Fabrico rápido de implantes ósseos personalizados

Actualmente existem situações clínicas específicas relacionadas com perdas ou correcções ósseas significativas, cuja solução dificilmente poderá ser alcançada com implantes ou próteses disponíveis comercialmente, sendo necessário o recurso a soluções personalizadas (ditas customizadas), isto é, implantes que são concebidos e fabricados em função das especificidades do paciente. Neste sentido, o desenvolvimento de uma nova metodologia que permita o fabrico rápido de implantes ósseos em simultâneo com o acto cirúrgico poderá apresentar vantagens significativas, pois permite ao cirurgião corrigir ou alterar a geometria do implante em função de uma qualquer ocorrência anómala detectada já durante a cirurgia. A abordagem neste trabalho passou pelo desenvolvimento de uma aplicação informática que permitisse integrar numa única plataforma um conjunto de ferramentas como scanner 3D, sistema de fabrico assistido por computador (CAM) e fabrico em máquinas controladas por computador (CNC) para assim fabricar de forma rápida um implante adaptado à anatomia do paciente. O método estabelecido assentou em quatro etapas essenciais: a primeira consiste na captação da geometria do implante, realizada localmente pelo cirurgião e não envolve meios computacionais. A segunda consiste na obtenção do modelo virtual da geometria do implante, realizada a partir do levantamento de forma do modelo obtido na etapa anterior, utilizando um scanner 3D por laser. A terceira etapa consiste na utilização de um sistema CAM para a elaboração do programa de maquinagem do implante. Na quarta e última etapa materializa- se o fabrico do implante numa fresadora CNC. O sistema desenvolvido permitiu integrar recursos e tecnologias cuja utilização exige conhecimentos muito especializados, mas inseridos num ambiente amigável para o utilizador possibilita que estes possam ser utilizados por pessoas não profundamente conhecedoras das tecnologias integradas. A solução implementada revelou-se mais acessível ao nível dos custos de aquisição das tecnologias de suporte e da facilidade de utilização quando comparada com outros processos de fabrico de implantes customizados, nomeadamente os obtidos a partir de informação gerada por tomografia computorizada (TAC)

Obsessive Compulsive Disorder as a functional interhemispheric imbalance at the thalamic level

Obsessive Compulsive Disorder (OCD) involves failures in two main inhibitory processes, namely cognitive (obsessions) and behavioral (compulsions). Recent research has supported two cortical-subcortical pathways on OCD pathogenesis: (a) the frontostriatal loop (dorsolateral-caudate-striatum-thalamus) responsible for impairments of behavioral inhibition; (b) the orbitofrontal loop (orbitofrontal, medial prefrontal and cingulate) responsible for impairments with cognitive inhibitory processes. These failures in both cognitive and motor inhibitory systems may mediate several neuropsychological deficits in these patients, namely memory, attention, planning and decision making. But are those deficits related to specific hemispheric effects, namely functional imbalance between hemispheres? In this article we hypothesize that: (1) OCD patients have an inter-hemispheric functional imbalance, probably due to inadequate filtering at the thalamic level; (2) the restoration of inter-hemispheric balance, will be correlative to symptomatic improvement

Sediment-matrix igneous breccias at the top contacts of felsic units in the IPB : implications for VHMS exploration

The Volcanic Sedimentary Complex of the Iberian Pyrite Belt is dominated by mudstone units and comprises felsic lavas/domes and pyroclastic units that define lava-cryptodome-pumice cone volcanoes. Sediment-matrix igneous breccias may outline the contacts of volcanic units, occur within them, or lie laterally to the volcanic centres. These breccias can form by several processes, each with its genetic implications, having nevertheless very similar final aspect. We have distinguished and characterized several sediment-matrix breccia types. The most abundant types are sediment-infill volcanic breccia and peperite; however other types of sediment-matrix breccia were also identified. The correct identification of these breccias is crucial to reconstruct the volcanic centres and to define the stratigraphy, which in mineralized volcanic provinces is a major issue both for metallogenic and mineral exploration models

The effect of inventory record inaccuracy in information exchange supply chains

The goal of this paper is to quantify the impact of Inventory Record Inaccuracy on the dynamics of collaborative supply chains, both in terms of operational performance (i.e. order and inventory stability), and customer service level. To do so, we model an Information Exchange Supply Chain under shrinkage errors in the inventory item recording activity of their nodes, present the mathematical formulation of such supply chain model, and conduct a numerical simulation assuming different levels of errors. Results clearly show that Inventory Record Inaccuracy strongly compromises supply chain stability, particularly when moving upwards in the supply chain. Important managerial insights can be extracted from this analysis, such as the role of 'benefit-sharing' strategies in order to guarantee the advantage of investments in connectivity technologies

Ensaios de integridade estrutural de placas angulares de fixação de fracturas ósseas do fémur

Neste trabalho descreve-se o projecto de um dispositivo mecânico desenvolvido para a realização de ensaios segundo a norma ASTM F384-00 (2000) de placas de osteossíntese anguladas. O dispositivo foi objecto de uma análise estrutural usando o método dos elementos finitos. Algumas placas foram ensaiadas estaticamente e suas características mecânicas, de acordo com a norma, determinadas

Electroconvulsive therapy in puerperal psychosis

Puerperal psychosis (PP) is an exuberant clinical syndrome with an estimated frequency of 1 case per 1,000 childbirths that has been most consistently associated with the bipolar disorders spectrum. Available evidence is scarce, namely regarding management and treatment. The authors present the clinical case of a 28 year-old first-time mother, with no psychiatric history, who developed a florid psychotic syndrome in the first weeks of puerperium. Due to lack of improvement following pharmacological treatment, electroconvulsive therapy (ECT) was applied, with substantial and quick response. In this context, the authors reviewed current literature on the use of ECT for the treatment of puerperal psychosis

Chronic hemolytic anemia is associated with a new glucose-6-phosphate dehydrogenase in-frame deletion in an older woman

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, an X-linked disorder, is usually observed in hemizygote males and very rarely in females. The G6PD class 1 variants, very uncommon, are associated with chronic hemolytic anemia. Here we report a Portuguese woman who suffered in her sixties from a chronic hemolytic anemia due to G6PD deficiency. Molecular studies revealed heterozygosity for an in-frame 18-bp deletion, mapping to exon 10 leading to a deletion of 6 residues, 362-367 (LNERKA), which is a novel G6PD class 1 variant, G6PD Tondela. Two of her three daughters, asymptomatic, with G6PD activity within the normal range, are heterozygous for the same deletion. The patient's leukocyte and reticulocyte mRNA studies revealed an almost exclusive expression of the mutant allele, explaining the chronic hemolytic anemia. Patient whole blood genomic DNA HUMARA assay showed a balanced pattern of X chromosome inactivation (XCI), but granulocyte DNA showed extensive skewing, harboring the mutated allele, implying that in whole blood, lymphocyte DNA, with a very long lifetime, may cover up the current high XCI skewing. This observation indicates that HUMARA assay in women should be assessed in granulocytes and not in total leukocytes