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Ramião NG, Martins PS, Barroso ML, Santos DC, Fernandes AA. Biomechanical analysis of intact versus ruptured Poly Implant Prothèse breast implants. Interface Focus 2019; 9:20180086. [PMID: 31263530 DOI: 10.1098/rsfs.2018.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Despite there being many studies that have evaluated breast implant rupture, there is no consensus about causes and incidence. Most studies lack a multifactorial analysis of what causes breast implants to rupture. To fill this gap, an experimental protocol was developed to compare ruptured and intact Poly Implant Prothèse (PIP) breast implants from the same woman. These conditions guarantee that the physical/biological variables are the same for each pair of ruptured and intact implants. A total of 1008 samples from 22 PIP explants (11 intact and 11 ruptured) and three control PIP implants were analysed. The mechanical properties (tensile strength) of the ruptured and intact implants were compared according to brand, lot, implantation time and demographic conditions. In general, statistically significant differences were found between the intact and ruptured PIP implants. Ruptured implants were thinner (0.73 ± 0.10 mm versus 0.91 ± 0.11 mm) and weaker (7.42 ± 2.65 MPa versus 9.59 ± 2.37 MPa) than intact implants. Intact and ruptured implants have shown distinct mechanical behaviours and variations in thickness. Our understanding is that these differences may be associated with the typical manufacturing process of breast implant shells. These results stress the importance of thorough control of the shell thickness. Given its relevance, shell thickness should be used as a quality control measure for homologation purposes. Thus, the homogeneity of the shell should be considered as a relevant parameter during the manufacturing process. This will translate into an improved quality of life for patients and will potentiate safer and longer lasting products.
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Affiliation(s)
- N G Ramião
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Campus da FEUP, Rua Dr. Roberto Frias, 400, 4200-465 Porto, Portugal
| | - P S Martins
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Campus da FEUP, Rua Dr. Roberto Frias, 400, 4200-465 Porto, Portugal
| | - M L Barroso
- Department of Plastic Surgery, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - D C Santos
- Department of Plastic Surgery, Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - A A Fernandes
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Campus da FEUP, Rua Dr. Roberto Frias, 400, 4200-465 Porto, Portugal
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Ramião NG, Martins PS, Barroso ML, Santos DC, Fernandes AA. An experimental analysis of shell failure in breast implants. J Mech Behav Biomed Mater 2017; 72:22-28. [PMID: 28437660 DOI: 10.1016/j.jmbbm.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Breast implant durability and the mechanisms of rupture are important topics in the medical community, for patients, manufactures and regulatory medical agencies. After concerns about the Poly Implant Prosthesis (PIP) implants, the need for understanding the adverse outcomes and the failure mode to improve the breast implants increased. The objective of this research is to analyze and describe the rupture characteristics of failed explanted PIP implants to study the modes and causes of rupture. Eleven explanted PIP implants were analyzed by visual inspection and scanning electron microscopy (SEM). To simulate hypothetical ruptures caused by cyclic mechanical stress (fatigue) in the implant shell, two control implants were submitted to fatigue tests, and analyzed with SEM. Small ruptures (either Hole or split) striations were found, which normally appear due to fatigue phenomena. Similar striations were also found in specimens (control) tested under laboratory controlled conditions. In the context of this work, the striations found in explants constitute a significant finding as they point to the occurrence of fatigue phenomena associated with mammary implants rupture. This research, also demonstrates that rupture surface analysis of explanted breast implants has the potential to become a useful indicator for assessing implant rupture mechanisms.
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Affiliation(s)
- N G Ramião
- INEGI, LAETA, Faculdade de Engenharia da Universidade do Porto, Portugal.
| | - P S Martins
- INEGI, LAETA, Faculdade de Engenharia da Universidade do Porto, Portugal.
| | - M L Barroso
- Department of Plastic Surgery of Gaia Hospital Center, Vila Nova de Gaia, Portugal.
| | - D C Santos
- Department of Plastic Surgery of Gaia Hospital Center, Vila Nova de Gaia, Portugal.
| | - A A Fernandes
- INEGI, LAETA, Faculdade de Engenharia da Universidade do Porto, Portugal.
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Ramião NG, Martins PS, Barroso ML, Santos DC, Fernandes AA. Breast implants rupture induced by fatigue phenomena. J Plast Reconstr Aesthet Surg 2017; 70:552-553. [PMID: 28159545 DOI: 10.1016/j.bjps.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/16/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Affiliation(s)
- N G Ramião
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Portugal
| | - P S Martins
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Portugal.
| | - M L Barroso
- Department of Plastic Surgery of Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - D C Santos
- Department of Plastic Surgery of Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - A A Fernandes
- INEGI, LAETA, Faculty of Engineering of the University of Porto, Portugal
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Fumis RRL, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One 2015; 10:e0115332. [PMID: 25616059 PMCID: PMC4304779 DOI: 10.1371/journal.pone.0115332] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/21/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients and family members undergo different experiences of suffering from emotional disorders during ICU stay and after ICU discharge. The purpose of this study was to compare the incidence of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in pairs (patient and respective family member), during stay at an open visit ICU and at 30 and 90-days post-ICU discharge. We hypothesized that there was a positive correlation with the severity of symptoms among pairs and different patterns of suffering over time. METHODS A prospective study was conducted in a 22-bed adult general ICU including patients with >48 hours stay. The Hospital Anxiety and Depression Scale (HADS) was completed by the pairs (patients/respective family member). Interviews were made by phone at 30 and 90-days post-ICU discharge using the Impact of Event Scale (IES) and the HADS. Multivariate models were constructed to predict IES score at 30 days for patients and family members. RESULTS Four hundred and seventy one family members and 289 patients were interviewed in the ICU forming 184 pairs for analysis. Regarding HADS score, patients presented less symptoms than family members of patients who survived and who deceased at 30 and 90-days (p<0.001). However, family members of patients who deceased scored higher anxiety and depression symptoms (p = 0.048) at 90-days when compared with family members of patients who survived. Patients and family members at 30-days had a similar IES score, but it was higher in family members at 90-days (p = 0.019). For both family members and patients, age and symptoms of anxiety and depression during ICU were the major determinants for PTSD at 30-days. CONCLUSIONS Anxiety, depression and PTSD symptoms were higher in family members than in the patients. Furthermore, these symptoms in family members persisted at 3 months, while they decreased in patients.
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Affiliation(s)
- Renata Rego Lins Fumis
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
- * E-mail:
| | - Otavio T. Ranzani
- Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, São Paulo 05403-900, Brazil
| | - Paulo Sérgio Martins
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
| | - Guilherme Schettino
- Intensive Care Unit, Hospital Sírio Libanês, Rua Dona Adma Jafet, 91, São Paulo 01308-050, Brazil
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Martins PS, Brunialti MKC, da Luz Fernandes M, Martos LSW, Gomes NE, Rigato O, Salomao R. Bacterial recognition and induced cell activation in sepsis. Endocr Metab Immune Disord Drug Targets 2006; 6:183-91. [PMID: 16787293 DOI: 10.2174/187153006777442350] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The pathogenesis of sepsis involves complex interaction between the host and the infecting microorganism. Recognition and processing of microorganism antigens are essential functions of the cells of innate immune systems, and will ultimately, through the antigen presentation to the cells of adaptive immunity and the synthesis and secretions of mediators, such as cytokines, drive a coordinated immune response. Neutrophils and monocytes will therefore function as sensing and effectors cells. Fundamental in this process is the ability to discriminate self from non-self molecules. Of major interest in sepsis is that the protective and damaging host responses are part of the same process, that is, the inflammatory response that controls the infection process also underscores many of the pathophysiological events of sepsis. Moreover, this is a dynamic process according to the continuum of sepsis and its complications; up and down regulation of cellular activities may be differently regulated in different tissues, different cells and even in different functions of the same cell. This review will focus on microorganism recognition and signalization in sepsis, with emphasis on the neutrophils and monocytes adaptation during the ongoing disease.
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Affiliation(s)
- Paulo Sérgio Martins
- Immunology Laboratory, Division of Infectious Diseases, Universidade Federal de Sao Paulo, CEP 04039-032, São Paulo, SP, Brazil
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Rigato O, Silva E, Kallas EG, Brunialti MK, Martins PS, Salomao R. Pathogenetic aspects of sepsis and possible targets for adjunctive therapy. Curr Drug Targets Immune Endocr Metabol Disord 2001; 1:13-30. [PMID: 12476779 DOI: 10.2174/1568008013341794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The outcome of patients with sepsis arises from multiple factors affecting both the host and the invading microorganisms. Age, presence of underlying disease, source of infection and some specific etiological agents have been related to prognosis. Appropriateness of antimicrobial therapy, considering the in vitro susceptibility tests for the infecting bacteria, has been strongly associated with the outcome. Therefore even after the cascade of sepsis has been triggered, the control of bacteria growth is still fundamental for the outcome of the infection. This is a major distinction point from experimental studies in which whole killed bacteria and their products are used as model of sepsis. However, even within the setting of adequate antimicrobial use, patients still die of sepsis. Thus, strategies focusing on further therapy targets are an important area of interest for basic and clinical research. Although such adjunctive sepsis therapy has failed to achieve consistent better survival rates so far, nevertheless, it improved our understanding of the pathophysiological events seen in sepsis that the possibility that a new and effective treatment may arise has been warmly considered. In this paper we aim to review some aspects of the pathogenesis of sepsis, focusing on recent advances and on possible targets for adjunctive therapy. Published clinical trials and experimental data supporting such trials are commented on.
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Affiliation(s)
- O Rigato
- Division of Infectious Diseases, Universidade Federal de São Paulo-UNIFESP, Rua Pedro de Toledo, 781 15o. andar, 04039-032 São Paulo SP, Brazil.
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Silva E, Blecher S, Garrido AG, Kai MH, Assunção MC, Martins PS, Cardoso F, Knobel E. Is there any difference between SOFA and LODS scores to discriminate outcome in septic patients? Crit Care 2001. [PMCID: PMC3333415 DOI: 10.1186/cc1295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Martins PS, Dalboni MA, Cendoroglo M, Blecher S, Kallás EG, Salomão R. Neutrophil apoptosis, phagocytosis and oxidative metabolism in septic patients. Crit Care 2001. [PMCID: PMC3333244 DOI: 10.1186/cc1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martins PS, Blecher S. Predictive accuracy of three scoring systems in a single intensive care unit. Crit Care 2000. [PMCID: PMC3333161 DOI: 10.1186/cc958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martins PS, Perrechi FR, Kai MH, Zanella RC, Valdetaro F, Blecher S. Risk factors associated with vancomycin-resistant enterococcal colonization in a general ICU and the effect of surveillance and prevention over respiratory tract and nosocomial infections. Crit Care 2000. [PMCID: PMC3333015 DOI: 10.1186/cc811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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