Evaluation of the rigid stable techniques of the sagittal split ramus osteotomies : mechanical, photoelastic, finite elements analysis and clinical stability studies

Orientadores: Márcio de Moraes, Luciana AsprinoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo nesse trabalho foi avaliar a resistência mecânica, a distribuição de tensões e a estabilidade em longo prazo das diversas formas de fixação da osteotomia sagital dos ramos mandibulares (OSRM). No trabalho 1, cinco técnicas de fixação da OSRM foram submetidas a análise de elementos finitos: 3 parafusos bicorticais lineares a 60° e a 90°, 3 parafusos bicorticais em disposição L invertido, 1 miniplaca com 4 parafusos monocorticais convencionais e com sistema de travamento. Pelos resultados obtidos, a disposição em L invertido foi a que apresentou melhor distribuição de tensões, seguido pela linear 90° e 60°. Em relação às miniplacas, as tensões apresentaram melhor distribuição naquela com sistema de travamento se comparada com a convencional. No trabalho 2, foi realizada um análise mecânica, fotoelástica e de elementos finitos da chamada técnica híbrida, comparando-a com a fixação tradicional com três parafusos bicorticais em L invertido e com miniplaca e parafusos monocorticais. A técnica híbrida apresentou resistência intermediária entre os dois sistemas tradicionais de fixação da OSRM, com concentração de tensões principalmente ao redor do parafuso bicortical e melhora da distribuição de tensões na região da miniplaca. No trabalho 3, foi realizada uma análise da estabilidade esquelética de três formas de fixação da OSRM: técnica híbrida, parafusos bicorticais e miniplacas/parafusos monocorticais. Os resultados mostraram não haver diferença estatisticamente significante entre os três grupos, sendo positiva a correlação entre a quantidade de avanço mandibular e a quantidade de recidiva. Pelos resultados obtidos nos trabalhos, pode-se concluir que todas as técnicas avaliadas podem ser empregadas com segurança na fixação da osteomia sagital dos ramos mandibularesAbstract: The aim of this research was to evaluate the mechanical resistance, stress distribution and long-term stability of fixation techniques of the sagittal split ramus osteotomy (SSRO). In the first study, five fixation techniques of the SSRO were submitted to finite element analysis: 3 linear screws 90°, 3 linear screws 60°, 3 screws in inverted L arrangement, conventional and locking miniplate with monocortical screws. The results demonstrated that the bicortical screws in inverted L arrangement presented the best stress distribution, followed by linear 90° and linear 60°. The locking system miniplate presented better stress distribution if compared with conventional miniplate and monocortical screws. In the second study, a mechanical, photoelastic and finite element analysis were performed to the so-called hybrid technique, comparing it with bicortical screws in inverted L arrangement and miniplate with monocortical screws. The hybrid technique had an intermediate mechanical resistance between the two traditional fixation techniques, with high stress concentration around the bicortical screw with improvement in the stress distribution around the miniplate. In the third study, skeletal stability was evaluated of three fixation techniques of the SSRO: the hybrid technique, bicortical screws and miniplates with monocortical screws. The results demonstrated no significant statistically difference between the groups, with a positive correlation between the amount of advancement and relapse. From the results obtained in the research, it is possible to conclude that all fixation techniques could be safely applied to sagital split ramus osteotomyDoutoradoCirurgia e Traumatologia Buco-Maxilo-FaciaisDoutor em Clínica Odontológic

Redução do efetivo na GNR: Como aumentar a eficiência com menos meios e a mesma missão

A contínua redução de efetivo militar na Guarda Nacional Republicana, tem provocado limitações ao nível do preenchimento do quadro orgânico dos Comandos Territoriais, bem como, ao nível do cumprimento do serviço operacional. Como objetivo geral, este Trabalho de Investigação Aplicada visa apurar se é possível aumentar a eficiência no serviço territorial, dispondo de menos meios humanos e assegurando a mesma missão. Para tal, foi elaborada uma questão de partida e as suas questões derivadas, e ainda, as hipóteses de investigação. A metodologia utilizada tem como base a identificação dos dois Comandos Territoriais que apresentam as duas maiores percentagens de défice de preenchimento dos seus quadros orgânicos e neste âmbito, foi selecionado o Comando Territorial de Beja e o Comando Territorial da Guarda. Posteriormente, realizou-se uma entrevista exploratória ao Diretor dos Recursos Humanos e foram comparados os valores numéricos do Quadro Orgânico de Referência de 2010 e os efetivos totais constantes do Mapa Geral do Efetivo disponibilizado pela Direção de Recursos Humanos. Por forma a alcançar os objetivos traçados, entrevistaram-se nestas duas Unidades os Comandantes, os Chefes das Secções de Recursos Humanos e Justiça, os Chefes das Secções de Operações, Treino e Relações Públicas e também, os Comandantes de Destacamento. Este Trabalho de Investigação Aplicada está dividido em quatro partes. A primeira parte, designada por Parte Introdutória, compreende a introdução propriamente dita através do enquadramento da investigação, destaca a importância e a justificação da escolha do tema, enuncia os objetivos, a questão de partida, as questões derivadas e as hipóteses de investigação, sintetiza a metodologia utilizada ao longo de todo o trabalho e descreve a estrutura da organização do mesmo. Na Parte Teórica são escalpelizados os conceitos teóricos mais importantes relativos aos recursos humanos e sua gestão, assim como, é feita uma análise alusiva à evolução dos recursos humanos militares e uma caraterização dos Comandos Territoriais de Beja e da Guarda. Por sua vez, a parte prática integra a metodologia e procedimentos utilizados na investigação e comporta a análise, apresentação e interpretação dos resultados obtidos nas entrevistas. Por fim, na Parte Conclusiva estão expostas as respostas às questões levantadas inicialmente, a confirmação ou refutação das suas hipóteses de investigação e as reflexões finais do estudo. São também enunciadas, apenas como demonstração teórica, as propostas de implementação no dispositivo territorial dos dois Comandos Territoriais alvo deste estudo, são referidas as limitações encontradas no decorrer de todo o trabalho e enunciadas algumas sugestões para futuras investigações. Os resultados mais relevantes e as principais conclusões alcançadas retratam a necessidade de adotar medidas que contrariem a diminuição de recursos humanos militares a que temos assistido. Relativamente à atividade operacional neste cenário de défice no quadro orgânico das Unidades territoriais, concluímos que é possível aumentar a sua eficiência, caso sejam operacionalizadas algumas modalidades de ação alternativas. De igual modo concluímos que a missão da Guarda Nacional Republicana nos dois Comandos Territoriais em estudo, não está colocada em causa, mesmo com os baixos valores de efetivos militares de que dispõe atualmente.The continuous reduction of military personnel in the National Republican Guard (Guarda Nacional Republicana), has caused limitations to the level of completion of the organic framework of Territorial Commands, as well as at the level of fulfillment of operational service. The major objective of this Applied Research Work aims to determine whether it is possible to increase efficiency in territorial service, with less resources and ensuring the same mission. In order to structure the applied research and, as a way to defuse the study an initial question was given that led to some derived questions and hypotheses. The methodology employed is based on the identification of the two Territorial Commands that have the two largest deficit percentages of completion of their organic frameworks and in this context, we will study Beja´s Territorial Command and Guarda´s Territorial Command. Therefore, we have conducted an exploratory interview with the Director of Human Resources and then compared the numerical values of the Organic Framework of Reference of 2010 and the total effective listed in the general statement of the Human Resources Management. In order to achieve the objectives outlined, we went to the area of action of those Units and interviewed their Commanders, the Chiefs of Sections of Human Resources and Justice, the Chiefs of Sections of Operations, Training and Public Relations as well as the Commanders of Detachment. The Applied Research Work is divided into four parts. The first part, the Introductory Part comprises the introduction, the framing of the research work, highlights the importance and the justification of the research theme, sets out the objectives, the main question, the derived questions and answer hypotheses, synthesizes the methodology used throughout the work and describes how it´s structured. In the Theoretical Part we describe the most important concepts relating to human resources and their management, analyse the evolution of military human resources and characterize the Territorial Command of Beja and Guarda. The Practical Part includes the methodology and procedures used in this research and the analysis, presentation and interpretation of the results obtained from the interviews. Finally, the Concluding Part in which it was possible to answer to the questions raised initially, to verify the hypothesis, and to set out some proposals in the territorial device of the two Territorial Commands analyzed, point out the limitations of the research and defines conclusions and recommendations for future researches. The results of this investigation show that it is necessary to adopt measures to counter the decline we have witnessed. Regarding the operational activity, we conclude that it is possible to increase their efficiency if we operationalized some alternative courses of action. We conclude that the mission of the Guarda Nacional Republicana in the two Territorial Commands is not called intoquestion, even with the low values of military personnel at its disposal nowadays

Eficácia do ácido tranexâmico como agente hemostático em pessoas submetidas a artroplastia total primária do joelho e anca : Revisão sistemática da literatura

Enquadramento: O ácido tranexâmico (TXA) é um agente anti-fibrinolítico normalmente utilizado para reduzir a perda de sangue e da necessidade de recorrer a transfusões na artroplastia total primária da anca e do joelho, contribuindo para um menor tempo de internamento e recuperação mais célere. Objetivos: Evidenciar a eficácia do protocolo de administração profilática do ácido tranexâmico em pessoas submetidas a artroplastia total primária do joelho e anca. Métodos: Revisão sistemática da literatura realizada através da metodologia PRISMA, tendo por base os critérios PICO. A busca foi realizada nos bancos de dados PubMed e Web of Science, usando uma expressão de busca baseada nos seguintes termos MeSH: arthroplasty" AND ((Arthroplasty, Replacement, Hip) OR ((Arthroplasty, Replacement, Knee)) AND "tranexamic acid" AND "hemostatics" OR Hemostatics” (287 artigos). Após leitura, análise e aplicação dos critérios de inclusão estabelecidos resultaram 4 artigos que foram integrados neste estudo. Aplicadas as orientações da JBI à metodologia PRISMA tendo em conta os critérios PICO. Resultados: As evidências dos estudos revelam que o TXA possui um antifibrinolítico no campo cirúrgico devido à acumulação no espaço extracelular. Todavia, não tem efeito sistémico de ação e, por conseguinte, não impedirá a formação de coágulos noutras zonas. O TXA não foi associado a um risco acrescido de trombose venosa profunda ou embolia pulmonar. A utilização profilática do TXA é igualmente eficaz na redução de hemorragias na ATA e na ATJ. Ambas as cirurgias tiveram um efeito semelhante na fibrinólise. O TXA, administrado na mesma dose, consegue uma redução comparável na hemorragia em doentes submetidos a ARA e ATJ. As alterações nos parâmetros de fibrinólise são semelhantes em ambas as cirurgias e isto pode explicar porque é que a mesma dose de TXA leva a uma redução semelhante na hemorragia. Conclusão: Os resultados obtidos sugerem que as grandes cirurgias ortopédicas estimulam o sistema de fibrinólise e que o TXA pode neutralizar parcialmente este efeito, tanto local como sistemicamente. Palavras-chave: Artoplastia primária total da anca; Artoplastia primária total do joelho; ácido tranexâmico.Abstract Background: Tranexamic acid (TXA) is an anti-fibrinolytic agent commonly used to reduce blood loss and the need for transfusions in primary total hip and knee arthroplasty, contributing to a shorter hospital stay and faster recovery. Objectives: To demonstrate the efficacy of a prophylactic tranexamic acid administration protocol in people undergoing primary total knee and hip arthroplasty. Methods: Systematic literature review using the PRISMA methodology, based on the PICO criteria. The search was performed in PubMed and Web of Science databases using a search expression based on the following MeSH terms: arthroplasty" AND ((Arthroplasty, Replacement, Hip) OR ((Arthroplasty, Replacement, Knee)) AND "tranexamic acid" AND "hemostatics" OR Hemostatics" (287 articles). After reading, analysis and application of the established inclusion criteria, 4 articles resulted that were integrated in this study. Applied the JBI guidelines to the PRISMA methodology taking into account the PICO criteria. Results: Evidence from the studies reveals that TXA has an antifibrinolytic effect in the surgical field due to accumulation in the extracellular space. However, it has no systemic effect of action and therefore will not prevent clot formation in other areas. TXA has not been associated with an increased risk of deep vein thrombosis or pulmonary embolism. The prophylactic use of TXA is equally effective in reducing bleeding in ATA and TKA. Both surgeries had a similar effect on fibrinolysis. TXA, given at the same dose, achieves a comparable reduction in bleeding in patients undergoing both ATA and TKA. The changes in fibrinolysis parameters are similar in both surgeries and this may explain why the same dose of TXA leads to a similar reduction in bleeding. Conclusion: The results obtained suggest that major orthopedic surgeries stimulate the fibrinolysis system and that TXA can partially counteract this effect, both locally and systemically. Keywords: Primary total hip arthroplasty; Primary total knee arthroplasty; tranexamic acid

Interpreting Late Pleistocene Paleoenvironments through the geosites of the Estrela Geopark, Central Portugal

The UNESCO Global Geoparks are territories whose geological relevance is the starting point for a territorial development strategy. As territories of the 21st century, we want them to be places of science, culture and education, through a holistic vision, which intends to establish strong connections between the geological and cultural heritage. In this context, the geodiversity of Estrela, the richness of its geosite’s diversity and the scenic character of its landscapes make this territory a unique geography, whose structured approach allows for a solid interpretation of the paleoenvironmental evolution of the Estrela Mountain. The Estrela Geopark, with 2,216 km2, centered on the highest mountain in mainland Portugal (1993 m), is a reference for glacial geomorphology in the southwest European context. The territory shows the most significant glacial, fluvioglacial and periglacial landforms and deposits in Portugal, some of them of international relevance. The Geopark shows a diversity of granites and metasedimentary formations, with evidences of contact metamorphism. The geological history of the Estrela Geopark dates back to the Neoproterozoic, with ages older than 650 Ma, represented by an extensive sequence of metasediments dominated by schists and greywackes. These were deformed by the Variscan orogeny, during which, intrusions of granite batholiths occurred. At the end of the orogeny, the relief was razed by erosive processes that extended until the Miocene, when Variscan faults were reactivated leading to the uplift of the Estrela as a pop-up structure. The summit plateau, showing an elevation close to 2000 m, was key for the development of Estrela’s glaciers during the Pleistocene. These were responsible for a remarkable set of glacial landforms and deposits that drive the geological relevance of the Estrela Geopark. The interaction of the Pleistocene glaciers with the geoheritage reflecting the long geological history of the territory, together with the current geomorphological dynamics, long history of human settlement resulting in rich land use features and traditions, lead to the high international relevance of the territory of Estrela, a UNESCO Global Geopark candidate. The Estrela Geopark inventoried and classified 124 geosites, 40% of them related to glacial and fluvioglacial phenomena and periglacial processes. These include glacial valleys, cirques, glacial overdeepenings, several types of moraines and till outcrops, glacial erratics, glacial polished surfaces, and fluvioglacial deposits. The joint interpretation of landforms and sediments, including the palinological record has been crucial for a better understanding of the paleoenvironmental evolution and significance of the Estrela and of its high sensitivity to climate variability and change as a consequence of its high plateau-dominated morphology, bounded by steep marginal scarps and deeply carved valleys.info:eu-repo/semantics/publishedVersio

Nasotracheal tube wire support: a safety device in maxillofacial surgery technical note after five years of experience

A well fixed endotracheal tube is essential for safety during general anesthesia. In maxillofacial surgeries, securely fixing a nasotracheal tube in place has always been problematic. The aim of this article is to describe a simple but effective technique to fasten the nasotracheal tube using a wire support that allows a full range of head movement without interference in the surgical field. During the last 5 years, this device was successfully used in almost two hundred patients with very few complications

The Integration of the Communities in an Application Process

A UNESCO Global Geopark builds its strategy on the Communities and their development, contributing to the reinforcement of the sense of belonging and their active participation in the whole process, like it is expected from a Bottom-Up process. In this way, Estrela, as an aspirant to UNESCO Global Geopark, has defined its strategy based on this premise. With a 2216km2 territory, 9 municipalities and around 170,000 inhabitants, AGE has been working on the dissemination of both the concept of Geopark and the advantages that an application such as this offers territories with low density and high levels of depopulation. Thus, the year 2017 was marked by the start of several activities with the objective of improving the involvement of the Population in a process so structurant for the territory as this is, because a holistic vision of the territory has finally emerged, opposing the fragmented vision existing until then of the municipalities that compose this application. In this context, the Estrela Conferences advocate a new approach to integrate the people in this application process, giving them an active voice and bringing them to the stage, giving them the opportunity to discuss and participate in the decisions that are being made. The nine municipalities that have promoted this project have been travelled through for nine months, in which the main themes related to Serra da Estrela were discussed through public sessions open to the community, inspired by the concept of Community Forums. These focus groups, with the main objective of discussing and finding solutions to the main challenges that Estrela faces nowadays, were occurred, preferably outside the county headquarters with the clear objective of decentralizing and taking the Geopark to places which usually are removed from the calendar of the municipalities. Examples of this decentralization were the cases of Aldeia de São Francisco de Assis and Caria. These debate sessions made us travel through themes such as "Heritage, Culture and Tradition", "Communication and Territorial Identity", "Geology and Geodiversity", "Tourism: Challenges and Opportunities", "Education and Science: (re)interpreting natural spaces", "Environment and Biodiversity and Mountain Spaces", "Development and Territorial Cohesion", "Depopulation and Low Density" and "Geoparks: new strategies of the 21st Century". Thus, this communication intends to present the Conferências of Estrela as an example of good practices, since in addition to fostering the values of an UNESCO Global Geopark, it also places the Populations at the centre of the strategy of a Geopark, favouring the development of a critical spirit, active citizenship and a sense of belonging. It also helps the sharing of ancestral knowledge by the eldest population, which would otherwise be lost in time.info:eu-repo/semantics/publishedVersio

Promotion of Education in Geosciences and UNESCO Global Geoparks

Considering that Earth is an active planet and that anthropic action contributes to alter the planet's dynamic equilibrium, through the increase of the natural hazards and depletion or destruction of the geological heritage, often for lack of knowledge of its scientific and didactic value, the dissemination of the work developed in Geosciences as well as Education, is of the utmost importance. In this context, the dissemination and teaching of Geosciences gained another dynamic with the creation of Geoparks because, these geographically well-defined territories that possess a remarkable geological heritage, in association with the other elements of the natural and cultural heritage, have as fundamental pillars Geoconservation, Tourism and Education for Sustainability. In this context, the UNESCO Global Geoparks promote the development of educational programs and interpretive resources, contributing to the dissemination of scientific knowledge enabling a greater visibility to Geosciences among the educational community and the general public. The Estrela Aspiring Geopark, which has an area of approximately 2216 km2 and includes 9 municipalities around Estrela, is a territory where sustainable development is sought in an integrated way, based on its geological and geomorphological heritage, of national and international relevance, its biodiversity and its culture, a reflection of the secular adaptation of its communities to this mountain territory. Here we can find important marks of the last glaciation that occurred about 30,000 years ago. This aspiring UNESCO Global Geopark is promoting multidisciplinary educational programs, which include indoor and outdoor activities, aimed at different levels of education (Basic, Secondary and Higher Education), in order to foster direct contact with the geological heritage, thus contributing to the recognition of its importance and consequently to the need for its conservation, since it is only possible to value and preserve what is truly known. The Estrela Aspiring Geopark has also interpretive routes in the field of non-formal education, aimed at the general public, and thus contributing to the dissemination and preservation of the valuable natural and cultural heritage of Estrela, as well as its use in a sustainable way. This article intends to demonstrate the importance of education in the dissemination of scientific knowledge, especially in the field of Geosciences, and to reveal how UNESCO Global Geoparks can be living laboratories, where multiple didactic and learning experiences are developed.info:eu-repo/semantics/publishedVersio

Communicate Science in UNESCO Global Geopark

UNESCO territories are spaces of Education, Science and Culture, but also of Communication. Today, communication is an imperative of these territories, both as dissemination strategies and as a way of positioning in different development domains. In any case, knowing how to communicate its resources, differentiating elements or defining strategies, constitutes a competitive advantage that cannot be neglected at the present time. In other perspective, communication translates a strategy defined by the territories, visible in the way it communicates and in what is communicated. However, it’s not always easy to convey the values we want, much less when we speak about Science. The UNESCO Global Geoparks, as well-defined spaces where a community development strategy based on geology is built, are also areas of science. As such, communicating scientific knowledge, heritage resources, tangible and intangible values and culture itself are part of the daily life of a Geopark. Assuming the old maxim that we can only value what we know, the development of instruments, strategies and processes is fundamental, allowing the interpretation and dissemination of the geological heritage, but also of what is intended to be achieved with its valorisation, not only promoting greater attractiveness, but also a greater involvement of their communities, leading them to contribute in their own development. At Estrela Geopark, an aspirant to the UNESCO Global Geoparks network, communication plays a prominent role in its transverse development strategy. In each of its vital axes, tourism, science, education and sustainability, communication seeks to achieve three essential objectives: first, greater awareness of the Geopark brand and its own concept; secondly, greater dissemination of the territory; and thirdly, greater attractiveness, with more tourists, residents and investors. However, it`s not always easy to communicate science and scientific research. How to convey knowledge in an accessible, interesting and appealing way to the general public, whether visitors or residents? Aware of this difficulty, the Estrela Geopark betted early on interpretation as a central strategy for the whole communicative process. To interpret is the sine quo non condition for spreading knowledge, promoting geoconservation, achieving new forms of education and fostering our sense of belonging and pride. Throughout the last four years, several communication measures have been adopted, among which we highlight the "Portas do Geopark ", which are points of information and dissemination of heritage, and provide an entry into the territory. These "Portas" are the materialization of a dissemination strategy for the values of the Geopark throughout the 9 municipalities that compose this Aspiring with more than 2 thousand km2. Thus, 9 "Portas" and a tenth in the highest point of Continental Portugal, the Torre of Serra da Estrela, a place that receives approximately 2 million visitors per year, were created. In fact, communicating is much more than a simple way of transmitting knowledge, it`s a methodology that leverages the whole strategy of the Geopark, so that Estrela truly becomes a territory of Science, Education, Culture and Communication.info:eu-repo/semantics/publishedVersio