publicado ningún estudio comparativo de su uso en fracturas de FP. Nuestro objetivo es determinar la estabilidad que se obtiene con el uso de TESC retrógrados y anterógrados en un modelo en cadáver de fractura transversa proximal de FP, a dos niveles diferentes. Material y métodos: Realizamos un estudio biomecánico en 30 modelos de fractura de FP de cadáver fresco-congelado. La osteotomía se realizó a los 9 mm desde la articulación metacarpofalángica (MCF) en 15 especímenes, y a una distancia de 15 mm en los otros 15. A su vez, en cada grupo, cinco osteotomías se estabilizaron con un TESC anterógrado intraarticular, cinco mediante un TESC anterógrado transarticular y cinco con un TESC retrógrado. Resultados: La fijación con TESC anterógrado en osteotomías realizadas a los 9 mm (tanto con la técnica transarticular como intraarticular, 62,74 N y 70,86 N, respectivamente) fue más estable que la fijación con TESC retrógrado (32,72 N) (p 0,022). Por otra parte, la fijación con TESC retrógrado fue más estable en el modelo de fractura más distal (90,52 N retrógrado vs. 57,64 N transarticular vs. 42,92 N intraarticular (p = 0,20). Conclusiones: La fijación con TESC retrógrado ofrece más estabilidad en fracturas más distales, mientras que las técnicas anterógradas son más estables en fracturas proximales.(AU)

Background and objective: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. Material and methods: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. Results: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). Conclusions: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.(AU)

[Translated article] Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study / Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico

Background and objective: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. Material and methods: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. Results: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). Conclusions: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.(AU)

Antecedentes y objetivo: Las fracturas de falange proximal (FP) son las fracturas más frecuentes de la mano. En los últimos años, se ha descrito el uso de tornillos endomedulares sin cabeza (TESC) para las fracturas inestables transversas u oblicuas de la FP. A pesar de que tanto la técnica anterógrada como retrógrada con TESC han mostrado buenos resultados, no se ha publicado ningún estudio comparativo de su uso en fracturas de FP. Nuestro objetivo es determinar la estabilidad que se obtiene con el uso de TESC retrógrados y anterógrados en un modelo en cadáver de fractura transversa proximal de FP, a dos niveles diferentes. Material y métodos: Realizamos un estudio biomecánico en 30 modelos de fractura de FP de cadáver fresco-congelado. La osteotomía se realizó a los 9 mm desde la articulación metacarpofalángica (MCF) en 15 especímenes, y a una distancia de 15 mm en los otros 15. A su vez, en cada grupo, cinco osteotomías se estabilizaron con un TESC anterógrado intraarticular, cinco mediante un TESC anterógrado transarticular y cinco con un TESC retrógrado. Resultados: La fijación con TESC anterógrado en osteotomías realizadas a los 9 mm (tanto con la técnica transarticular como intraarticular, 62,74 N y 70,86 N, respectivamente) fue más estable que la fijación con TESC retrógrado (32,72 N) (p 0,022). Por otra parte, la fijación con TESC retrógrado fue más estable en el modelo de fractura más distal (90,52 N retrógrado vs. 57,64 N transarticular vs. 42,92 N intraarticular (p = 0,20). Conclusiones: La fijación con TESC retrógrado ofrece más estabilidad en fracturas más distales, mientras que las técnicas anterógradas son más estables en fracturas proximales.(AU)

Optimal posterior screw placement configuration in Sanders 2B calcaneal fractures: A biomechanical study.

BACKGROUND: Calcaneal fractures can be high energy intra-articular injuries associated with joint depression. Challenges to fracture reduction include lateral wall blow out, medial wall overlap, comminution and central bone loss. Secondary deformity such as hindfoot varus alters foot biomechanics. Minimally invasive approaches with indirect reduction of the calcaneal tuberosity to maintain the reduction using posterior screws is routinely being used in the treatment of joint depression fractures. Biomechanically, optimum screw numbers and configuration is not known. Biomechanical studies have evaluated and proposed different screw configurations, however, it is not clear which configuration best controls varus deformity. This study aims to determine the optimum screw configuration to control varus deformity in Sanders 2B calcaneal fractures. METHODS: Sawbone models were prepared to replicate Sanders type 2-B fracture, with central bone loss and comminution. 0.5cm medial wedge of the calcaneal tuberosity was removed to create varus instability. After stabilising posterior facet with a single 4mm partial threaded screw, and applied an 8 hole contoured plate to stabilise the angle of Gissane, inserted one or two 7mm cannulated partially threaded Charlotte™ (Wright Medical Technology, Inc. 5677 Airline Road Arlington, TN) Headless Multi-use Compression (under image guidance) extra screws to control varus and subsidence deformity of the fracture. Coronal plane displacement of the dissociated calcaneal tuberosity fragment relative to the body when applying 5N, 10N and 20N force was measured in millimetres (mm). RESULTS: 2 screws inserted (one medial screw into the sustentaculum talus from inferior to superior and, one lateral screw into the long axis anterior process) provides the least displacement (0.88±0.390 at 5N and 1.7±1.251 at 20N) and the most stable construct (p<0.05) when compared to other configurations. A single medial screw into the sustentaculum tali (conf. 3) resulted in the least stable construct and most displacement (4.04±0.971 at 5N and 11.24±7.590 at 20N) (p<0.05). CONCLUSION: This study demonstrates the optimal screw configuration to resist varus in calcaneal fractures using minimally invasive techniques. Optimal stability is achieved using 2 screws; one located along the long axis of the calcaneus (varus control) and the other placed in the short axis directed towards the posterior facet of the calcaneus (control varus and subsidence). Further cadaver research would help evaluate optimal screw placement in simulated fractures to further assess reproducibility.

Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study. / Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico.

BACKGROUND AND OBJECTIVE: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. MATERIAL AND METHODS: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. RESULTS: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). CONCLUSIONS: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

[Translated article] Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study.

BACKGROUND AND OBJECTIVE: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. MATERIAL AND METHODS: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15mm in the other 15. In turn, in each group, five fractures were stabilised with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. RESULTS: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74N and 70.86N, respectively) was found to be more stable than retrograde IMHCS one (32.72N) (p=0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52N retrograde vs. 57.64N trans-articular vs. 42.92N intra-articular; p=0.20). CONCLUSIONS: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

Optimal posterior screw placement configuration in Sanders 2B calcaneal fractures: A biomechanical study. / [Artículo traducido] Configuración y localización óptima de los tornillos posteriores en las fracturas de calcáneo Sanders 2B: estudio biomecánico.

BACKGROUND: Calcaneal fractures can be high energy intra-articular injuries associated with joint depression. Challenges to fracture reduction include lateral wall blow out, medial wall overlap, comminution and central bone loss. Secondary deformity such as hindfoot varus alters foot biomechanics. Minimally invasive approaches with indirect reduction of the calcaneal tuberosity to maintain the reduction using posterior screws is routinely being used in the treatment of joint depression fractures. Biomechanically, optimum screw numbers and configuration is not known. Biomechanical studies have evaluated and proposed different screw configurations, however, it is not clear which configuration best controls varus deformity. This study aims to determine the optimum screw configuration to control varus deformity in Sanders 2B calcaneal fractures. METHODS: Sawbone models were prepared to replicate Sanders type 2-B fracture, with central bone loss and comminution. 0.5 cm medial wedge of the calcaneal tuberosity was removed to create varus instability. After stabilising posterior facet with a single 4 mm partial threaded screw, and applied an 8 hole contoured plate to stabilise the angle of Gissane, inserted one or two 7 mm cannulated partially threaded CharlotteTM (Wright Medical Technology, Memphis, USA) Headless Multi-use Compression (under image guidance) extra screws to control varus and subsidence deformity of the fracture. Coronal plane displacement of the dissociated calcaneal tuberosity fragment relative to the body when applying 5 N, 10 N and 20 N force was measured in millimetres (mm). RESULTS: 2 screws inserted (one medial screw into the sustentaculum talus from inferior to superior and, one lateral screw into the long axis anterior process) provides the least displacement (0.88 ± 0.390 at 5 N and 1.7 ± 1.251 at 20 N) and the most stable construct (p < 0.05) when compared to other configurations. A single medial screw into the sustentaculum tali (conf. 3) resulted in the least stable construct and most displacement (4.04 ± 0.971 at 5 N and 11.24 ± 7.590 at 20 N) (p < 0.05). CONCLUSION: This study demonstrates the optimal screw configuration to resist varus in calcaneal fractures using minimally invasive techniques. Optimal stability is achieved using 2 screws; one located along the long axis of the calcaneus (varus control) and the other placed in the short axis directed towards the posterior facet of the calcaneus (control varus and subsidence). Further cadaver research would help evaluate optimal screw placement in simulated fractures to further assess reproducibility.

El primer rocker: influencia del patrón de contacto inicial sobre la biomecánica, lesiones y rendimiento en la carrera de larga distancia / The first rocker: influence of the initial contact pattern on biomechanics, injuries, and performance in long-distance running

Este artículo examina la relación entre los patrones de pisada de corredores de larga distancia (Rearfoot Strike [RFS] y Non Rearfoot Strike [NRFS]) y varios aspectos como lesiones, rendimiento y biomecánica. A pesar de que correr se ha establecido como una actividad popular con beneficios cardiovasculares, respiratorios y psicológicos, conlleva un riesgo significativo de lesiones. Se encontró que la mayoría de los corredores adoptan un patrón RFS, que tiende a aumentar con la distancia recorrida, la fatiga y el uso de calzado amortiguado. Aunque algunos estudios sugieren una relación entre ciertos patrones de pisada y lesiones específicas, no hay suficiente evidencia para recomendar cambios en el patrón de pisada para la prevención de lesiones. Los corredores de élite tienden a usar un patrón NRFS más que los amateurs, pero la relación entre el patrón de pisada, el rendimiento y las variables biomecánicas es compleja y varía según el individuo. Se concluye que los profesionales de la salud y entrenadores deben considerar estas variaciones al asesorar a los corredores sobre técnicas y estrategias de entrenamiento, prevención, tratamiento y readaptación de lesiones (AU)

This paper examines the relationship between long-distance runners’ foot strike patterns (Rearfoot Strike [RFS] and Non Rearfoot Strike [NRFS]) and various aspects such as injuries, performance, and biomechanics. While running has established itself as a popular activity with cardiovascular, respiratory, and psychological benefits, it carries a significant risk of injuries. It was found that most runners adopt an RFS pattern, which tends to increase with distance covered and the use of cushioned footwear. Although some studies suggest a relationship between certain foot strike patterns and specific injuries, there is insufficient evidence to recommend changes in foot strike patterns for injury prevention. Elite runners tend to use an NRFS pattern more than amateurs, but the relationship between foot strike patterns, performance, and biomechanical variables is complex and varies indivually. It concludes that health professionals and coaches should consider these variations when advising runners on training techniques and strategies, prevention, treatment, and rehabilitation of injuries (AU)

Gait analysis of a patient with severe motor impairment post- intensive care due to COVID-19: 1 year follow up and physical therapy / Análise da marcha de paciente com comprometimento motor grave após terapia intensiva por COVID-19: acompanhamento de 1 ano e fisioterapia

Abstract Introduction Viral infections, such as infection by SARS-CoV-2, can affect gait biomechanics, but this effect can be overlapped by consequences of critical illness and time in intensive care unit. Objective To report biomechanical alterations during the clinical evolution of a post-COVID-19 patient who presented severe motor impairment after intensive care. Methods Data was collected from the patient's chart at José Silveira Foundation and previous medical reports from the hospitalization period. The patient was wheelchair bound, with physiotherapy twice a week, and by the end of 1-year follow-up was able to walk independently. Three-dimensional gait analysis with kinetics and electromyography were conducted at three time points. Results All spatiotemporal gait parameters, kinematic, kinetic and electromyographic data was importantly altered when compared to the normal range of values. With physiotherapy, gait quality indicators showed important improvements and all muscles presented a significant increase in the magnitude of the electromyographic signal (at least a two-fold increase). Trunk kinematic alterations decreased significantly during this period. Kinetic and kinematic changes perceived in the hips, knees and ankles showed approximation to the expected pattern, however still without normalizing, and patient's muscle coordination improved over time. Conclusion This report has great clinical importance, as it describes, using an instrumented gait laboratory, the evolution of a patient with severe motor impairment post intensive care due to COVID-19, a condition in lack of description in the literature, which will help health professionals in the planning of rehabilitation strategies.

Resumo Introdução Infecções virais, como a infecção por SARS-CoV-2, podem afetar a biomecânica da marcha, mas esse efeito pode ser sobreposto por consequências de doença crítica e tempo em unidade de terapia intensiva. Objetivo Relatar as alterações biomecânicas durante a evolução clínica de um paciente pós-COVID-19 que apresentou comprometimento motor severo após terapia intensiva. Métodos Os dados foram coletados a partir do prontuário do paciente na Fundação José Silveira e dos relatórios médicos anteriores referentes ao período de inter-nação. O paciente estava em cadeira de rodas, com fisioterapia duas vezes por semana, e ao final de 1 ano de acompanhamento era capaz de deambular de forma independente. A análise tridimensional da marcha com cinética e eletromiografia foi realizada em três momentos. Resultados Todos os parâmetros espaço-temporais da marcha, dados cinemáticos, cinéticos e eletromiográficos estavam significativamente alterados quando comparados com a faixa normal de valores. Com a fisioterapia, os indicadores de qualidade da marcha apresentaram melhorias importantes e todos os músculos apresentaram um aumento significativo na magnitude do sinal eletromiográfico (aumento de pelo menos duas vezes). As alterações cinemáticas do tronco diminuíram significativamente neste período. As alterações cinéticas e cinemáticas percebidas nos quadris, joelhos e tornozelos mostraram aproximação do padrão esperado, porém ainda sem normalização, e a coordenação muscular do paciente melhorou com o passar do tempo. Conclusão Este relato é de grande importância clínica, pois descreve, por meio de um laboratório de marcha instrumentado, a evolução de um paciente com comprometimento motor severo após terapia intensiva por COVID-19, quadro pouco descrito na literatura, o que ajudará profissionais de saúde no planejamento de estratégias de reabilitação.

Orthodontic aligners: between passion and science

ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.

RESUMO Introdução: As vantagens e desvantagens do uso de alinhadores ortodônticos têm sido reportadas com base mais na experiência clínica e opinião de experts do que em evidências científicas. Outro aspecto importante é que os alinhadores estão em processo de evolução constante. Assim, torna-se importante obter evidências recentes, que abranjam as novas atualizações na tecnologia de confecção, no desenvolvimento de novos protocolos de planejamento para as movimentações, a incorporação e desenho dos attachments e o auxílio da ancoragem esquelética. Métodos: As evidências encontradas em seis bases de dados eletrônicas (CINAHL, MEDLINE, EMBASE, Psych Info, Biblioteca Cochrane e Biblioteca Joanna Briggs) serão apresentadas por meio de perguntas e respostas. Conclusões: Há evidências de que os alinhadores apresentam diferentes níveis de dificuldade para realizar cada tipo de movimento, sendo os movimentos rotacionais e verticais os mais difíceis de serem executados. Quanto à percepção da dor causada pela movimentação dentária, parece haver menos impacto no início do tratamento, mas os alinhadores produzem mais alterações fonoarticulatórias e parecem exigir mais tempo de tratamento em casos mais complexos. Não há evidência de diferença na estabilidade pós-tratamento, e os alinhadores não impedem a ocorrência de reabsorção radicular, apesar da incidência e a gravidade da reabsorção poderem ser menores, facilitam a higiene bucal, reduzindo o risco de manchas brancas, cáries e doenças periodontais. Dada a evidência conflitante, a liberação de bisfenol-A pelo alinhador não pode ser negada. É preciso encontrar soluções que reduzam o impacto ambiental do descarte dos alinhadores. Há uma necessidade urgente de ensaios clínicos randomizados bem desenhados.

University curriculum update on aerobic physical education / Atualização do currículo universitário em educação física aeróbica / Actualización del plan de estudios universitario de educación física aeróbica

ABSTRACT Introduction Although colleges and universities have improved their aerobic physical education systems, the teaching design has a partially scientific basis, requiring urgent updating. Objective Research means of scientific improvement to the aerobic physical education curriculum in colleges and universities. Methods A total of 594 students and 52 teacher questionnaires were collected to understand the background of the research. Four groups of athletes were selected for relevant data collection. A kinematic analysis with a reflective ball at different joints and limbs archived the main variables of the most demanded actions on a force measurement platform, which were combined with the athletes' data. Results Through the integration and analysis of the research results, this paper obtained a scientifically based training scheme with clear training objectives. It also displays a deeper understanding of the actual situation of teaching aerobic physical education in colleges and universities. Conclusion This paper designs a scientifically-based aerobics optimization scheme according to the characteristics of colleges and universities, addressing the real needs of students and promoting the improvement of aerobic physical education teaching in colleges and universities. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Embora as faculdades e universidades tenham aprimorado seus sistemas de educação física aeróbica, o projeto do ensino não dispõe de um embasamento científico completo, necessitando de uma urgente atualização. Objetivo Pesquisar meios de aprimoramento científico ao currículo de educação física aeróbica em faculdades e universidades. Métodos Um total de 594 questionários de estudantes e 52 questionários de professores foram coletados para compreender o histórico da pesquisa. Quatro grupos de atletas foram selecionados para a coleta de dados relevantes. Uma análise cinemática com bola refletiva em diferentes articulações e membros, arquivou as principais variáveis das ações mais demandadas numa plataforma de medição de força, que foram combinados aos dados dos atletas. Resultados Através da integração e análise dos resultados da pesquisa, este trabalho obteve um esquema de treinamento com embasamento científico e objetivos claros de treinamento. Também exibe um entendimento mais profundo da situação real do ensino de educação física aeróbica nas faculdades e universidades. Conclusão Este documento projeta um esquema de otimização de aeróbica com embasamento científico de acordo com as características das faculdades e universidades, abordando as necessidades reais dos estudantes, promovendo a melhoria do ensino no curso de educação física aeróbica das faculdades e universidades. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Aunque los colegios y universidades han mejorado sus sistemas de educación física aeróbica, el proyecto de enseñanza no tiene una base científica completa, lo que requiere una actualización urgente. Objetivo Investigar los medios para mejorar científicamente el plan de estudios de educación física aeróbica en los colegios y universidades. Métodos Se recogieron un total de 594 cuestionarios de alumnos y 52 de profesores para conocer los antecedentes de la investigación. Se seleccionaron cuatro grupos de atletas para recoger los datos pertinentes. Un análisis cinemático con un balón reflectante en diferentes articulaciones y extremidades, archivó las principales variables de las acciones más demandadas en una plataforma de medición de fuerza, que se combinaron con los datos de los atletas. Resultados A través de la integración y el análisis de los resultados de la investigación, este trabajo obtuvo un esquema de formación con base científica y objetivos de formación claros. También muestra un conocimiento más profundo de la situación real de la enseñanza de la educación física aeróbica en los colegios y universidades. Conclusión Este trabajo diseña un esquema de optimización del aeróbic con base científica según las características de los colegios y universidades, atendiendo a las necesidades reales de los estudiantes, promoviendo la mejora de la enseñanza en el curso de educación física aeróbica en los colegios y universidades. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.