Comparison of Surgical Techniques Used in Treating Acromioclavicular Dislocation in Patients Participating in Sports: A Systematic Review

Introduction: The acromioclavicular joint is a superficial diarthrodial joint that surrounds the medial articular facet of the acromion and the distal portion of the clavicle. Due to its anatomy and biomechanics, it is highly susceptible to trauma and in young men who play contact sports, acromioclavicular dislocation is common. This article aimed to systematically review the literature and compare the surgical techniques used in the treatment of acromioclavicular dislocation in patients who practice sports. Methods: This systematic review was conducted according to the International Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Eligible studies for this systematic review included articles in English or Spanish published between 2013 and 2023, which mention the occurrence of acromioclavicular dislocation during sports practices. Additionally, only studies that addressed the surgical treatment of acromion-clavicular dislocation and contained original data on the topic were included. Results: We found 144 eligible studies after searching the LILACS and PubMed databases. Based on the inclusion and exclusion criteria and the reviewers’ consensus, we selected four studies for the systematic review. 133 patients with AC joint displacement were evaluated. Mean Age: approximately 31.90 years. 81.92 of these injuries occurred during sports practice. Surgical Procedures Used: titanium plates fixation (49 patients), arthroscopy (24), single tunnel technique (30) and coracoid sling technique (30). The results of the visual analog scale and Constant-Murley scores varied between the techniques used. Twenty-two complications after surgical treatment were identified. Conclusion: A significant variability of operative techniques can be used in the surgical approach of acromioclavicular dislocation, such as arthroscopy, single tunnel, coracoid sling and titanium plates. Although it presented excellent functional results compared to the other three techniques evaluated by this review, using titanium plates is not the gold standard since other techniques not assessed by this work may be more effective.

Real-Time Monitoring of Climactic and Geotechnical Variables during Landslides on the Slopes of Serra do Mar and Serra da Mantiqueira (São Paulo State, Brazil)

The municipalities of Ubatuba, Campos do Jord?o, and S?o José dos Campos are located in the region of S?o Paulo State (Brazil). These municipalities are recognized nationally for having an elevated number of recorded landslides on slopes and embankments. In addition, these municipalities contain multiple areas that are at risk for landslides. Various soil landslides occurred in these municipalities in January 2013, when real-time climactic and geotechnical variables were monitored by automatic rain gauges, humidity sensors and soil temperature and suction devices. The resulting data were used to understand the functions of each variable in the occurrence of land- slides. Analyses of rainfall, humidity and soil temperature were used with field investigations to formulate a hypothesis regarding the predominant rupture mechanism and the role of each monitored variable in the deflagration of the soil landslides that occurred in the three studied municipalities. The geotechnical variable data revealed that both temperature and soil moisture contents played fundamental roles in the deflagration of shallow planar landslides in urban areas. The hourly rain intensity and/or rainfall accumulation for 24 and/or 72 h were responsible for the deflagration of the landslides that occurred in the studied areas, along with the existing anthropic constraints in the risk areas. Significant variations did not occur in the soil suction data during the landslides, principally due to the unsatisfactory sensor precision when reading field suction between –10 and?–100 kPA (±25%).

Profile of Patients Treated in Outpatient Vestibular Rehabilitation at a Hospital in São Paulo

Introduction: Currently it is very common that the search for diagnosis and treatment for curing diseases can cause vertigo or dizziness. Objective: This study sought to characterize the profile of patients seen in the clinic for vestibular rehabilitation in a tertiary hospital in the last 10 years. Methods: Survey questionnaires of patients with dizziness. Results: The prevalence of treated subjects was female 65.3% (N = 439). The average age was 54.9 years old. Dizziness type roundabout was more prevalent 33.04% (N = 222). Tinnitus occurred in 58.33% of the population. The time of most observed dizziness was less than 5 years 70.68% (N = 475). Neurovegetative symptoms appeared in 63.98% (N = 430) of the population. The bilateral normal hearing was more standard 35.26% (N = 237). The topographic diagnosis of peripheral origin was the most usual 65.47% (N = 440). Conclusion: The peripheral otoneurologic involvement was more prevalent in this population, affecting more women at an average age of 54.9 years old. The most prevalent symptoms were vertigo, nausea, tachycardia, sweating, vomiting and tinnitus, characterizing the peripheral vestibular impairment. The time of dizziness was less than five years. Audiological standard normal curve was predominant and the symptom of tinnitus was the most reported. The most prevalent comorbidity was Hypertension.

Sevoflurane Preconditioning and Total Knee Arthroplasty Bleeding: Randomized Controlled Trial

Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.

COVID-19 Downgraded Already Impaired Mental Health of Medical Undergraduates during the Pandemic Years

Background: Measures to contain the COVID-19 transmission reached teaching routines of universities worldwide with possible mental health consequences for anxiety. This study assessed prevalence and risk factors for stress, depression, and anxiety (SDA) in medical students during quarantine by COVID-19. Methods: A cross-sectional observational study of medical students by means of the DASS-21 questionnaire. Risk factors for SDA were assessed based on epidemiologic questions related to COVID-19. Receiver Operating Characteristics (ROC) curves were calculated for each predictor, as well as sensitivity and specificity. Results: This survey reached 1009 responses. A prevalence of 77.5% for some SDA disorder was found, 63% being severe. Previous diagnosis of psychiatric disorder was a factor of risk for anxiety (OR 2.78 CI95% 1.44 - 14.25, p = 0.044), as well as for depression (OR 3.37 CI95% 1.98 - 6.02, p Conclusion: Psychiatric conditions as well as chronic illnesses were risk factors for high prevalence of anxiety, depression and stress during the COVID-19 pandemic among medical students.

Role of Genetic Ancestry in Oropharyngeal Squamous-Cell Carcinoma: A Cross-Sectional Study in Brazil

Background: HPV infection represents an important etiologic factor for Oropharyngeal Squamous Cell Carcinoma (OPSCC). The different ethnic backgrounds could be related to different susceptibility to Human Papillomavirus (HPV). The aim of our study was to assess the whole of genetic ancestry in HPV status in OPSCC patients. Methods: We conducted a cross-sectional study on patients with OPSCC admitted to the Barretos Cancer Hospital, Brazil from 2014 to 2019. Of these, DNA extraction was performed on 40 patients and genetic ancestry was assessed using a specific panel of 46 informative ancestry markers. Results: We observed a predominance of European ancestry (63%), followed by African (18%), Amerindian (9%) and Asian (8%) both in the OPSCC HPV-positive and HPV-negative group. We did not find any statistically significant differences between the HPV-positive and HPV-negative OPSCC groups in relation to European (p = 0.499), African (p = 0.448), Asian (p = 0.275) or Amerindian (p = 0.836) ancestry. Conclusions: We found a predominance of European ancestry, both in the HPV-positive and HPV-negative groups. In our study, we did not find statistically significant differences between HPV-positive or HPV-negative groups in relation to ancestry.

Experimental Evaluation of Thermal Conductivity and Other Thermophysical Properties of Nanofluids Based on Functionalized (-OH) Mwcnt Nanoparticles Dispersed in Distilled Water

A possible way to increase thermal conductivity of working fluids, while keeping pressure drop at acceptable levels, is through nanofluids. Nanofluids are nano-sized particles dispersed in conventional working fluids. A great number of materials have potential to be used in nanoparticles production and then in nanofluids;one of them is Multi-Walled Carbon Nano Tubes (MWCNT). They have thermal conductivity around 3000 W/mK while other materials used as nanoparticles like CuO have thermal conductivity of 76.5 W/mK. Due to this fact, MWCNT nanoparticles have potential to be used in nanofluids production, aiming to increase heat transfer rate in energy systems. In this context, the main goal of this paper is to evaluate from the synthesis to the experimental measurement of thermal conductivity of nanofluid samples based on functionalized (-OH) MWCNT nanoparticles. They will be analyzed nanoparticles with different functionalization degrees (4% wt, 6% wt, and 9% wt). In addition, it will be quantified other thermophysical properties (dynamic viscosity, specific heat and specific mass) of the synthetized nanofluids. So, the present work can contribute with experimental data that will help researches in the study and development of MWCNT nanofluids. According to the results, the maximum increment obtained in thermal conductivity was 10.65% in relation to the base fluid (water).

Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Assessment of Pesticide Contamination in Cidade Dos Meninos, Rio de Janeiro, Brazil, Using Regional Screening Levels (RSL)

In the mid-20th century, the Malaria Institute in Brazil researched hexachlorocyclohexane (HCH), dichlorodiphenyltrichloroethane (DDT), and other organochlorines in Cidade dos Meninos, Rio de Janeiro, Brazil. After Malaria Institute closure, there was a 200-ton stock of chemicals compounds abandoned without any surveillance, which led to massive contamination of the nearby community by carcinogenic organochlorines. This article presents a new review of the Cidade dos Meninos’ case, analyzing the HCH and DDT contamination using a Haddon Matrix and Regional Screening Levels (RSL).

Challenges of the Global COVID-19 Pandemic and Invasive Fungal Pathogens in SARS-COV-2 Associations: A Dangerous Relationship

Background: COVID-19 is a rapidly transmissible pneumonia-like illness caused by SARS-CoV-2 that out broke in China in 2019 and is currently circulating worldwide. In the current context of the SARS-CoV-2 pandemic, complications are observed in clinical settings for the treatment of severe COVID-19 disease in nosocomial settings, due to cases of fungal co-infections. Objective: To carry out a review on fungal infections associated with respiratory infections caused by COVID-19 (Sars-Cov-2) and their aggravation. Methodology: The purpose of this study is to inform the reader about the characteristics of SARS-CoV-2 and the main fungal species that are affecting patients undergoing treatment for severe COVID-19, provoking discussion of the importance of the proposed topic, in relation to co-infections by different fungal microorganisms. Result: 80 scientific studies were selected, resulting from patients with COVID-19 and most commonly observed in patients with a history of comorbidities such as diabetes mellitus, hypertension, kidney disease, severe liver disease, oncological diseases, obesity and with severe COVID-19. These data do not represent the total number of records of the disease in the world, but cases reported by researchers in their series, showing the overlapping of fungal co-infection through the compromised immune status due to the use of therapeutic drugs, dysregulation of the microbiota, age of patients and the severity itself of the severe inflammation caused by COVID-19. Conclusion: The immunosuppression caused by the infection of COVID-19 concomitant with its therapy through corticosteroid therapy and comorbidities of the patients made fungal infections more susceptible, and these interfere in the evolution of the case and in the treatment of COVID-19, being relevant to distinguish secondary infections to therapy and the best possible reconstitution of the clinical picture.

Comparative Study of the Complications of Pedicular Screw Fixation Techniques in the Thoracolumbar Spine: A Systematic Review

Introduction: The use of pedicle screws increases postoperative stability and consolidation of arthrodesis. Pedicle arthrodesis is currently the standard treatment for the thoracolumbar spine, presenting the best fusion and stiffness rates, and among its main indications is the possibility of better correction of spine deformities in the thoracic and lumbar region. However, due to different definitions and the lack of a control group, many of these studies have limited comparative analysis, resulting in the scarcity of comparative studies with standardized methodology. Objective: It was to analyze, through a systematic review, the safety and efficacy of instrumentation with pedicle screws in the spine which have been questioned, despite its wide use for stabilization of the spine, comparing the complications present in the insertion techniques of pedicle screws. Methods: The rules of the Systematic Review-PRISMA were followed. The literary search process was carried out from January to March 2023. A bibliographic search was carried out in MEDLINE, PubMed, and Scielo for articles produced between 2001 and 2023. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. The Cohen test (Funnel Plot) and The Heterogeneity Test (Chi-Square Test – X2) were performed, with p Results and Conclusion: A total of 134 articles were found. A total of 67 articles were evaluated in full and 12 were selected to compose the results of this systematic review. According to the GRADE instrument, most studies (X2 = 90.2% > 50%) followed a controlled clinical study model and had a good methodological design, with p < 0.05. It was shown that poor positioning of pedicle screws is the most common cause of complications. The surgeon’s skills and the length and diameter of the pedicle screw can also affect the different modes of placement. Robotic computer assistance has the potential to reduce the incidence of postoperative revisions. Minimally invasive techniques have contributed to the reduction of surgical trauma and complications, thus allowing patients who had restrictions on performing the surgical approach, such as the elderly and critically ill patients, to undergo surgical treatment.

Residual Stress and Fracture Toughness Study in A516 Gr70 Steel Joints Welded and Repaired by Arc Processes

Structural components made of steel are used in several areas and require welding for assembly. In some situations, repair of the weld bead, also performed by electric arc welding, can be used to correct, and eliminate any discontinuities. However, electric arc welding causes the presence of residual stresses in the joint, which can impair its performance and not meet specific design requirements. In this paper, welded joints made of ASTM A 516 GR 70 steel plates, with a thickness of 30.5 mm, welded by the MAG—Metal Active Gas process (20% CO2) and using a “K” groove were analysed. The joints were manufactured with seven welding passes on each side of the groove. After welding, one batch underwent repair of the bead by TIG welding (Tungsten Insert Gas) and another batch underwent two repairs by TIG welding. Were presented results of the behaviour of the residual stress profile measured by X-ray diffraction and the Vickers microhardness profile in the joints as well the fracture toughness in the conditions only welded and submitted to repairs. The results indicated that the greater number of repair passes reduced the residual compressive stress values obtained in the material manufacturing process and caused a stabilization on the Vickers hardness values. It was concluded that compressive residual stresses did not play a major role in the R-curve results. The presence of discontinuities in the welded joint caused greater influence on the behaviour of the R curve.

Designing Artemisinins with Antimalarial Potential, Combining Molecular Electrostatic Potential, Ligand-Heme Interaction and Multivariate Models

Artemisinins tested against W-2 strains of malaria falciparum are investigated with molecular electrostatic potential (MEP), in an attempt to identify key features of the compounds that are necessary for their activities, as well as to investigate likely interactions with the receptor in a biological process and to use that information to propose new molecules. In order to discover the best geometry involving the ligand-receptor complexes (heme) studied and help in the proposition of the new derivatives, molecular simulations of interactions between the most negative charged region around the peroxide and heme locates (the ones around the Fe2+ ion) were carried out. In addition, PCA (principal components analysis), HCA (hierarchical cluster analysis), SDA (stepwise discriminant analysis), and KNN (K-nearest neighbor) multivariate models were employed to investigate which descriptors are responsible for the classification between the higher and lower antimalarial activity of the compounds, and also this information was used to propose new potentially active molecules. The information accumulated in studies of MEP, molecular docking, and multivariate analysis supported the proposal of new structures with potential antimalarial activities. The multivariate models constructed were applied to the new structures and indicated numbers 19 and 20 as the most prominent for syntheses and biological assays.

Numerical Simulation of Saint-Venant Equations with Thermal Energy Dependency: Applications on Global Warming

Since the Industrial Revolution, humanity has been intensifying the burning of fossil fuels and as a consequence, the average temperature on Earth has been increasing. The 20th century was the warmest and future prospects are not favorable, that is, even higher temperatures are expected. This demonstrates the importance of studies on the subject, mainly to predict possible environmental, social and economic consequences. The objective of this work was to identify the interference of the increase in ambient temperature in the dynamics of fluids, such as ocean waves advancing over the continent. For this, thermal energy was considered in the Saint-Venant equations and computational implementations were performed via Lax-Friedrichs and Adams-Moulton methods. The results indicated that, in fact, depending on the amount of thermal energy transferred to the fluid, the advance of water towards the continent can occur, even in places where such a phenomenon has never been observed.

Important Issues and Results When Considering the Stochastic Representation of Wind Power Plants in a Generation Optimization Model: An Application to the Large Brazilian Interconnected Power System

Wind power has an increasing share of the Brazilian energy market and may represent 11.6% of total capacity by 2024. For large hydro-thermal systems having high-storage capacity, a complementarity between hydro and wind production could have important effects. The current optimization models are applied to dispatch power plants to meet the market demand and optimize the generation dispatches considering only hydroelectric and thermal power plants. The remaining sources, including wind power, small-hydroelectric plants and biomass plants, are excluded from the optimization model and are included deterministically. This work introduces a general methodology to represent the stochastic behavior of wind production aimed at the planning and operation of large interconnected power systems. In fact, considering the generation of the wind power source stochastically could show the complementarity between the hydro and wind power production, reducing the energy price in the spot market with the reduction of thermal power dispatches. In addition to that, with a reduction in wind power and a simultaneous dry-season occurrence, this model, is able to show the need of thermal power plants dispatches as well as the reduction of the risk of energy shortages.

Development and Validation of Two Methods to Quantify Volatile Acids (C2-C6) by GC/FID: Headspace (Automatic and Manual) and Liquid-Liquid Extraction (LLE)

The concentration of the volatile fatty acids (VFA) is an important indicator of the status of an-aerobic processes, but most of the existing methods require sample pretreatment and are labor-intensive. It was developed and validated a rapid Gas Chromatographic (GC) method to quantify seven VFA (acetic, propionic, isobutyric, butyric, isovaleric, valeric and caproic), acetone, methanol, ethanol and n-butanol by headspace (automatic and manual) and liquid-liquid extraction (LLE) with diethyl ether (only VFA). The determination was made in a Shimadzu Gas Chromatograph equipped with a Flame Ionization Detector (GC/FID), a headspace auto-sampler and an HP-INNOWAX column. Isobutanol and crotonic acid were utilized as internal standards (IS). The validation parameters evaluated were: precision (coefficient of variation—C.V.% for the retention times, from 0.02 to 0.87), linearity (R2 = 0.9291 - 0.9997), limits of detection (from 3.97 to 36.45 mg·L﹣1) and instrumental precision (from 0.01 to 0.53), which provide evidence that the methods are adequate to determine these analytes in samples from anaerobic reactors and from the environment.

Comparative Study between Endometrial Resection and Electrocoagulation in Patients with Abnormal Uterine Bleeding

Objective: To compare clinical outcomes between two first-generation endometrial ablation techniques. Design: Prospective comparative coorte. Setting: Tertiary public hospital, university teaching center. Seventy-three patients with abnormal uterine bleeding unresponsive to clinical treatment submitted to endometrial ablation from October 2011 to September 2013. Methods and Main Outcome Measures: Patients were assigned to either monopolar U-shaped electrode resection with rollerball electrocoagulation (group A, n = 36) or rollerball electrocoagulation alone (group B, n = 37). Mean follow-up length was 359 (280 - 751) and 370 days (305 - 766) in groups A and B, respectively. Bleeding pattern, associated symptoms, failure/success rates were assessed 30, 90, 180 and 360 days post-procedure. Findings: Patient characteristics were similar in both groups (P ≥ 0.05). Surgery duration (mean of 48.5 [±12.0] vs. 31.9 [±5.6] min, P Conclusions: Endometrial ablation using rollerball electrocoagulation alone may be considered safer than resection with rollerball electrocoagulation, which requires shorter surgical time and less distention medium, and is associated with lower postoperative vaginal discharge incidence. Success rate did not statistically differ between groups, but study parameters in absolute values and percents were superior in group B.

Asymptomatic Intrahepatic Portosystemic Venous Shunt: Case Report and Review of Literature

A spontaneous portosystemic shunt is a rare malformation of the liver vessels. The etiology of these shunts is controversial. They can be divided into acquired (most commonly associated with liver cirrhosis) and congenital. Vascular shunts are asymptomatic in the majority of the patients, and when symptomatic were presented by severe complications. The specific way of management can be selected depended on whether the patient was symptomatic or not, and also on the size of the shunt, shunt ratio and whether it was associated with cancer. We will present a clinical case and discuss the importance of the radiological imaging in the screening, diagnosis and follow up of these anomalies.

Deep and Ultra-Deep Earthquakes Worldwide, Possible Anomalies in South America

The aim of this paper is to evaluate the worldwide variation of deep and ultra-deep earthquakes (DQ and UDQ) during the period 1996-2017. This project found only three locations around the globe presenting this kind of seismicity. Although there are other global settings showing deep seismicity, they are not periodical and cannot be considered by a statistical view. The three areas with intense activity for DQ and UDQ events are located mostly in subduction areas. The largest variations of DQ and UDQ border the Pacific Ocean and include the North Pacific, South Pacific, and South America. The major difference in this set is that the first two sites are subduction zones and the South American occurrences happened in the interior of the continent. Another anomaly is an internal layer between 300 - 500 km in South America that shows no tremors in the period studied. However, below 500 km activity reappears, even at extreme depths of up to 650 km. We suggested that the reason for those occurrences would be due to an anomaly in the asthenosphere in this region. This anomaly would probably be presenting a breakable material that was pushed by the Nazca platform against the South America plate. Other depths below 100 km in all the regions are discussed as well. We suggested that the reason for those occurrences was an anomaly created in the asthenosphere as part of the process of the South America collision with the Nazca plate. Part of the Nazca plate has subducted below South America, creating a slab as deep as 500 km. The convergent slab is still moving against South America and sinking due to the gravity and rotation of the Earth. The discrepancies in the occurrences we tracked at different locations indicated that this slab had different thicknesses around South America. We found similar results for Vanuatu and Fiji;in these regions UDQ events occur at the subduction zones under the ocean with depths greater than 700 km. Here, a possible explanation is that part of the lithosphere is subducted at these depths and is causing tremors.

Reducing Intermittence of Renewable Energy Sources with Seasonal-Pumped-Storage Plants

This paper presents a computational method to model and evaluate if Pumped Storage Plants (PSP) have the potential to reduce the intermittency of wind generation from different sites in Brazil and to improve the operation efficiency of hydroelectric plants when operating in cascade. Since the problem to be solved does not have a defined analytic solution, a Stochastic Optimization Algorithm was implemented to reach an optimal solution to the set of equations, inputs and proposed scenarios. A case study was developed based on the Paraná River Basin and the results shows that the model can operate in a variety of different operational patterns, making feasible the evaluation of different hydrological and wind scenarios. Given the Model support, it is easy to assume different PSP storage and generation capacities, allowing the comparison between the efficiency improvement of a conventional Pumped-Storage and a Season-al-Pumped-Storage in the same scenario. The study concludes that a PSP can effectively reduce the intermittency of wind and solar sources and contribute to the optimization of the Brazilian electricity sector.