Σκοπός της παρούσας ερευνητικής εργασίας ήταν η επιδημιολογική μελέτη των λοιμώξεων από πηκτάση-αρνητικούς σταφυλοκόκκους (CNS) σε ασθενείς με προσθετικά υλικά, όπως ενδαγγειακούς καθετήρες και η σύγκριση με στελέχη που προκαλούν βακτηριαιμία. Συνολικά μελετήθηκαν 168 Staphylococcus epidermidis και 58 S. haemolyticus από βακτηριαιμίες (BSIs, 100 στελέχη) και εντοπισμένες λοιμώξεις σχετιζόμενες με την εφαρμογή προσθετικών υλικών (PDAIs, 126 στελέχη) από ασθενείς του Πανεπιστημιακού Γενικού Νοσοκομείου Πατρών (ΠΓΝΠ) και του Νοσοκομείου Παίδων Πεντέλης (ΝΠΠ). Η πλειοψηφία των στελεχών (89.8%) ήταν ανθεκτικά στην methicillin (MR-CNS) και πολυανθεκτικά (90.7%). Βιομεμβράνη συνέθεταν τα 106/226 στελέχη, ενώ 208 παρήγαγαν β-λακταμάση. Τα γονίδια σύνθεσης προσκολλητινών aap, fnbA και bap βρέθηκαν σε συχνότητα 40.3%, 35.8% και 20.4% αντίστοιχα. Οι S. epidermidis έφεραν τα γονίδια atlE και fbe σε ποσοστά 88.1% και 81%, αντίστοιχα. Από τα γονίδια σύνθεσης τοξινών, συχνότερο ήταν το γονίδιο της τοξίνης τοξικής καταπληξίας tst (8.4%) ενώ τα γονίδια που κωδικοποιούν τις εντεροτοξίνες sea, sec βρέθηκαν μόνο σε μικρό ποσοστό στελεχών S. epidermidis και S. haemolyticus (5.3% και 3.1% του συνολικού πληθυσμού αντίστοιχα). Κανένα στέλεχος δεν έφερε τα γονίδια σύνθεσης των εντεροτοξινών seb και sed. Ο πληθυσμός των στελεχών S. epidermidis έδειξε μεγάλη γενετική ποικιλομορφία, με 67 PFGE τύπους, μεταξύ των οποίων δύο κύριοι τύποι (a, b) με 50 και 36 στελέχη αντίστοιχα. Έλεγχος με MLST ανέδειξε τρεις κύριους κλώνους (ST2, ST5 και ST16) που ανήκαν στο ίδιο κλωνικό σύμπλεγμα (Clonal Complex 2). Τα στελέχη του PFGE τύπου a παρουσίασαν υψηλότερα ποσοστά αντοχής στα αντιμικροβιακά clindamycin, ciprofloxacin, fusidic acid, SXT και στις αμινογλυκοσίδες, ενώ τα στελέχη του τύπου b έφεραν συχνότερα το γονίδιο aap (p=0.049). Τα στελέχη S. haemolyticus παρουσίασαν μικρότερη γενετική ποικιλομορφία, με έναν κύριο PFGE τύπο (h), που περιελάμβανε 44/58 στελέχη (75.9% του συνολικού πληθυσμού). Τα στελέχη CNS από BSIs ήταν συχνότερα ανθεκτικά στην methicillin (p<0.001) και στα υπόλοιπα αντιμικροβιακά (p<0.05), ενώ υπερείχαν και στην παραγωγή biofilm (p=0.003). Αντιθέτως, οι CNS από PDAIs έφεραν συχνότερα τα γονίδια των προσκολλητινών aap (p=0.006) και bap (p=0.045). Σε ένα δεύτερο σκέλος της παρούσας ερευνητικής εργασίας μελετήθηκε ένας πληθυσμός S. lugdunensis από το ΠΓΝΠ (37 στελέχη) και το ΝΠΠ (1 στέλεχος). Ο S. lugdunensis κατέχει ιδιαίτερη θέση μεταξύ των CNS, καθώς μπορεί να μιμηθεί την παθογόνο δράση του S. aureus και να προκαλέσει σοβαρές λοιμώξεις. Είκοσι δύο S. lugdunensis απομονώθηκαν από ασθενείς με λοιμώξεις δέρματος και μαλακών μορίων (Skin and Soft Tissue Infections: SSTIs), εννέα από εν τω βάθει λοιμώξεις (Deep Sited Infections: DSIs), συμπεριλαμβανομένων τριών στελεχών από ασθενείς με βακτηριαιμία, και επτά στελέχη από λοιμώξεις σχετιζόμενες με προσθετικά υλικά, κυρίως ενδαγγειακούς καθετήρες, (PDAIs). Όλα τα στελέχη ήταν ευαίσθητα στην methicillin (MS-CNS), στις αμινογλυκοσίδες (kanamycin, gentamicin), καθώς και στα: ciprofloxacin, rifampicin, teicoplanin, vancomycin, linezolid και daptomycin, ενώ μόνο τέσσερα στελέχη ήταν πολυανθεκτικά. Οι S. lugdunensis της συλλογής μας έδειξαν μικρή γενετική ποικιλομορφία. Τα 38 στελέχη ταξινομήθηκαν σε επτά κλώνους, με δύο κύριους PFGE τύπους (C και D), οι οποίοι περιελάμβαναν 22 και εννέα στελέχη αντίστοιχα. Τα 26 από τα 38 στελέχη έφεραν το οπερόνιο ica, ενώ συνολικά 14 ήταν biofilm-θετικά. Δεν παρατηρήθηκε συσχέτιση της παρουσίας του ica με κάποιο κλώνο, αλλά ούτε και με την παραγωγή βιομεμβράνης. Οι S. lugdunensis από PDAIs ήταν συχνότερα biofilm-θετικοί σε σχέση με τα στελέχη από SSTIs και DSIs, ενώ ο κύριος κλώνος C παρήγαγε biofilm σε μεγαλύτερο ποσοστό από τον D, δεύτερο σε συχνότητα κλώνο. Το γονίδιο fbl ανιχνεύθηκε σε όλα τα στελέχη S. lugdunensis που εξετάστηκαν, επιβεβαιώνοντας την φαινοτυπική ταυτοποίηση σε επίπεδο είδους. Ο επόμενος κατά σειρά συχνότητας παράγοντας παθογένειας που ανιχνεύθηκε ήταν το γονίδιο atlL, το οποίο βρέθηκε σε 36 από τα 38 στελέχη (94.7%). Ακολουθούν οι παράγοντες vwbl και slush, που βρέθηκαν σε 31 (81.6%) και 15 (39.5%) S. lugdunensis, αντίστοιχα. Τα στελέχη από εν τω βάθει λοιμώξεις (DSIs) έφεραν σε μεγαλύτερο ποσοστό τα γονίδια vwbl και slush σε σχέση με αυτά από PDAIs και SSTIs . Ο κλώνος C υπερείχε στην παρουσία του ermC, ενώ τα στελέχη που ανήκαν στον κλώνο D έφεραν σε μεγαλύτερο ποσοστό τα γονίδια vwbl και slush. / Coagulase-negative staphylococci (CNS), especially Staphylococcus epidermidis and S. haemolyticus, have emerged as opportunistic pathogens in patients with low immune response or indwelling medical devices. In the present study, bloodstream (BSIs) and prosthetic-device associated infections (PDAIs) CNS isolates were compared in terms of biofilm formation, antimicrobial resistance, clonal distribution, adhesin and toxin genes carriage. A collection of 226 CNS (168 S. epidermidis and 58 S. haemolyticus) recovered from BSIs (100) and PDAIs (126) of different patients in the Patras tertiary-care University General Hospital (UGHP) and Pentelis Paediatric Hospital in Athens (PPHA), was tested for biofilm formation, antimicrobial susceptibility, mecA, ica operon, adhesin (aap, bap, fnbA, atlE, fbe) and toxin (tst, sea, seb, sec, sed) genes carriage. All CNS were classified into pulsotypes by PFGE, whereas S. epidermidis strains were assigned to sequence types by MLST. In total, 106 isolates (46.9%) produced biofilm, whereas 150 (66.4%) carried ica operon. Most isolates carried mecA and were multidrug resistant (90.7%). The adhesin encoding genes aap, fnbA and bap were identified in 40.3%, 35.8% and 20.4% of the total population, respectively. Genes encoding AtlE and Fbe were found in 88.1% and 81% of S. epidermidis isolates, respectively. CNS recovered from BSIs prevailed in biofilm formation (P=0.003), resistance to antimicrobials and mecA carriage (P<0.001) as compared to isolates derived from PDAIs. CNS from PDAIs carried more frequently aap and bap genes (P=0.006 and P=0.045, respectively). No statistically significant difference in toxin genes carriage was identified (P>0.05). Even though PFGE showed genetic diversity, especially among S. epidermidis, analysis of representative strains from the main PFGE types by MLST, revealed three major clones (ST2, ST5, ST16). A clonal relationship was found concerning antimicrobial susceptibility, ica and aap gene carriage, reinforcing the aspect of clonal expansion in hospital settings. Pathogenesis of BSIs is associated with biofilm formation and high-level antimicrobial resistance, whereas PDAIs are related to the adhesion capability of CNS. In the second part of this study we analyzed a collection of S. lugdunensis isolates recovered from different inpatients hospitalized in UGHP (37 isolates) and PPHA (one isolate) during a six-year period (2008-2013). S. lugdunensis has emerged as a significant human pathogen with distinct clinical and microbiological characteristics. A collection of 38 S. lugdunensis was tested for biofilm formation, antimicrobial susceptibility, clonal distribution, virulence factors (ica operon, fbl, atlL, vwbl, slush) and antibiotic resistance genes (mecA, ermC) carriage. The majority (22) was isolated from skin and soft tissue infections (SSTIs), nine from deep-sited infections (DSIs), including three bacteraemias and seven from PDAIs. All isolates were oxacillin-susceptible, mecA-negative and fbl-positive. The higher resistance rate was detected for ampicillin (50%), followed by erythromycin and clindamycin (18.4%). Fourteen isolates (36.8%) produced biofilm, 26 carried ica operon, but no relation between ica carriage and biofilm formation was identified. Biofilm formation was more frequent in isolates recovered from PDAIs. Thirty six strains (94.7%) carried atlL, 31 (81.6%) vwbl, whereas, slush was detected in fifteen (39.5%). PFGE revealed low level of genetic diversity: strains were classified into seven pulsotypes, with two major clones C and D including 22 and nine strains, respectively. Type C strains, recovered from all infection sites, prevailed in biofilm formation and ermC carriage, whereas, type D strains, associated with SSTIs and DSIs, carried more frequently vwbl, slush or both genes. Despite susceptibility to antimicrobials, clonal expansion and carriage of virulence factors combined with biofilm-producing ability render this species an important pathogen that should not be ignored.

The aim of the study was to assess the feasibility of CT based 3D analysis of degenerated aortic bioprostheses to make easier their morphological assessment. This could be helpful during regular follow-up and for case selection, improved planning and mapping of valve-in-valve procedure. The challenge was represented by leaflets enhancement because of highly noised CT images. Contrast-enhanced ECG-gated CT scan was performed in patients with degenerated aortic bioprostheses before reoperation (in-vivo images). Different methods for noise reduction were tested and proposed. 3D reconstruction of bioprostheses components was achieved using stick based region segmentation methods. After reoperation, segmentation methods were applied to CT images of the explanted prostheses (exvivo images). Noise reduction obtained by improved stick filter showed best results in terms of signal to noise ratio comparing to anisotropic diffusion filters. All segmentation methods applied to the best phase of in-vivo images allowed 3D bioprosthetic leaflets reconstruction. Explanted bioprostheses CT images were also processed and used as reference. Qualitative analysis revealed a good concordance between the in-vivo images and the bioprostheses alterations. Results from different methods were compared by means of volumetric criteria and discussed. A first approach for spatiotemporal visualization of 3D+T images of valve bioprosthesis has been proposed. Volume rendering and motion compensation techniques were applied to visualize different phases of CT data. Native valve was also considered. ECG-gated CT images of aortic bioprostheses need a preprocessing to reduce noise and artifacts in order to enhance prosthetic leaflets. Stick based methods seems to provide an interesting approach for the morphological characterization of degenerated bioprostheses.

Chronic Venous Insufficiency (CVI) is a condition in present in almost 27% of adults in which an insufficient amount of blood is pumped back to the heart due to damaged or poorly apposed one-way valves in the leg veins. During forward flow, vein valves allow blood to return to the heart while posing very little resistance to the flow. During gravity-driven reverse flow, normal valves close and prevent blood from flowing backward through the valve. Incompetent, or damaged, vein valves cannot prevent this reverse flow and lead to a pooling of blood at the feet. CVI is a painful disease presents itself in various ways, including varicose veins, ulcerations of the lower extremities, and severe swelling. Current therapies and treatments include compressive stockings, destruction or removal of affected veins, valve repair, and valve transplants. The implantation of prosthetic vein valves is a future treatment option that does not require an invasive surgery, human donor, or lengthy hospital stay. While no prosthetic vein valves are currently commercially available, this thesis describes the design, verification, and validation of a novel prosthetic vein valve. Verification tests include CFD simulations, functional tests, mechanical tests, and in vitro thromogenicity tests. The validation of the device was done through an animal study in sheep external jugular veins. CFD analysis verified that shear rates within the valve support its lower thrombogenicity as compared to a previous vein valve. Benchtop tests demonstrate superiority in short-term patency over a previous polymer valve. In a sheep study, patency was shown at 6 weeks, surpassing many autograft valves and showing great potential to meet the goal of 3 month patency in sheep.

abstract: Effective tactile sensing in prosthetic and robotic hands is crucial for improving the functionality of such hands and enhancing the user's experience. Thus, improving the range of tactile sensing capabilities is essential for developing versatile artificial hands. Multimodal tactile sensors called BioTacs, which include a hydrophone and a force electrode array, were used to understand how grip force, contact angle, object texture, and slip direction may be encoded in the sensor data. Findings show that slip induced under conditions of high contact angles and grip forces resulted in significant changes in both AC and DC pressure magnitude and rate of change in pressure. Slip induced under conditions of low contact angles and grip forces resulted in significant changes in the rate of change in electrode impedance. Slip in the distal direction of a precision grip caused significant changes in pressure magnitude and rate of change in pressure, while slip in the radial direction of the wrist caused significant changes in the rate of change in electrode impedance. A strong relationship was established between slip direction and the rate of change in ratios of electrode impedance for radial and ulnar slip relative to the wrist. Consequently, establishing multiple thresholds or establishing a multivariate model may be a useful method for detecting and characterizing slip. Detecting slip for low contact angles could be done by monitoring electrode data, while detecting slip for high contact angles could be done by monitoring pressure data. Predicting slip in the distal direction could be done by monitoring pressure data, while predicting slip in the radial and ulnar directions could be done by monitoring electrode data. / Dissertation/Thesis / M.S. Bioengineering 2012

A falta de um membro, devido a doenças, más-formações ou traumas, impacta enormemente na vida de um indivíduo. Para que o mesmo possa realizar Atividades de Vida Diária (AVD), sem drásticas limitações, faz-se necessário o desenvolvimento de próteses e cientes. Para auxiliar no projeto de tais produtos, este trabalho visa criar e solucionar um modelo de sistema dinâmico capaz de simular o comportamento de joelhos prostéticos. A m de alcançar tal objetivo, foi estudada a biomecânica da marcha humana, além dos tipos de amputações existentes e seus impactos na mesma. Buscou-se também estudar os principais componentes de próteses existentes atualmente no mercado, além de suas geometrias básicas. Após de nir-se um modelo simpli cado que representasse os componentes protéticos e as partes remanescentes do corpo, foram buscadas métodos de solução disponíveis para tal sistema. Baseado nos estudos encontrados em uma revisão bibliográ ca, foi de nida uma metodologia de solução numérica de sistemas multi-corpos. Durante o trabalho, surgiu a necessidade de representar forças de contato entre corpos rígidos, e foram incluídas soluções de atuais teorias do assunto. Essas metodologias foram então empregadas para a construção de um algoritmo capaz de solucionar o sistema proposto. Depois de resolvido o sistema, os valores encontrados para as variáveis cinéticas foram comparados com valores obtidos por uma simulação numérica utilizando dois programas computacionais comercias, cujas fundamentações teóricas utilizam diferentes métodos de solução. A comparação das diferenças entre os resultados apontou similaridade entre o algoritmo e os programas utilizados, mas com a necessidade de validação do método através de ensaio mecânico. Ao nal foram sugeridas ideias para trabalhos futuros. / The lack of a member due to diseases, malformations or trauma, greatly impacts the life of an individual. In order to perform Activities of Daily Living (ADL) without drastic limitations, it is necessary to develop e cient prosthetic devices. To assist the design of such products, this work aims to create and solve a dynamic system model to simulate the behavior of prosthetic knees. In order to achieve this goal, the biomechanics of human gait was studied, as well as the existing types of amputation and their impact on human gait. The main components of existing prosthetic devices, currently on the market, were identi ed, as well as its basic geometries. After de ning a simpli ed model able to incorporate the prosthetic components and the individual remaining body parts, an available methodology for the solution of such a system was prospected. Based on the studies found in the currently literature of multibodysystems, a numerical solution methodology for has been set. During the work, the need to represent contact between parts occurred, leading to the implementation of currently theories of contact forces for rigid bodies. These methodologies were then used to construct an algorithm for solving the proposed system. After the system has been solve, the values found for the kinetic variables were compared with those obtained by numerical simulations using two commercial softwares, whose theoretical foundation used di erent solution methodology. Comparing the di erences in results of these simulations, it was revealed a similar behavior between the algorithm and the commercial programs, but with the need of an experimental test, for truly validation of the method. At the end of this work, ideas for future improvement were suggested.

La cécité touche 39 millions de personnes dans le monde et génère de nombreuses difficultés dans la vie quotidienne. Plus précisément, les capacités de navigation (incluant orientation et mobilité) sont fortement diminuées, ce qui amène les personnes non-voyantes à limiter, voire à cesser leurs déplacements. Pour restaurer des sensations "visuelles", et par-delà, une certaine autonomie, il est possible de stimuler directement le système visuel résiduel d'une personne non-voyante à l'aide d'un implant administrant des micro-stimulations électriques. Le dispositif complet se compose d'une micro-caméra portée sur des lunettes et reliée à un ordinateur de poche, qui lui-même est connecté à l'implant. Lors des micro-stimulations, les sujets perçoivent des tâches grises, blanches ou jaunâtres appelées phosphènes. Ainsi la qualité de la vision restaurée est directement dépendante de la résolution et de la position de l'implant. Le nombre d'électrodes étant faible pour les implants en développement (moins d'une centaine), il est nécessaire de réduire drastiquement la résolution du flux vidéo pour la faire correspondre à la faible résolution de l'implant. Actuellement, l'Argus II de la société Second Sight est l'implant dont le développement est le plus avancé et sa résolution est de 60 électrodes, ce qui permet aux patients implantés de percevoir 60 phosphènes différents. Cette vision restaurée est donc très pauvre et un travail d'optimisation du signal est nécessaire pour pouvoir utiliser l'implant de manière fonctionnelle. Les sujets implantés sont impliqués dans des protocoles cliniques fermés ne permettant pas de les inclure dans d'autres expériences. Malgré cela, il est possible d'étudier les possibilités offertes par ces implants visuels en simulant la vision prothétique dans un casque de réalité virtuelle porté par des sujets voyants. Il s'agit du domaine de la vision prothétique simulée (VPS). La navigation n'a jamais été étudiée chez les patients implantés et très rarement en VPS. Il s'avère qu'avec des implants de très faible résolution, elle pose de grandes difficultés liées à la mobilité mais également des difficultés liées à l'orientation. Les travaux entrepris dans ce doctorat se concentrent sur l'étude de la navigation en VPS. Différentes théories en psychologie nous ont permis d'identifier les éléments importants pour les sujets afin qu'ils se repèrent et se construisent une représentation mentale fiable de l'environnement lors de la navigation. À partir de ces modèles, différents rendus prothétiques utilisant la vision par ordinateur ont été conçus et testés dans une tâche de navigation réalisée dans un environnement virtuel. Les expérimentations effectuées avaient pour objectif d'optimiser la perception et la compréhension de l'espace parcouru avec un implant de faible résolution. Ces évaluations reposaient sur la performance de temps des sujets pour effectuer la tâche de navigation et sur leur représentation mentale de l'environnement. Après la tâche de navigation, il leur était demandé de dessiner la carte des environnements explorés, afin d'évaluer ces représentations. Cette double évaluation a permis d'identifier les indices importants permettant de faciliter la perception et la mémorisation de la structure des environnements dans une tâche de navigation en VPS. Pour améliorer les performances des personnes non-voyantes implantées, il apparaît notamment nécessaire de limiter la quantité d'information présentée, tout en préservant la structure de l'environnement grâce à des algorithmes de vision par ordinateur. Lorsque l'accès à des patients implantés sera plus ouvert, il deviendra nécessaire de valider ces différents résultats en les faisant naviguer en environnement virtuel puis en environnement réel. / Blindness affects thirty nine millions people in the world and generates numerous difficulties in everyday life. Specifically, navigation abilities (which include wayfinding and mobility) are heavily diminished. This leads blind people to limit and eventually to stop walking outside. Visual neuroprosthesis are developed in order to restore such "visual" perception and help them to get some autonomy back. Those implants generate electrical micro-stimulations which are focused on the retina, the optic nerve or the visual cortex. Those stimulations elicit blurry dots called "phosphenes". Phosphenes can be mainly white, grey or yellow. The whole stimulation device contains a wearable camera, a small computer and the implant which is connected to the computer. The implant resolution and position impact directly the quality of the restored visual perception. Current implants include less than a hundred electrodes so it is mandatory to reduce the resolution of the visual stream to match the implant resolution. For instance, the already commercialized Argus II implant from the company Second Sight (Seymar, California) is the leading visual implant worldwide and uses only sixty electrodes. This means that Argus II blind owners can perceive only sixty phosphenes simultaneously. Therefore this restored vision is quite poor and signal optimization is required to get to a functional implant usage. Blind people with implants are involved in restricted clinical trials and are difficult to reach. Yet, studying those implant possibilities is at our reach by simulating prosthetic vision and displaying it in a head mounted display for sighted subjects. This is the field of simulated prosthetic vision (SPV). Navigation was never studied with people with implant, and only a few studies approached this topic in SPV. In this thesis, we focused on the study of navigation in SPV. Computer vision allowed us to select which of the scene elements to display in order to help subjects to navigate and build a spatial representation of the environment. We used psychological models of navigation to conceive and evaluate SPV renderings. Subjects had to find their way and collect elements in a navigation task in SPV inspired by video games for the blind. To evaluate their performance we used a performance index based on the completion time. To evaluate their mental representation, we asked them to draw the environment layout after the task for each rendering. This double evaluation lead us to spot which elements can and should be displayed in low resolution SPV in order to navigate. Specifically those results show that to be understandable in low vision, a scene must be simple and the structure of the environment should not be hidden. When blind people with implant will become available we will be able to confirm or deny those results by evaluating their navigation in virtual and real environments.

This thesis named: "Problems of usage of prosthetic aids for children" focuses on the nursing care specifics of the child patient after an amputation. The Amputation is defined as removal of the peripheral portion of the body with an interruption of a bone and the soft tissues which allows subsequent prosthetic solution. Prosthesis is externally applied aid, which replace missing or underdeveloped part of a limb eventually the whole limb. The aim of the Prosthetic centers is to offer to its clients the exact prosthetic solution which could fully replace the function of a missing limb and allow the child to live full life without any limitations. The intention of the thesis was to summarize the problematic of the upper and lower limbs amputation into one publication and also to focus this thesis on children and prosthetic aids for them. The reason is that in Czech literature there is no complex information which focuses on specifics for children. The list of synoptic distribution of the types of prosthetic aids was created based on the level of amputation. A large part of this thesis deals with the nursing care, including rehabilitation after amputation and prosthetic solutions. The possibility of the children´s active life with prosthetic aids was mentioned, also how they coped with the loss of a limb. And then the specifics of the nursing care and the attitude of the nursing staff to children and their parents were mentioned too. In the research part of the thesis three aims were set: Find out the limitations or the changes in the family´s life style which has child with prosthesis and the limitations in child´s active life with prosthesis. Ascertain the specifics and the lacks of the nursing care during preparation of children for the prosthetic aid. Based on these following aims the research questions were set: How was the life style of the family with child with prosthetic aid affected? What are the limitations in child´s active life with prosthesis? What are the specifics of the nursing care during preparation of the child for the prosthetic aid? The empirical part of my thesis was processed with qualitative data analysis using technique of the unstructured in-depth interviews. The first research group consisted of seven respondents. Five out of them were parents of the children without the limb and two out of them were children without the limb itself, who were old enough to give us the trustworthy information. The information from the prosthetic technicians was followed with these interviews. The prosthetic technicians clarified us the questions which resulted from reaching the respondents who cannot have all theoretical knowledge regarding the issue. We hope that the results from this thesis will be benefit not only for the medical staff to improve the quality of the nursing care, but also for the respondents who can find the information which was missing till this time.

O afrouxamento dos parafusos protéticos é descrito na literatura como uma das complicações mais frequentes das próteses sobre implantes. Durante sua confecção, os profissionais sentem necessidade de remover várias vezes as próteses e/ou componentes protéticos, soltando e re-apertando os parafusos repetidamente. O principal objetivo deste trabalho foi avaliar a variação do torque de remoção de parafusos de fixação de pilares protéticos a implantes osteointegráveis após sucessivos ciclos de parafusamento e desparafusamento. Outro objetivo foi avaliar a influência do hexágono da base do pilar no torque de remoção dos parafusos. Para isso, foram utilizados 20 implantes de plataforma regular com hexágono externo e 20 pilares protéticos sextavados, que foram parafusados aos implantes com um parafuso de titânio, aplicando-se a este um torque de 32Ncm, por meio de um torquímetro digital. Os conjuntos implante/pilar/parafuso foram divididos em dois grupos: (1) pilares cujo hexágono da base foram removidos e (2) pilares convencionais, com hexágono na base. Cada conjunto recebeu uma restauração provisória e foi submetido a ciclagem mecânica por 15 minutos. Depois, os parafusos foram removidos, medindo-se o torque de remoção. Esta sequência foi repetida dez vezes e então o parafuso foi trocado por outro sem uso, e mais um ciclo foi realizado. Uma análise de regressão linear demonstrou nos dois grupos uma queda do torque de remoção do parafuso ao longo dos repetidos ciclos de inserção/remoção. A comparação entre os coeficientes da regressão nos dois grupos não revelou diferença entre eles. Também não houve diferença entre as médias das 5 últimas repetições e o 11 ciclo, com o parafuso novo. Concluiu-se que (1) repetidos parafusamentos e desparafusamentos promoveram a diminuição progressiva do torque de remoção dos parafusos, (2) a troca do parafuso por outro sem uso após dez ciclos de inserção/remoção não aumentou sua resistência ao afrouxamento, e (3) a remoção do hexágono da base do pilar protético não exerceu nenhum efeito sobre o torque de remoção do parafuso. / Screw loosening is one of the most common problems of implant-retained prostheses. During their confection, dentists need to remove and re-install them several times, loosening and re-tightening the screws repeatedly. The first purpose of this study was to evaluate the effects of repeated insertion/removal cycles on the removal torque of retaining prosthetic screws. The second purpose was to evaluate the influence of the hexagon of the abutment on the removal torque. For that, 20 regular external hex implants were used and 20 hexagonal abutments were tightened to the implants with a titanium alloy screw, with an insertion torque of 32Ncm, given by a digital torque gauge. The implant/abutment/screw assemblies were divided into two groups: (1) abutments with no hexagon on the base and (2) abutments with an hexagon on the base. Each assembly received a provisional restoration and was submitted to mechanical loading cycles for 15 minutes. After this, the screws were removed and the removal torque measured. This sequence was repeated ten times and then, the screw was changed for a new one, and another cycle was done. Linear regression analysis was performed and showed that removal torque values tended to decrease as the number of insertion/removal cycles increased, for both groups. Comparisons of the slopes and the intercepts between the two groups showed no statistic difference between them. There was also no difference between the mean values of last 5 cycles and the 11th cycle. It was concluded that (1) repeated insertion/removal cycles promoted gradual reduction in removal torque of screws, (2) changing screw by a new one after ten insertion/removal cycles did not increase resistance to loosening, and (3) removal of the hexagon of the abutment base had no effect on the removal torque of the screw.

A falta de um membro, devido a doenças, más-formações ou traumas, impacta enormemente na vida de um indivíduo. Para que o mesmo possa realizar Atividades de Vida Diária (AVD), sem drásticas limitações, faz-se necessário o desenvolvimento de próteses e cientes. Para auxiliar no projeto de tais produtos, este trabalho visa criar e solucionar um modelo de sistema dinâmico capaz de simular o comportamento de joelhos prostéticos. A m de alcançar tal objetivo, foi estudada a biomecânica da marcha humana, além dos tipos de amputações existentes e seus impactos na mesma. Buscou-se também estudar os principais componentes de próteses existentes atualmente no mercado, além de suas geometrias básicas. Após de nir-se um modelo simpli cado que representasse os componentes protéticos e as partes remanescentes do corpo, foram buscadas métodos de solução disponíveis para tal sistema. Baseado nos estudos encontrados em uma revisão bibliográ ca, foi de nida uma metodologia de solução numérica de sistemas multi-corpos. Durante o trabalho, surgiu a necessidade de representar forças de contato entre corpos rígidos, e foram incluídas soluções de atuais teorias do assunto. Essas metodologias foram então empregadas para a construção de um algoritmo capaz de solucionar o sistema proposto. Depois de resolvido o sistema, os valores encontrados para as variáveis cinéticas foram comparados com valores obtidos por uma simulação numérica utilizando dois programas computacionais comercias, cujas fundamentações teóricas utilizam diferentes métodos de solução. A comparação das diferenças entre os resultados apontou similaridade entre o algoritmo e os programas utilizados, mas com a necessidade de validação do método através de ensaio mecânico. Ao nal foram sugeridas ideias para trabalhos futuros. / The lack of a member due to diseases, malformations or trauma, greatly impacts the life of an individual. In order to perform Activities of Daily Living (ADL) without drastic limitations, it is necessary to develop e cient prosthetic devices. To assist the design of such products, this work aims to create and solve a dynamic system model to simulate the behavior of prosthetic knees. In order to achieve this goal, the biomechanics of human gait was studied, as well as the existing types of amputation and their impact on human gait. The main components of existing prosthetic devices, currently on the market, were identi ed, as well as its basic geometries. After de ning a simpli ed model able to incorporate the prosthetic components and the individual remaining body parts, an available methodology for the solution of such a system was prospected. Based on the studies found in the currently literature of multibodysystems, a numerical solution methodology for has been set. During the work, the need to represent contact between parts occurred, leading to the implementation of currently theories of contact forces for rigid bodies. These methodologies were then used to construct an algorithm for solving the proposed system. After the system has been solve, the values found for the kinetic variables were compared with those obtained by numerical simulations using two commercial softwares, whose theoretical foundation used di erent solution methodology. Comparing the di erences in results of these simulations, it was revealed a similar behavior between the algorithm and the commercial programs, but with the need of an experimental test, for truly validation of the method. At the end of this work, ideas for future improvement were suggested.

A falta de um membro, devido a doenças, más-formações ou traumas, impacta enormemente na vida de um indivíduo. Para que o mesmo possa realizar Atividades de Vida Diária (AVD), sem drásticas limitações, faz-se necessário o desenvolvimento de próteses e cientes. Para auxiliar no projeto de tais produtos, este trabalho visa criar e solucionar um modelo de sistema dinâmico capaz de simular o comportamento de joelhos prostéticos. A m de alcançar tal objetivo, foi estudada a biomecânica da marcha humana, além dos tipos de amputações existentes e seus impactos na mesma. Buscou-se também estudar os principais componentes de próteses existentes atualmente no mercado, além de suas geometrias básicas. Após de nir-se um modelo simpli cado que representasse os componentes protéticos e as partes remanescentes do corpo, foram buscadas métodos de solução disponíveis para tal sistema. Baseado nos estudos encontrados em uma revisão bibliográ ca, foi de nida uma metodologia de solução numérica de sistemas multi-corpos. Durante o trabalho, surgiu a necessidade de representar forças de contato entre corpos rígidos, e foram incluídas soluções de atuais teorias do assunto. Essas metodologias foram então empregadas para a construção de um algoritmo capaz de solucionar o sistema proposto. Depois de resolvido o sistema, os valores encontrados para as variáveis cinéticas foram comparados com valores obtidos por uma simulação numérica utilizando dois programas computacionais comercias, cujas fundamentações teóricas utilizam diferentes métodos de solução. A comparação das diferenças entre os resultados apontou similaridade entre o algoritmo e os programas utilizados, mas com a necessidade de validação do método através de ensaio mecânico. Ao nal foram sugeridas ideias para trabalhos futuros. / The lack of a member due to diseases, malformations or trauma, greatly impacts the life of an individual. In order to perform Activities of Daily Living (ADL) without drastic limitations, it is necessary to develop e cient prosthetic devices. To assist the design of such products, this work aims to create and solve a dynamic system model to simulate the behavior of prosthetic knees. In order to achieve this goal, the biomechanics of human gait was studied, as well as the existing types of amputation and their impact on human gait. The main components of existing prosthetic devices, currently on the market, were identi ed, as well as its basic geometries. After de ning a simpli ed model able to incorporate the prosthetic components and the individual remaining body parts, an available methodology for the solution of such a system was prospected. Based on the studies found in the currently literature of multibodysystems, a numerical solution methodology for has been set. During the work, the need to represent contact between parts occurred, leading to the implementation of currently theories of contact forces for rigid bodies. These methodologies were then used to construct an algorithm for solving the proposed system. After the system has been solve, the values found for the kinetic variables were compared with those obtained by numerical simulations using two commercial softwares, whose theoretical foundation used di erent solution methodology. Comparing the di erences in results of these simulations, it was revealed a similar behavior between the algorithm and the commercial programs, but with the need of an experimental test, for truly validation of the method. At the end of this work, ideas for future improvement were suggested.