A hierarquia das evidências em cirurgia da mão nas revistas ortopédicas nacionais

CONTEXT AND OBJECTIVE: There is no systematic assessment of the quality of scientific production in the specialty of hand surgery in our setting. This study aimed to systematically assess the status of evidence generation relating to hand surgery and to evaluate the reproducibility of the classification method based on an evidence pyramid. DESIGN AND SETTING: Secondary study conducted at Universidade Federal de São Paulo (UNIFESP) and Faculdade Estadual de Medicina de Marília (Famema). METHODS: Two researchers independently conducted an electronic database search for hand surgery studies published between 2000 and 2009 in the two main Brazilian orthopedic journals (Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia). The studies identified were subsequently classified according to methodological design (systematic review of the literature, randomized clinical trial, cohort study, case-control study, case series and other studies) and evidence level (I to V). RESULTS: A total of 1,150 articles were evaluated, and 83 (7.2%) were included in the final analysis. Studies with evidence level IV (case series) accounted for 41 (49%) of the published papers. Studies with evidence level V (other studies) accounted for 12 (14.5%) of the papers. Only two studies (2.4%) were ranked as level I or II. The inter-rater reproducibility was excellent (k = 0.94). CONCLUSIONS: Hand surgery articles corresponded to less than one tenth of Brazilian orthopedic production. Studies with evidence level IV were the commonest type. The reproducibility of the classification stratified by evidence level was almost perfect.CONTEXTO E OBJETIVO: Não há uma avaliação sistemática da qualidade da produção científica na especialidade de cirurgia da mão em nosso meio. Este estudo objetiva analisar o status da geração de evidências em cirurgia da mão, por meio de avaliação sistematizada, além de avaliar a reprodutibilidade da classificação baseada na pirâmide das evidências. TIPO DE ESTUDO E LOCAL: Estudo secundário realizado pela Universidade Federal de São Paulo (UNIFESP) e Faculdade Estadual de Medicina de Marília (Famema). MÉTODOS: De forma independente, dois pesquisadores promoveram uma busca eletrônica dos trabalhos envolvendo cirurgia da mão, no período de 2000-2009, para duas principais revistas na literatura ortopédica nacional (Acta Ortopédica Brasileira e Revista Brasileira de Ortopedia). Os trabalhos identificados foram subsequentemente classificados pelo tipo de delineamento metodológico (revisões sistemáticas da literatura, estudos clínicos randomizados, estudos de coorte, estudos caso-controle, séries de casos e outros estudos) e nível de evidência (I a V). RESULTADOS: Foram avaliados 1.150 artigos, sendo 83 (7,2%) considerados para a análise final. Estudos com nível de evidência IV (séries de caso) correspondem a 41 (49%) das publicações. Estudos nível de evidência V (outros estudos), corresponderam a 12 (14,5%) da amostra. Apenas dois estudos (2,4%) foram identificados como nível I ou II. A reprodutibilidade interobservadores foi excelente (k = 0.94). CONCLUSÕES: Os artigos de cirurgia da mão correspondem a menos de um décimo da produção ortopédica nacional. Estudos nível de evidência IV foram os mais encontrados na literatura nacional. A classificação estratificada por níveis de evidência apresenta reprodutibilidade quase perfeita.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Department of Orthopedics and TraumatologyFaculdade Estadual de Medicina de MaríliaFaculdade Estadual de Medicina de Marília Department of Orthopedics and TraumatologyUniversidade Federal de São Paulo (UNIFESP)UNIFESP, EPMUNIFESP, Department of Orthopedics and TraumatologyUNIFESPSciEL

Compostos orgânicos como substratos na formação de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) Standl) irrigadas com água residuária

A necessidade de estudar a utilização dos resíduos de podas de árvores é de grande importância ambiental para solucionar os problemas de resíduos sólidos existentes nas áreas urbanas junto com os resíduos de lixos domésticos. O estudo destes materiais foi avaliado com o desenvolvimento de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) sandl) em diferentes misturas de substratos e tipos de água para irrigação. O experimento foi instalado no Departamento de Engenharia Rural da Faculdade de Ciências Agrárias e Veterinárias - UNESP, Câmpus de Jaboticabal. Foram realizados dois experimentos, avaliados juntamente com delineamento experimental em blocos casualizados, de oito substratos, duas qualidades de águas e quatro repetições, totalizando 64 parcelas. Cada parcela foi composta por 30 plantas (cinco linhas de seis plantas), sendo consideradas como úteis as três linhas de quatro plantas centrais da parcela. Foram testados oito substratos, resultantes da combinação de substrato comercial, composto de lixo e composto de poda de árvores com dois tipos de água de irrigação (água potável e residuária) e quatro repetições. Para acompanhar o desenvolvimento das mudas de ipê-amarelo, foram avaliados a altura da parte aérea das plantas (H) e o diâmetro do colmo (D). As características foram avaliadas aos 21; 42; 63 e 84 dias após a emergência. da análise dos resultados, possibilitou-se concluir que os substratos estudados promoveram diferenças significativas para a altura média das plantas e o diâmetro de colmo, em todos os períodos de avaliação. Os substratos 4 e 5 e a água residuária apresentaram os melhores resultados no desenvolvimento das mudas de ipê-amarelo.The need to study the use of waste of tree pruning is of great importance to solve the environmental problems of solid waste in the urban areas along with the household waste. The study of these materials was evaluated with the development of seedlings of yellow- ipe (Tabebuia Chrysotricha (Mart. Ex DC.) Sandl) in different types of substrate mixtures and water for irrigation. The experiment was installed at the Department of Rural Engineering in the Faculty of Agricultural Sciences and Veterinary - UNESP, Jaboticabal Campus, in a randomized block design, with 8 substrates, 2 qualities of water and 4 repetitions, totaling 64 plots. Each plot was composed of 30 plants (5 lines of 6 plants), being regarded as useful, the 3 lines of 4 plants of the central plot. Eight substrates were tested, resulting from the combination of commercial substrate, composed of garbage and of trees pruning with 2 types of irrigation water (clean water and residuary) with 4 repetitions. To track the development of the yellow- ipe seedlings, were evaluated the height of the shoots (H) and the diameter of the stem (D). The characteristics were evaluated at 21, 42, 63 and 84 days after the emergency. The analysis of the results allowed to conclude that the substrates studied promoted significant difference in average height and diameter of the stems in all periods of assessment. The substrate 4, 5 and the residuary water showed the best results in the development of the yellow-ipe seedlings

Variáveis biométricas da cana-de-açúcar fertilizada com resíduos orgânico e industrial e irrigada com água servida e potável

O uso agrícola de resíduos orgânicos e industriais é uma alternativa de aproveitamento como fertilizante e fonte de matéria orgânica ao solo. Neste sentido, o objetivo deste trabalho foi avaliar o uso do composto de lixo e biofertilizante como fonte de nutrientes, e o resíduo do processamento da bauxita como corretivo da acidez do solo, para a cultura da cana-de-açúcar (cana-planta), irrigada com água potável e servida. Para tanto foi conduzido experimento em vaso, utilizando-se de solo Argissolo Vermelho-Amarelo distrófico, cultivado com a variedade RB855536. Foram avaliadas variáveis biométricas da planta, tais como: altura de plantas, diâmetro do colmo, perfilhamento, número de folhas, matéria seca de raiz e parte aérea. Os dados obtidos evidenciaram que a qualidade da água de irrigação, potável ou servida, não influenciou as variáveis avaliadas. A aplicação de composto de lixo e de biofertilizante constituiu-se numa fonte eficiente de nutrientes para as plantas de cana-de-açúcar, mas é necessária a aplicação adicional de fertilizantes para a obtenção de produção de colmos, similar ao do tratamento com adubação mineral convencional. Já o resíduo do processamento da bauxita mostrou-se eficiente na correção da acidez, apresentando as variáveis físicas semelhantes ao tratamento com adubação mineral, com exceção da matéria seca de raiz.The agricultural use of organic and industrial residues is an alternative of exploitation with fertilization and source of organic matter to the soil. In this direction, the objective of this research was to evaluate the use of the urban solid waste and biofertilizer as nutrient source, and residue of the bauxite processing as agricultural liming materials of the soil for sugar cane (cane plant) and culture yields, irrigated with potable water and wastewater. For in such an experiment in vase was lead, under Alfisol soil, cultivated with the variety RB855536. It had been evaluated biometric variable of the plant such as: plant height, diameter of stem, tillering, leaf number, dry matter of the root and dry matter of the aerial part. The data showed that the quality of the irrigation water, potable and wastewater, did not influence the evaluated parameters. The application of urban solid waste and biofertilizer had consisted in an efficient source of nutrients for sugar cane plants, but is necessary to apply additional fertilizer for the attainment of stem production similar to the treatment with conventional mineral fertilization. Now the residue of the bauxite processing revealed efficient in the correction of the acidity presenting similar physical parameters to the treatment with mineral fertilization and lime, with exception of the dry matter of the root.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Características topográficas y evaluación del agua en el manejo de cuencas hidrográficas

Se evaluaron características topográficas y muestras de agua en un cauce de la hacienda Gloria, municipio Jaboticabal, São Paulo, Brasil. Las características morfométricas del relieve y del agua fueron estudiadas en una pequeña cuenca hidrográfica, considerando zonas protegidas con bosque nativo y aquellas que presentaban uso agrícola de la tierra para ajustar la hipótesis de que el uso de ella afecta la calidad del agua y ayuda a predecir cómo se producen los cambios en este y en el local paisaje circundante. La calidad del agua fue evaluada en seis sitios y se analizaron los cambios de los parámetros físicos y químicos. Las muestras fueron recolectadas el mismo día de cada mes, durante un año, mediante un equipo de Horiba. Para determinar diferencias entre los sitios estudiados se realizó el análisis de varianza (Anova). El análisis de los datos presentó diferencias significativas de pH, conductividad eléctrica, turbidez, oxígeno disuelto y temperatura. Las características topográficas han sido influenciadas por las actividades agrícolas, impactando el medio ambiente. La escorrentía superficial es predominante en las laderas pronunciadas, sobre todo en las zonas altas de la cuenca. Los resultados indican la fragilidad de la cuenca agrícola a la exposición de contaminantes o agentes tóxicos, debido a la turbidez en el agua causada por la erosión de los suelos, la deposición de residuos agrícolas y por la escorrentía superficial.Topographical characteristics and water quality were evaluated at Hacienda Gloria, in Jaboticabal, São Paulo State, Brazil. Understanding the relief's morphometric characteristics and the course of the streams in a small watershed supported the hypothesis that land-use affects water quality and helps predict how changes in water-flow and the surrounding landscape occur; areas protected by native forest and those dedicated to agriculture were considered. Water quality was sampled at six sites and physical and chemical changes were analysed. Monthly water samples were collected from the streams on the same day of each month during the course of a year; Horiba equipment was used for recording data. One-way analysis of variance (ANOVA) was used for determining differences between the sites being investigated. Analysing the data revealed significant differences in pH, electric conductivity, turbidity, dissolved oxygen and temperature. Topographical characteristics have been influenced by agricultural activity, thereby having an environmental impact. Surface runoff was predominant on steep slopes, mainly in areas near the top of the watershed. Land-use has had a significant impact on many physical parameters, including stream turbidity and temperature which increased with deforestation. The results indicated the agricultural watershed's fragility to pollutant exposure and/or toxicity, mainly due to turbidity in the streams caused by soil erosion, waste discharge and runoff

Quali/quantitative characterization of biogas produced in batch digesters supplied with six distinct substrates

Com a finalidade de se analisar quali/quantitativamente o biogás produzido por 6 tipos de substratos, efetuou-se a presente pesquisa no DER/FCAV/UNESP- SP, Brasil. Os substratos utilizados na digestão anaeróbia foram caracterizados como: 1- Esterco de aves de postura (EAP); 2- Esterco de aves de postura triturado (EAPT); 3- Esterco de aves de corte com cama de maravalha (EACM); 4- Esterco de aves de corte com cama de maravalha triturado (EACMT); 5- Esterco de aves de corte com cama de casca de amendoim (EACA), e 6- Esterco de aves de corte com cama de casca de amendoim triturado (EACAT). Dos resultados obtidos, concluiu-se que, em relação à produção acumulada de biogás, o substrato EAPT foi superior aos demais, enquanto EACM apresentou produção acumulada inferior. em geral, os substratos triturados apresentaram maior quantidade de biogás acumulado em relação aos não triturados, exceto o EACAT, com 20,9 m³ inferior ao EACA. O período de produção máxima de biogás teve início entre 45 e 60 dias, começando a decair a partir dos 120 dias. Aos 57 dias após o enchimento dos biodigestores, o gás produzido possuía teores de CH4 superiores a 53%, e a partir dos 99 dias, todos produziram biogás com teores de CH4 superiores a 70%. Os substratos EAP e EAPT apresentaram maiores concentrações de metano no biogás.The present research was carried out at the DER/FCAV, São Paulo State University - Brazil, with the purpose of analyzing the quantity and quality of biogas produced by six types of substrates. The substrates used in the anaerobic digestion were characterized as: 1- Litter of broiler (LB); 2- Grinded broiler litter (GBL); 3- Broiler litter with wood shavings (BLWS); 4- Grinded broiler litter with wood shavings (GBLWS); 5- Broiler litter with peanut hulls (BLPH); 6- Grinded broiler litter with peanut hull (GBLPH). It was concluded from the collected data that: the (GBL) substrate showed a superior biogas accumulated production in relation to the other substrates, while the BLWS presented an inferior accumulated production; the grinded substrates showed higher quantities of accumulated biogas in relation to the non-grinded substrates, except for GBLPH, with 20.9 m³ inferior than BLPH; the period of maximum biogas production started from 45 to 60 days, declining after 120 days; at 57 days after filling up the digesters the biogas produced had levels of CH4 superior than 53%, and from 99 days all of them produced biogas with levels of CH4 superior than 70%; LB and GBL presented higher concentrations of CH4 in the biogas

Retrospective Study of the Results of Surgical Treatment of 31 Giant Cell Tumors of the Tendon Sheath in the Hand

Abstract Objective To evaluate the results of the treatment of 31 giant-cell tumors of the tendon sheath of the hand cared for between 2006 and 2015. Methods A group of patients for the present retrospective evaluation was defined, covering the period between February 2006 and November 2015, in which 31 records of patients who underwent surgery due to cell tumor of the tendon sheath of the fingers were studied and evaluated. The recommended treatment was complete excision of the tumor with preservation of the adjacent structures. The diagnosis was confirmed by pathological examination. The progress of the treatment after surgery was evaluated, especially regarding the rate of tumor recurrence. Results Taking all 31 patients into consideration, there was a predominance of the female gender and white ethnicity. Most of these patients were aged between 30 and 50 years. The most affected side was the left one, and most tumors were in the flexor face. There was a predominance of the radial fingers, along with their distal end. A total of 27 patients are being followed up at regular intervals at an outpatient clinic, and three cases of tumor recurrence have been identified. Conclusion An appropriate surgical technique is essential in order to prevent GCTTS recurrences. The results obtained in this research are in agreement with the literature

Terrible triad of the elbow: evaluation of surgical treatment

ABSTRACT Objective: This study aims at analyzing retrospectively the clinical-functional and radiographic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function. Methods: A group of patients for retrospective analysis from 2004 to 2015 was defined, in which 12 patients were studied. They underwent surgery due to fracture of the radial head, coronoid fracture, and elbow dislocation; they were evaluated by the Disabilities of the Arm, Shoulder and Hand (DASH) score, the degree of patient satisfaction, the degree of trauma energy, radiographic images, range of motion, and complications. Results: There was a higher incidence of Regan and Morrey type II coronoid process fractures; in relation to the injuries, nine patients had deinsertion of the brachialis. Half of the patients suffered a fall from their own height as the mechanism of trauma. The extent of elbow flexion and extension averaged 126.6 and 24.1 degrees, respectively; the averages for pronation and supination were 64.1 and 62.0 degrees, respectively. All patients presented muscle strength of grade IV or V. The mean DASH score was 14.3, the mean pain score was 2.5, and a majority of the patients were satisfied with the treatment. Conclusion: Despite the total loss of range of motion of the elbow, especially in extension, the treatment was satisfactory for most patients