As fraturas do fêmur proximal são frequentes em idosos, consideradas uma devastadora consequência da osteoporose, acometem mais o sexo feminino, estão comumente associadas a traumas de pequena energia e, embora apresentem poucas complicações referentes a consolidação no caso das fraturas extracapsulares, estão relacionadas a déficits funcionais, a elevadas taxas de morbidade e mortalidade, além dos altos custos aos serviços de saúde. Representam importante problema de saúde pública mundial devido a sua alta incidência. Trata-se de um estudo retrospectivo com base em um levantamento de prontuários, objetivando caracterizar os pacientes com fraturas do fêmur proximal atendidos na Santa Casa de Misericórdia de Batatais SP. Foram analisados 258 prontuários, de 258 pacientes, correspondendo a 260 fraturas do fêmur proximal (duas fraturas bilaterais) de indivíduos atendidos na Santa Casa de Misericórdia de Batatais no período de janeiro de 2007 a dezembro de 2010 com idade média de 74,8 anos, com predomínio de fraturas na faixa etária entre 80 e 89 anos (35,8%), mulheres (64,6%) e que se declaravam brancos (73%). As fraturas trocantéricas foram as mais incidentes com 60% dos casos, o mecanismo de trauma mais comum foi a queda da própria altura com 91,1% e o lado mais acometido foi o direito com 51,9%. O tratamento cirúrgico foi aplicado a 95,7% das fraturas do fêmur proximal. Dos 258 pacientes incluídos no estudo, 50 foram a óbito, sendo frequente entre as mulheres (61,6%) e o período mais incidente foi com três meses após a fratura. / Proximal femur fractures (PFFs) are common among the elderly. Rendered as a devastating consequence of osteoporosis, women are the most affected. PFFs are commonly associated with low-energy traumas, and, although they have few complications related to consolidation in the case of extracapsular fractures, they are related to functional deficits, high morbidity and mortality rates, besides being costly to health services. Due to the high incidence, PFFs are considered a relevant global public health issue. This is a retrospective study based on a survey of patient records with the objective to characterize the patients with proximal femur fractures seen at the Santa Casa de Misericórdia de Batatais Hospital São Paulo. A total of 258 patient records were analyzed, corresponding to 260 proximal femur fractures (two bilateral fractures) of individuals seen at Santa Casa de Misericórdia de Batatais between January of 2007 and December 2010. Most subjects were women (64.6%) with a mean age of 74.8 years, most in the age group between 80 and 89 years (35.8%), and self-declared being white (73%). Trochanteric fractures were the most common, with 60% of cases. The most common trauma mechanism was falling from ones own height with 91.1%, and the most affected side was the right side with 51.9%. Surgery was the chosen treatment in 95.7% of the proximal femur fractures. Of all the 258 study patients, 50 died, mostly women (61.6%), and the most incident time was at three months after the fracture.

Submitted by Cátia Araújo (catia.araujo@unipampa.edu.br) on 2017-01-26T12:21:32Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Analise numérica e experimental da fratura em materiais quase frágeis.pdf: 6564317 bytes, checksum: 0170494c4f4ae0ff6e64f917d9bd4d0a (MD5) / Approved for entry into archive by Cátia Araújo (catia.araujo@unipampa.edu.br) on 2017-01-26T12:21:51Z (GMT) No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Analise numérica e experimental da fratura em materiais quase frágeis.pdf: 6564317 bytes, checksum: 0170494c4f4ae0ff6e64f917d9bd4d0a (MD5) / Made available in DSpace on 2017-01-26T12:21:51Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Analise numérica e experimental da fratura em materiais quase frágeis.pdf: 6564317 bytes, checksum: 0170494c4f4ae0ff6e64f917d9bd4d0a (MD5) Previous issue date: 2016-05-09 / Neste trabalho, são realizados estudos experimentais e simulações de ensaios de tração simples para analisar a fratura em materiais quase frágeis. São utilizados três tipos de poliestireno expandido para a confecção de seis modelos de corpos de prova com variações dimensionais. Para evitar a repetitividade, são apresentados e discutidos os resultados experimentais e numéricos obtidos para um tipo de poliestireno expandido, os demais são apresentados no apêndice do trabalho. São analisadas as propriedades mecânicas dos materiais estudados, sendo esses dados posteriormente utilizados nas simulações realizadas através do método dos elementos discretos formados por barras (LDEM). Este método também e utilizado no ambiente do Abaqus para a realização de simulações nas quais uma parte do corpo de prova e modelada em elementos discretos e o restante em elementos finitos. Os ensaios experimentais de tração mostraram que os materiais sofrem um efeito de escala, sendo que os maiores corpos de prova apresentaram uma menor deformação de ruptura. O LDEM utilizado para simular esses ensaios mostrou-se uma boa ferramenta para analisar aa fratura e o efeito de escala em materiais quase frágeis, além disso, sua utilização no ambiente de Abaqus mostrou que os corpos de prova não deformam somente na região central. As simulações no LDEM e no LDEM-Abaqus mostraram que e possível simular somente a região central dos corpos de prova desde que sejam levados em conta os valores de energia elástica. Além disso, através de uma sub-rotina implementada no LDEM foi possível a criação de um mapa de dano da estrutura, possibilitando observar a localização do dano. / In the present work the experimental study and the simulation of simple tensile tests are carried out to analyze the fracture in quasi fragile materials. Three types of expanded polystyrene for the make six models of specimens with dimensional variations are used. However to avoid repetitiveness, is shown and discussed the experimental and numerical results obtained for one type of expanded polystyrene and the results for the other are shown in the appendices. It also analyzed the mechanical properties of the materials studied and the data is subsequently used in the simulations performed by the Lattice Discrete Element Method. It addition, this method is used in Abaqus environment for performing simulations in which part of the specimen is patterned into discrete elements and the remainder in finite elements. The tensile tests showed that the materials suffer a size effect, and the bigger specimens had a shown low rupture strain. The LDEM used to simulate the tests proved to be a good tool to analyze the fracture and size effect on quasi-fragile materials, moreover, their use in Abaqus environment showed that the samples do not strain only in the central region. Simulations in LDEM and LDEM-Abaqus showed that it is possible to simulate only the central region of the specimens provided that are not taken into account the values of elastic energy. Furthermore, by a subroutine implemented in LDEM it was possible to create a structure damage map, allowing observation of the location of the damage.

Introdução: A osteoporose (OP) é doença caracterizada pela fragilidade do osso e, consequentemente, pelo incremento do risco de fraturas. É considerada problema de saúde pública na maioria dos países. Evidências epidemiológicas apontam associação entre variáveis sociodemográficas, variáveis de estilo de vida (como a ingestão de alimentos e de bebidas alcoólicas e hábito de fumar), e indicadores antropométricos (como índice de massa corporal -IMC-) e risco de OP e fraturas osteoporóticas. Objetivo: Estimar a incidência de OP e a prevalência de fraturas referidas, em idosos domiciliados no Município de São Paulo e verificar associação com variáveis sociodemográficas, de estilo de vida, e IMC. Método: analisaram-se dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento) 2000 - 2006, o qual é estudo epidemiológico, longitudinal, de base domiciliar, cuja amostra inicial foi composta por 2143 idosos (&#8805;60 anos), de ambos os sexos, residentes habituais de domicílios urbanos no Município de São Paulo, e selecionados por amostragem probabilística, sendo que 829 idosos (39%) constituíram a amostra de estudo, em 2000, para análise da incidência de OP referida, em 2006, e 1072 idosos (50%) foi a amostra de estudo para análise de prevalência de fraturas após 60 anos referidas, em 2006. Investigou-se a associação entre variáveis sociodemográficas (sexo, grupo etário, vida no campo por 5 anos ou mais durante a infância ou adolescência, escolaridade e etnia), de estilo de vida (ingestão referida de leite e produtos lácteos, ovos e leguminosas, carnes, peixes e aves, frutas e verduras, frequência de ingestão de bebidas alcoólicas, e hábito de fumar); e variável antropométrica (IMC), com relação à referência de OP e fraturas após 60 anos, em 2006. Para verificar associação entre as variáveis categóricas e o desfecho, utilizou-se o teste de Rao & Scott (p<0,05) e a análise de regressão logística univariada (IC95%).O programa Stata, versão 10.1 foi usado para realizar os cálculos estatísticos. Resultados: Houve 114 casos novos de OP referida em 2006, sendo que o coeficiente de incidência (CI) de OP referida foi estimado em 13,93/1000 pessoas-ano (IC95%=11,60 16,87). O CI de OP referida em mulheres foi 22,95/1000 pessoas-ano (IC95%: 19,08 27,87), e 3,34/1000 pessoas-ano (IC95%: 1,85 6,73), em homens.A prevalência de fraturas após os 60 anos referidas foi 17,16%. Sexo feminino (OR= 7,69; p=0,000) e ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR= 2,26; p=0,019), foram fatores de risco para referência de OP. Sexo feminino (OR=2,38;p=0,000), idade avançada (&#8805;75 anos)(OR=1,72; p=0,012), ingestão referida de bebidas alcoólicas < 4 vezes/semana (OR=2,45; p=0,016), referência de OP em 2000 (OR=1,75; p=0,048), e referência de OP em 2006 (OR=2,29; p=0,000), foram fatores de risco para referência de fraturas após 60 anos. Conclusões: sexo feminino, idade avançada foram fatores de risco para OP e fraturas após os 60 anos. Dentre as variáveis modificáveis, a ingestão de bebida alcoólica com frequência &#8805; 4 vezes/semana, esteve negativamente associado à referência de OP e fraturas após 60 anos. / Introduction: Osteoporosis (OP) is a disease characterized by bone fragility and increased risk of fractures. It is considered a public health problem worldwide. Epidemiological studies have found association between sociodemographic, lifestyle and anthropometrical variables and increased risk of OP and osteoporotic fractures. Objetive: To estimate incidence of self-reported OP, in 2006, and prevalence of fractures after the age of 60 year-old, on a sample of elderly individuals from the Município de São Paulo, and verify association between selected variables and outcome. Method: based on data from the SABE Study (health, well-being and aging) 2000 - 2006, which is an epidemiological prospective study of a probabilistic household sample of elderly population ((&#8805; 66 y), of both sexes, from São Paulo City, Brazil. Association between sociodemographic (sex, age, life in rural area for 5 year or more during childhood or adolescence, schooling, and race) lifestyle (reported food intake (milk and dairy products, eggs and legumes, meat, fish and poultry, fruit and vegetables), reported alcoholic beverages intake) and smoking habit; and anthropometrics\' variables, such as body mass index (BMI) and self-reported OP and fractures after the age of 60 year-old, in 2006. Rao & Scott Test was used to verify association between the categorical variables and outcome (p<0,05) as well as simple logistic regression (CI95%). Stata software, version 10.1, was used for statistical calculation. Results: There were 114 new cases of self-reported OP in 2006, and an incidence rate of 13,93/1000 persons-year (IC95%=11,60 - 16,87). In women the incidence rate was 22,95/1000 persons-year (CI95%: 19,08 - 27,87), and in men it was 3,34/1000 persons-year (IC95%: 1,85 - 6,73). Prevalence of self reported fractures after de age of 60 y was estimated in 17,16%. Female sex (OR= 7,69; p=0,000) and frequency of reported alcoholic beverages intake < 4 times/week (OR= 2,26; p=0,019), were risk factors for self-reported OP. Female sex (OR=2,38;p=0,000), advanced age (&#8805;75 y) (OR=1,72; p=0,012), frequency of reported alcoholic beverages intake < 4 times/week (OR=2,45; p=0,016), self-reported OP in 2000 (OR=1,75; p=0,048), and self-reported OP in 2006 (OR=2,29; p=0,000), were risk factors for reporting fractures after the age of 60 years-old Conclusions: female sex, advanced age, were risk factors for reported OP and fractures after 60 y. Among modifiable variables, intake of alcoholic beverages as often as > 4 times/week was negatively associated with reported OP and fractures after the age of 60 y.

A terapia celular é uma ferramenta que tem se mostrado eficiente para o tratamento de várias patologias veterinárias em estudos experimentais e clínicos, incluindo a estimulação osteogênica para o tratamento de não união e reparo de fraturas distais de rádio e ulna em cães. Muitas são as vantagens da utilização de células-tronco, ela é um tipo diferenciado de célula com alta capacidade de proliferação, auto renovação, produção de diferentes linhagens celulares e regeneração de tecidos, estando presente em embriões, células de cordão umbilical e medula óssea.O objetivo deste trabalho foi a avaliação clínica e radiográfica de pacientes com fraturas distais de rádio e ulna após cirurgia e tratamento com células-tronco de medula óssea de fetos caninos diretamente no foco da fratura. As avaliações radiográficas mostraram cicatrização óssea a partir de 45 dias pós-cirurgia nos dois grupos estudados, somente com cirurgia convencional e implantes e também no grupo da cirurgia convencional com implantes associada à terapia com células-tronco de medula óssea. Mostrando assim, que a terapia celular pode ser uma ferramenta favorável para auxiliar na consolidação óssea de fraturas distais de rádio e ulna. Paralelamente, realizamos um estudo com coelhos da Nova Zelândia para avaliar radiograficamente e histologicamente o uso de um scaffold esponja de colágeno com células tronco de medula óssea em modelo de fratura similar ao encontrado em cães realizado neste presente estudo, e observamos que um scaffold com células no local da fratura pode auxiliar de forma significativa na consolidação óssea. / Cell therapy has been an effective tool for the treatment of several animal diseases in experimental and clinical studies, including osteogenic stimulation for the treatment of non-union and repair fractures of distal radius and ulna in dogs. There are many advantages of using stem cells since this differentiated cell type has high proliferation capacity, self renewal, production of different cell lines and tissue regeneration, being present in embryos, cells from umbilical cord and bone marrow. The aim of this study was to perform a clinical and radiographic evaluation of dogs with distal radius and ulna fractures after surgery and treatment with stem cells from canine fetuses bone marrow directly into the fracture. Radiographic evaluations showed bone regeneration from 45 days post-surgery in both groups, only with conventional surgery and implant and also in the conventional surgery group with implants associated with stem cells from bone marrow therapy. Thus, cell therapy can be a favorable tool to assist in bone healing of distal fractures of radius and ulna. In parallel, we conducted a study with New Zealand rabbits for radiologically and histologically evaluate the use of a scaffold - collagen sponge with bone marrow stem cells - similar to that found in the fracture model in dogs performed in the present study, and we observed that an scaffold with cells on fracture site can help significantly in bone healing.

临床及动物实验的文献报告表明, 低能量脉冲超声波 (LIPUS) 能促进骨折愈合。 可是, 不同研究小组针对LIPUS的功效所提供的数据结果往往并不一致。为了找出导致数据结果不一致的原因, 以及提升LIPUS的生物功效, 科研人员正致力于测定超声波在骨折治疗中的最佳信号参数。 在临床运用上, LIPUS对骨折的治疗一般是以经皮方式应用的。 故此, 不同层次深度的骨折会暴露在不同的超声波场区里。 超声波场有两个不同的区域, 就是近场区 (接近超声波换能器的区域) 及远场区 (远离超声波换能器的区域)。 在我们早期的临床研究中, 我们曾使用超声波的近场区治疗胫骨的复杂性骨折。 我们发现, 当超声波换能器置于胫骨骨折处的前方, 骨痂集中生成于胫骨骨折处的背面。 这研究结果显示, 近场区以外的超声波场或许更具促进骨痂形成的功效。 再者, 针对LIPUS声场仿真分析的结果显示, 近场区内的声压分布是不稳定的, 而远场区内的声压则远比近场区的均及稳定。由于声压的稳定性会大大影响超声波于组织内的能量透射, 我们相信在超声波场中, 骨折的深度会影响LIPUS的生物效应。 / 本研究采用大鼠闭合性股骨骨折模型及细胞培养实验, 探究不同的超声波场区对骨折愈合的影响。本研究作出了以下三个科研假设: (1) LIPUS 的远场区在促进骨折愈合的应用上有着更高的生物效应; (2) LIPUS 的远场区能透过促使骨细胞产生旁分泌调节因子, 从而提升成骨细胞的成骨活性; (3) 通过换能器直径的调制而产生的LIPUS远场区能有效地促进骨折愈合。 / 在第一部分的实验里, 股骨骨折的SD大鼠被随机分为对照组 (control), 近场区超声波治疗组 (near field; 伤肢跟换能器相距0mm), 中近场区超声波治疗组 (mid-near field; 伤肢跟换能器相距60mm), 远场区超声波治疗组 (far field; 伤肢跟换能器相距130mm)。在伤肢及超声波换能器之间安放了跟软组织具有同一超声波衰减系数的凝胶 (长度: 0mm, 60mm, 130mm)。LIPUS每天治疗20分钟, 每周治疗5天。 我们研究结果显示, 治疗后的第四周, 远场治疗组的骨痂组织具有各组中最高的相对骨体积及组织矿密度, 这造就远场治疗组相比对照组具有更强的力学属性。我们的研究结果表明, LIPUS的远场区治疗能通过提升骨痂的骨体积及骨矿化, 进一步促进骨折的愈合。 / 在第二部分的实验里, 我们把骨细胞株(MLO-Y4) 暴露在三種不同的超声波場中: 0 mm, 60 mm 及130 mm 。 经过不同的LIPUS处理后, 我们把条件培养基(CM) 收集, 并将其用于培养成骨前趋细胞株(MC3T3-E1)。 这部分的实验共有5组: Non组(非条件培养基处理组), Con组(骨细胞条件培养基处理组), 0mm组(条件培养基处理组; 条件培养基收集自经过LIPUS近场区刺激后的骨细胞), 60mm组(条件培养基处理组; LIPUS中近场区刺激后的骨细胞), 以及 130mm组(条件培养基处理组; LIPUS远场区刺激后的骨细胞)。我们测试了各超声波场对骨细胞的直接影响, 以及成骨前趋细胞经过各类骨细胞条件培养基培养后的成骨活性。 免疫染色的结果显示近场区以后的超声波场 (130mm 及 60mm) 能进一步诱导β-catenin 于骨细胞的入核作用。 另外, 远场区的骨细胞条件培养基 (130mm CM) 的处理促进了成骨前趋细胞的: (1) 细胞迁移的能力 (反映自细胞伤口愈合测试) ; (2) 细胞分化成熟的机制 (BrdU细胞增殖检验及ALP活性分析): (3) 基质钙化 (Alizarin red 钙化结节染色)。 / 在第三部分的实验里, 我们把换能器的直径缩减致一半, 以致换能器跟LIPUS远场区之间的距离从130 mm被拉近至30 mm。 当LIPUS以经皮的方式应用, 位于皮下大约40 mm的大鼠股骨骨折因此暴露在LIPUS的远场区。 相对于在换能器及伤肢之间安置130 mm凝胶, 以调制换能器直径而直接让骨折暴露于LIPUS远场区是更具临床应用性的方法。 在这部分, 股骨骨折的SD大鼠被随机分为对照组 (control), LT-Near30 (正常的换能器直径; 近场超声处理; I[subscript SATA] = 30 mW/cm²), ST-Far30 (缩减后的换能器直径; 远场超声处理; I[subscript SATA] = 30 mW/cm²), ST-Far150 (缩减后的换能器直径; 远场超声处理; I[subscript SATA] = 150 mW/cm²)。 研究结果证实, 以调制换能器直径而产生的远场LIPUS (ST-Far30)能透过提升骨痂的生成及力学属性, 进一步促进骨折愈合。 同时, 我们的结果显示, 相对高强度 (150 mW/cm²) 的远场LIPUS治疗不能更有效地促进骨折愈合。 / 综上所述, 动物及细胞培养实验结果证明, LIPUS的远场区在促进骨折愈合上更具功效。由于LIPUS的远场区放射稳定的超声波束, 骨痂中的骨细胞受引发释放可溶性因子, 从而进一步激发成骨样细胞的成骨活性。 这些细胞的生物效应造就LIPUS的远场区在促进骨折愈合上更具治疗效果。最后, 我们亦把以上的研究发现转化成具临床应用性的LIPUS应用方法。 这应用方法能让超声波换能器以紧贴皮肤的方式直接使骨折暴露于LIPUS远场区, 从而达成促进骨折愈合的功效。 / Low-intensity Pulsed Ultrasound (LIPUS) has been confirmed to enhance fracture healing in many clinical and animal studies. However, the evidences from literatures to support the applications of LIPUS on fracture healing were inconsistent. Therefore, scientists have been studying various ultrasound parameters aiming to find out the factors resulting in the inconsistent outcomes among research groups, and to further enhance the efficacy of LIPUS. Clinically, LIPUS is usually applied onto fracture sites transcutaneously, hence, fractures at different depths are exposed to different zones of ultrasound beam. There are two characteristic zones of ultrasound beam: the near field (close to the transducer) and far field (farther from the transducer). In our previous clinical study, direct transcutaneously applied LIPUS (near field LIPUS exposure) was used to treat human tibial complex fractures. We found that callus usually formed on the posterior side when the transducer was placed on the anterior side. This finding implied that ultrasound beam beyond near field bears higher potential in promoting callus formation. Moreover, beam mapping measurement of LIPUS shows a variable spatial pressure in near field; while a more uniform pressure profile was found beyond it (far field). As the stability of pressure profile influences the ultrasound energy transmission in tissue, we postulate that the biological effects of LIPUS are affected by the fracture depths within the ultrasound field. / This study aims to address the research question of how ultrasound fields influence the fracture healing through testifying the following hypotheses in animal and cell culture studies: (1) Far field LIPUS bears higher biological effect in facilitating fracture healing; (2) Far field LIPUS could enhance the osteogenic activities of osteoblastic cells via paracrine factors secreted from osteocytes; (3) Far field LIPUS setup by transducer diameter modulation could facilitate fracture healing. / In part one study, femoral fractured Sprague-Dawley (SD) rats were randomized into control, near-field (fractures placed at 0mm away from transducer), mid-near field (60mm away from transducer) or far-field (130mm away from transducer) groups. Rubber gel block (lengths: 0mm, 60mm and 130mm) with attenuation coefficient equivalent to soft tissue was interposed between the transducer and the fractured limb. LIPUS was given 20min/day and 5days/week. We found the callus in 130mm group was the highest in bone volume fraction and tissue mineral density at week 4. These advancements mutually contributed to its significantly stronger mechanical properties than the control group. Our results indicated that far field LIPUS could further facilitate fracture healing by promoting bone volume increase and callus mineralization, which led to enhanced mechanical properties. / In part two study, LIPUS was applied to osteocyte cell line (MLO-Y4) at three distances: 0mm, 60mm and 130mm. The conditioned medium (CM) collected from different LIPUS treatment regimens were used to culture pre-osteoblast cell line (MC3T3-E1). There were 5 groups in the CM treatment: Non group (plain α-MEM treatment), Con group (osteocyte CM), 0mm group (Near field LIPUS treated osteocyte CM), 60mm group (Mid-near field LIPUS treated osteocyte CM) and 130mm group (Far field LIPUS treated osteocyte CM). The effect of ultrasound fields on osteocytes and the osteogenic activities of the pre-osteoblasts after different CM treatments were assessed. The immunostaining results indicated that beyond near field LIPUS (LIPUS at 130mm and 60mm) could further promote β-catenin nuclear translocation in osteocytes. The far field LIPUS osteocyte-CM (130mm group) caused the highest biological effect on (1) pre-osteoblasts migration (reflected by wound healing assay); (2) maturation of pre-osteoblasts: transition of cell proliferation into osteogenic differentiation (BrdU cell proliferation assay and ALP activity assay); and (3) matrix calcification (Alizarin red calcium nodule staining). / In part three study, the transducer diameter was reduced by half in order to draw the far field location closer to the transducer (i.e. from 130 mm to 30 mm). As the femoral shaft fractures of rats are located at around 40 mm beneath the skin, fractures were directly exposed to far field LIPUS transcutaneoulsy. It is a more clinically applicable approach than the method of physical separation (i.e. 130 mm separation between transducer and fractured limb). Femoral fractured SD rats were randomized into control, LT-Near30 (conventional transducer diameter, near field, I[subscript SATA] = 30 mW/cm²), ST-Far30 (small transducer, far field, I[subscript SATA] = 30 mW/cm²) and ST-Far150 (small transducer, far field, I[subscript SATA]=150 mW/cm²). Our results confirmed that the far field LIPUS emitted from the transducer diameter reduction setup (ST-Far30) could further facilitate fracture healing process by enhancing callus formation and mechanical properties. Our findings also indicated that fractures exposed to far field LIPUS with relatively higher intensity (150 mW/cm²) did not heal better. / In summary, our in vivo and in vitro findings reinforce each other to confirm the positive effects of far field LIPUS on promoting fracture healing. As far field LIPUS radiates a stable ultrasound beam, osteocytes inside the callus are triggered to secrete soluble factors to promote the osteogenic activities of osteoblastic cells. This contributes to the higher therapeutic effects of far field LIPUS on fracture healing. We also translated these findings to establish a clinically applicable LIPUS device, which directly radiates far field LIPUS to subcutaneous fracture site without any distance separation needed. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Fung, Chak Hei. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 186-207). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i / 中 文 摘 要 --- p.v / Publications --- p.ix / Acknowledgements --- p.xii / List of Abbreviations --- p.xiii / Index for Figures --- p.xvi / Index for Tables --- p.xviii / Chapter Chapter 1. --- Introduction and Literature Review --- p.1 / Chapter 1.1 --- Long Bone Fracture - A Growing Global Challenge --- p.2 / Chapter 1.2 --- Long-Bone Fracture - Current Management and Limitations --- p.5 / Chapter 1.3 --- Cellular Biology of Fracture Healing --- p.7 / Chapter 1.3.1 --- Stage 1: Inflammation --- p.7 / Chapter 1.3.2 --- Stage 2: Soft callus formation --- p.8 / Chapter 1.3.3 --- Stage 3: Hard callus formation --- p.9 / Chapter 1.3.4 --- Bone Remodeling --- p.10 / Chapter 1.4 --- Biophysical Stimulation to Bone --- p.13 / Chapter 1.5 --- Low-intensity Pulsed Ultrasound --- p.14 / Chapter 1.5.1 --- Application of LIPUS on Fracture Healing --- p.14 / Chapter 1.5.2 --- Physics of Ultrasound --- p.16 / Chapter 1.5.3 --- Ultrasound Parameters --- p.20 / Chapter 1.5.3.1 --- Ultrasound Frequency --- p.20 / Chapter 1.5.3.2 --- Duty Cycle --- p.22 / Chapter 1.5.3.3 --- Intensity --- p.22 / Chapter 1.5.3.4 --- Angle of Incidence --- p.24 / Chapter 1.5.3.5 --- Ultrasound Field --- p.25 / Chapter 1.5.4 --- Possible Mechanism of LIPUS on Tissue --- p.31 / Chapter 1.5.4.1 --- Thermal Effect --- p.31 / Chapter 1.5.4.2 --- Cavitation --- p.31 / Chapter 1.5.4.2 --- Acoustic Streaming --- p.32 / Chapter 1.5.4.3 --- Frequency Resonance Hypothesis --- p.32 / Chapter 1.5.4.4 --- Micromotion --- p.33 / Chapter 1.6 --- Possible Cellular and Molecular Mechanotransduction Mechanism of LIPUS --- p.34 / Chapter 1.6.1 --- Osteocyte: Potential Mechanosensor --- p.34 / Chapter 1.6.3 --- Osteocyte-osteoblast mechanotransduction --- p.39 / Chapter 1.7 --- Hypothesis --- p.39 / Chapter 1.8 --- Study Plan and Objectives --- p.40 / Chapter 1.8.1 --- Study Plan --- p.40 / Chapter 1.8.2 --- Objectives --- p.42 / Chapter Chapter 2. --- Characterization of Ultrasound Field Distances on Rat Fracture Model --- p.43 / Chapter 2.1 --- Introduction --- p.44 / Chapter 2.2 --- Material & Methods --- p.47 / Chapter 2.2.1 --- Closed Femoral Shaft Fracture Model in Rat --- p.47 / Chapter 2.2.2 --- Ultrasound Field Distances Setup --- p.51 / Chapter 2.2.3 --- Animal Grouping & LIPUS Treatment Protocol --- p.53 / Chapter 2.2.4 --- Assessments --- p.56 / Chapter 2.2.4.1 --- Radiological Analysis --- p.56 / Chapter 2.2.4.2 --- Micro-computed Tomography --- p.61 / Chapter 2.2.4.3 --- Histomorphometry --- p.64 / Chapter 2.2.4.4 --- Mechanical Testing --- p.66 / Chapter 2.2.4.5 --- Statistical Analysis --- p.66 / Chapter 2.3 --- Results --- p.68 / Chapter 2.3.1 --- Radiological Analysis --- p.71 / Chapter 2.3.2 --- MicroCT --- p.77 / Chapter 2.3.3 --- Histomorphometry --- p.82 / Chapter 2.3.4 --- Mechanical Testing --- p.85 / Chapter 2.4 --- Discussion --- p.87 / Chapter 2.4.1 --- Far Field LIPUS Enhances Mechanical Properties of Healing Callus --- p.88 / Chapter 2.4.2 --- Mid-near field and Near field LIPUS Enhances Woven Bone Formation --- p.90 / Chapter 2.4.3 --- The Biological Effects of LIPUS with Different Ultrasound Field Exposure --- p.94 / Chapter 2.5 --- Conclusion --- p.97 / Chapter Chapter 3. --- The Effect of Ultrasound Field Distances on Bone Cells --- p.100 / Chapter 3.1 --- Introduction --- p.101 / Chapter 3.2 --- Material & Methods --- p.102 / Chapter 3.2.1 --- Cell Culture --- p.102 / Chapter 3.2.2 --- Ultrasound Field Distances Setup & Treatment Protocol --- p.102 / Chapter 3.2.2 --- Immunostaining of β-catenin --- p.106 / Chapter 3.2.3 --- Wound Healing Assay --- p.109 / Chapter 3.2.4 --- BrdU Cell proliferation Assay --- p.111 / Chapter 3.2.5 --- Alkaline phosphatase activity assay --- p.112 / Chapter 3.2.6 --- Alizarin calcium nodule staining --- p.113 / Chapter 3.2.7 --- CM characterization - PGE₂ ELISA assay --- p.114 / Chapter 3.2.8 --- CM characterization - nitrite assay --- p.114 / Chapter 3.2.9 --- Statistical Analysis --- p.115 / Chapter 3.3 --- Results --- p.116 / Chapter 3.3.1 --- Immunostaining of β-catenin --- p.116 / Chapter 3.3.2 --- Wound healing assay --- p.119 / Chapter 3.3.3 --- BrdU Cell proliferation Assay --- p.119 / Chapter 3.3.4. --- Alkaline phosphatase activity assay --- p.122 / Chapter 3.3.5 --- Alizarin calcium nodule staining --- p.122 / Chapter 3.3.6. --- CM characterization - PGE₂ ELISA assay --- p.125 / Chapter 3.3.7 --- CM characterization - nitrite assay --- p.125 / Chapter 3.4 --- Discussion --- p.128 / Chapter 3.4.1 --- The Osteogenic Effect of Far Field LIPUS-Osteocyte Conditioned Medium --- p.128 / Chapter 3.4.2. --- Mechanisms of Mechanotransduction between Osteocyte and Osteoblast --- p.131 / Chapter 3.5 --- Conclusion --- p.136 / Chapter Chapter 4. --- Rat Fracture Exposed to Far Field LIPUS by Modulating Ultrasound Transducer Diameter --- p.139 / Chapter 4.1 --- Introduction --- p.140 / Chapter 4.2 --- Material & Methods --- p.143 / Chapter 4.2.1 --- Closed Femoral Shaft Fracture Model in Rat --- p.143 / Chapter 4.2.2 --- Ultrasound Field Distances Setup & Treatment Protocol --- p.143 / Chapter 4.2.3 --- Assessments --- p.148 / Chapter 4.2.3.1 --- Radiological Analysis --- p.148 / Chapter 4.2.3.2 --- Micro-computed Tomography --- p.148 / Chapter 4.2.3.3 --- Histomorphometry --- p.149 / Chapter 4.2.3.4 --- Mechanical Testing --- p.151 / Chapter 4.2.3.5 --- ex vivo Temperature Measurements --- p.151 / Chapter 4.2.3.6 --- Statistical Analysis --- p.151 / Chapter 4.3 --- Results --- p.152 / Chapter 4.3.1 --- Radiological Analysis --- p.154 / Chapter 4.3.2 --- MicroCT --- p.157 / Chapter 4.3.3 --- Histomorphometry --- p.160 / Chapter 4.3.4 --- Mechanical Testing --- p.166 / Chapter 4.3.5 --- ex vivo Temperature Measurement --- p.168 / Chapter 4.4 --- Discussion --- p.170 / Chapter 4.4.1 --- Far field LIPUS Setup by Transducer Diameter Modulation Enhanced Fracture Healing --- p.170 / Chapter 4.4.2 --- Fractures Exposed to Far Field LIPUS with Higher Intensity Did Not Heal Better --- p.174 / Chapter 4.4.3 --- Biphasic Effect of LIPUS Intensities on Fracture Healing --- p.176 / Chapter 4.5 --- Conclusion --- p.178 / Chapter Chapter 5. --- Conclusion --- p.179 / Chapter 5.1 --- Differential Biological Effects of Ultrasound Fields --- p.180 / Chapter 5.2 --- Far Field LIPUS exposure can be achieved by transducer diameter modulation --- p.181 / Chapter 5.3 --- Biphasic Effect of Ultrasound Intensities on Fracture Healing --- p.181 / Chapter 5.4 --- Mechanotransduction between Osteocyte and Osteoblastic cells --- p.182 / Chapter 5.5 --- Clinical Implications --- p.183 / Chapter 5.6 --- Future Investigations --- p.184 / Chapter 5.7 --- Limitations --- p.184 / Bibliography --- p.186 / Appendix --- p.208

Hur patienter upplever vården när de drabbas av höftfraktur är ett lite knapert utforskat område. Höftfraktur är den vanligaste orsaken till att äldre läggs in på sjukhus idag, och innebär stora kostnader för samhället. I samband med den ökande äldre befolkningen kommer även antalet höftfrakturer att öka. Det är en skada som innebär stora risker för patienten och även risk för komplikationer. Höftfraktur är ett tillstånd som medför stor smärta och immobilisering för patienten, med ett stort behov av vård och rehabilitering som följd. Syftet med studien är att belysa vuxna patienters upplevelse av den hospitala vården, efter att ha drabbats av höftfraktur. Den baseras på en analys och beskrivande sammanfattning av sex vetenskapliga artiklar med kvalitativ ansats. Resultatet beskriver patienters upplevelse av att vårdas för höftfraktur hospitalt, vilket återges i tre teman och sju underteman. I temana beskrivs hur patienten upplever mötet med vårdaren, betydelsen av kommunikation mellan vårdare och patient samt vårdarens engagemang. Vidare återges patienternas smärtupplevelse samt smärthantering. Påverkan på patienternas autonomi beskrivs också i det sista temat som skildrar hur höftfrakturen orsakar förlorad autonomi samt hur patienterna återvinner sin autonomi.I diskussionen framhävs svårigheter hos patienter att kommunicera sin smärta, få den lindrad och vårdarens ansvar att bemöta patienter med lyhördhet, respekt och acceptans. Hur man som vårdare vidrör patienten är av vikt för patientens upplevelse av vården. Förlorad autonomi kan för patienten upplevas som problematiskt och som vårdare spelar man en viktig roll i att assistera återupprättandet av den. / <p>Uppsatsen har tilldelats SÄS stipendium för studerande vid Institutionen för Vårdvetenskap, Högskolan i Borås för bästa C och/eller D uppsats som på ett berömligt </p><p>sätt behandlar integrationen av vårdvetenskap med klinisk verksamhet.</p><p>Uppsatsnivå: C</p>

Orientador: Bruno Watanabe Minto / Banca: Cláudia Valéria Seullner Brandão / Banca: Paola Castro Moraes / Resumo: Avanços na compreensão da biologia óssea e das complicações das fraturas têm levado a modificações na abordagem da fixação interna das mesmas, sendo a osteossíntese minimamente invasiva com placa (MIPO) uma das mais recentes evoluções para o manejo biológico das fraturas. O objetivo do presente estudo foi avaliar o uso de placas bloqueadas aplicadas de forma minimante invasiva em fraturas de tíbia de cães. Foram utilizados 10 cães apresentando fraturas de tíbia, de idades e raças variadas. Os animais foram avaliados quanto a deambulação, intensidade do edema, exames radiográficos, e densitometria óptica nos períodos 0, 15, 30, 60, 90 e 120 dias de pós-operatório. Após 15 dias de pós-operatório 80% dos cães já utilizavam o membro ao caminhar e apresentavam formação de edema leve a ausente no membro operado. Após 30 dias de pós-operatório 100% dos cães já apoiavam o membro ao caminhar e não apresentavam formação de edema no membro. Todos os pacientes apresentaram sinais radiográficos e densitométricos de início de consolidação óssea após 15 dias de pós-operatório. O tratamento de fraturas de tíbia por meio da MIPO é uma alternativa eficaz, resultando em utilização precoce do membro e união clínica efetiva, e pode ser realizada sem uso de intensificadores de imagem / Abstract: Advances in the comprehension of the bone healing and complications of the treatment of the fractures have been changed some concepts. Less invasive procedures have been advocated. A minimally invasive plate osteosynthesis (MIPO) is one of the best ways to avoid over tissue damage. The aim of this study was to evaluate the use of MIPO in tibial fractures in dogs. Ten dogs presenting a tibial fracture were used. Deambulation, swelling intensity and radiographic changes were evaluated preoperatively, just after the procedure and at 15, 30, 60, 90 e 120 days postoperatively. Six of 10 (60%) dogs were able to walk at 15 days postoperatively with slight swelling and mild lameness. Two of 10 (20%) presented normal walking at the same period. At 30 days postoperatively all dogs were able to walk normally. Six of them were not lame and 9 did not present swelling. Bone healing could be followed by radiographic evaluation. All dog presented initial radiographic signs of bone healing after 15 days postoperatively. Two of 10 showed clinical union at this time. In five of 10 (50%) clinical union could be observed after 60 days. The treatment of tibial fractures by MIPO is an effective alternative resulting in early and effective clinical union and can be performed without the use of image intensifiers / Mestre

Escoamento de água subterrânea em meios porosos fraturados é um problema de grande importância, principalmente nos contextos de petróleo, energia geotérmica e repositórios geológicos. Com o aquecimento da Terra, a geração de energia com baixa emissão de gases estufa torna-se imperativa, considerando o crescimento de uso de energia e o impacto do aquecimento global. Dentre as opções disponíveis para geração de energia, a energia nuclear apresenta-se como candidata. Entretanto, dentre os riscos do uso de energia nuclear, o destino do combustível usado e de materiais provenientes de descomissionamento é um problema em aberto. Repositórios geológicos surgem como uma alternativa para a estocagem de médio e longo prazo, por serem capazes de proporcionar isolamento em escalas geológicas de tempo. O principal vetor de propagação do material radioativo estocados em repositórios é a água subterrânea, e meios fraturados estão presentes na maioria dos domínios. Fraturas podem propagar a água subterrânea e, portanto, solutos com velocidades muito maiores que as do meio poroso. Além disso, fraturas são, geralmente, sistemas multiescala, em que diferentes escalas - de centímetros a kilômetros - podem ter um papel significativo. Métodos como elementos finitos, apesar de representarem certos comportamentos do escoamento em fraturas, têm dificuldade em simular sistemas com grandes diferenças de escala, já que necessitam de discretização do domínio. O Método de Elementos Analíticos (MEA) surge como uma alternativa a esse problema, pois não necessita de discretização de domínio, podendo simular características hidrogeológicas em diferentes escalas. Este trabalho tem como proposta aperfeiçoar o MEA, desenvolvendo um elemento analítico para fraturas que interagem com o meio poroso, aplicando os desenvolvimentos recentes na teoria do Método. Baseado na Integral de Cauchy e em transformações de coordenadas, o novo formalismo de solução no plano permite maior precisão na imposição das condições de contorno, sendo aplicado para inomogeneidades circulares, inomogeneidades poligonais formadas por line doublets e para o elemento de fratura. Dificuldades numéricas na simulação para fraturas levaram ao desenvolvimento de um método matricial de solução, aplicado com sucesso para todos os elementos apresentados neste trabalho. Soluções exatas para a inomogeneidade circular e para uma fratura foram comparadas com inomogeneidades poligonais equivalentes, com sucesso. O método matricial permitiu também um estudo da convergência do método iterativo e possibilita a melhoria do Método de Elementos Analíticos em geral. / Groundwater flow in fractured porous media is a recent and modern problem, considering the petroil, geothermic energy and geologic repositories context. As the Earth warms, low \'CO IND.2\' energy generation is paramount, when the projections of energy demand and worsening of the global warming effects are factored in. Nuclear energy generation appears as one of the canditates to generate electricity with low \'CO IND.2\' emissions. Several factors must be considered, thought, when nuclear energy is concerned. The spent nuclear fueld and the decomission residues must be safely stored for long periods of time. One of the alternatives for mid and long term disposal is the use of geological repositories. Because of its characteristics, groundwater studies must be conducted to assert the safety of the repositories, as its the main contaminant vector for the stored nuclear material. Fractures must be considered in those studies, as they are usually present in almost all settings considered for repositories, and can propagate groundwater (and dissolved solutes) with very high speeds, several orders of magnitude faster than the porous media. Fractures also forms multiscale problems, where different problem scales - from centimeters to kilometers - can influence the behavior of the groundwater flow and the consequent solute transport. The usual groundwater simulation methods, even when capable of including fracture phenomena, have problems with the scale differences, as they usually depend on domain discretization. The Analytic Element Method is based on analytic solutions of the groundwater governing equations and does not depend on domain discretization, being able to tackle multiscale problems that the other methods cant produce a feasible solution. The Analytic Element Method has been developed in recent years and has been applied in different fields, as wellhead protection area delineation. This work proposes to improve the Analytic Elemento Method developing an analytic element for flow in fractures, using the recent developments as the direct use of Cauchy Integrals in the plane. These new developments allow increased precision on the numerical boundary conditions matching. This method is applied on circular inhomogeneities, polygonal inhomogeneities modelled by line doublets and the fracture element. Numerical problems in the boundary condition matching for the fractures led to the development of matrix solution method, used on all elements presented in this work. Exact solutions for one circular inhomogeneity and for one fracture allowed comparison with the numerical ones, with satisfactory results. The matrix method also permitted a convergence study of the iterative methods, possibilitating for the general improvement of the Analytic Element Method.

Falls and fall-induced fractures are very common among the elderly. Hip fractures account for most of the deaths and costs of all the fall-induced fractures. This dissertation presents a novel MEMS based human airbag system used as a hip protector. A Micro Inertial Measurement Unit (muIMU) which is based on MEMS accelerometers and gyro sensors is developed as the motion sensing part of the system. The result using this muIMU based on Support Vector Machine (SVM) training to recognize falling-motions are presented, where we showed that selected eigenvector sets generated from 200 experimental data can be separated into falling and other motions completely. For real-time recognition, the SVM filter should be embedded to a high speed DSP system for fast computation and complex filter analyses. After the simulations for SVM filter and FFT were performed on a computer simulator (TI DSP320 C6713), we used DSK6713 (DSP Starter Kit) as our target board and integrated FFT and SVM filter on the chip. The whole algorithm works well with exist sensor data. Demo shows that our DSP system can successfully classify fall and non-fall states. At the same time, the system can trigger our airbag inflation mechanism when a fall occurs. The system was shown to open the airbag in real-time and protected the experimenter's hip area. / by Shi, Guangyi. / "March 2008." / Adviser: Wen Jung Li. / Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1855. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (p. 108-111). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

As fraturas da extremidade distal do rádio são muito comuns em nosso meio, sendo a mais freqüente do punho. Inúmeras pesquisas já foram realizadas sobre o tema e é conhecida a importância da redução anatômica das fraturas intra-articulares; porém, a causa de insucesso no seu tratamento pode ser a associação de outras lesões, envolvendo partes moles e cartilagem. O objetivo foi realizar uma avaliação artroscópica para analisar a incidência das lesões ligamentares e condrais associadas às fraturas intraarticulares da extremidade distal do rádio, correlacionado-a com classificação AO/ASIF. Trinta pacientes, com idade entre 20 a 50 anos, portadores de fratura fechada dos grupos B e C da classificação AO/ASIF foram selecionados. Todos eles foram submetidos à artroscopia do punho, para abordar as lesões intra-articulares e para redução e osteossíntese da fratura. Observou-se uma alta incidência de lesões intra-articulares, sendo que 76,7% deles apresentavam lesão do complexo da fibrocartilagem triangular, 36,6% do ligamento intrínseco escafo-semilunar, 6,6% do ligamento intrínseco semilunar-piramidal e 33,3% com lesão da cartilagem articular maior que três milímetros. Pacientes portadores de fraturas tipo C da classificação AO/ASIF apresentam uma incidência maior de lesões ligamentares associadas. Não houve relação entre a presença de lesão cartilaginosa e a classificação AO/ASIF das fraturas nesta casuística. / Fractures of the distal end of the radius are very frequent in our country and the most common is that of the wrist. Much research was carried out on the subject and the importance of the anatomical reduction of intra-articular fractures is well known, however the cause of unsuccessful treatment may be the association of other injuries involving soft tissues and cartilage. The purpose here was to perform an arthroscopic evaluation to analyze the incidence of ligament and chondral injuries associated to intra-articular fractures of the distal end of the radius, for correlation with the AO/ASIF classification. Thirty patients ranging from 20 to 50 years of age, bearers of closed fractures of groups B and C of the AO/ASIF classification were selected. They were submitted to wrist arthroscopy to treat the intra-articular injuries for fracture reduction and osteosynthesis. A high incidence of intraarticular injuries was noted, 76.7% of them presenting injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic lunotriquetral ligament and 33.3% of an injury of the articular cartilage larger than three millimeters. Patients bearers of a type C fracture in the AO/ASIF classification present with a higher incidence of associated ligament injuries. No relation between presence of cartilage injury and AO/ASIF Classification was found in this casuistry.