The posterior parietal cortex (PPC) is a cortical region receiving inputs from different sensory modalities which has been shown to subserve a visuospatial function. The potential contribution of PPC in audiospatial behaviours and recognition of amodal spatial correspondences were postulated and assessed in the present study. Adult male Long- Evans rats received PPC lesions by aspiration, and they were compared to sham operated control rats on three behavioural tasks. In the Morris water maze, the rats had to learn to use the distal visual cues to locate an escape platform hidden in the pool. In an open field task, the rats were assessed on their reactions to a spatial relocation of a visual or an auditory object. In a spatial cross-modal transfer (CMT) task (Tees & Buhrmann, 1989), rats were trained to respond to light signals using spatial rules, and were then subjected to transfer tests using comparable sound signals. Results from the Morris water maze, the open field, and the initial training phase of the spatial CMT task confirmed a visuospatial deficit in PPC lesioned rats. However, if given sufficient training, PPC lesioned rats could learn the location of a hidden platform in the Morris water maze, and they could also acquire spatial rules in the CMT task. Such results indicated that the visuospatial deficits in PPC lesioned rats were less severe than previously thought. On the other hand, a persistent navigational difficulty characterized by a looping pattern of movement was observed in the PPC lesioned rats in the Morris water maze. Results from the open field indicated that PPC was less involved in audiospatial behaviours. Moreover, results also indicated that PPC was not necessary for spatial CMT. Hence, data from the present study did not support the idea that PPC played an essential role in supramodal spatial abilities in the rats. Instead, data from the spatial CMT task seemed to imply a role of PPC in managing conflicting spatial information coming from different sensory modalities. / Arts, Faculty of / Psychology, Department of / Graduate

Orientador: Ana Terezinha Guillaumon / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-07-24T03:28:22Z (GMT). No. of bitstreams: 1 Felizzola_LuizRoberto_M.pdf: 2868530 bytes, checksum: 746925a4f6db823bc86bb2aa021360d2 (MD5) Previous issue date: 1998 / Resumo:Uma vez que a doença carotídea é a principal causa isolada de acidente vascular cerebral de origem tromboembólica, o qual é a terceira causa de óbito em países desenvolvidos, acredita-se ser imprescindível o diagnóstico precoce desta doença em nosso meio. Todavia, há a necessidade de manter os conceitos de praticidade e de viabilidade econômica, adequando-se às condições sócio-econômicas desfavoráveis típicas de um país em desenvolvimento. No período de 18 meses foram avaliados 50 doentes, sendo 35 do sexo masculino e 15 do sexo feminino, com idade média de 67,2 anos. Todos apresentavam indicação de revascularização miocárdica, considerados neste estudo coronariopatas graves. Avaliou-se a incidência e grau de estenose carotídea com base no mapeamento duplex. Da mesma forma, foi avaliada a possív~l relação com fatores de risco previamente descritos na literatura: Diabetes melito, hipertensão arterial sistêmica, tabagismo, sintomatologia neurológica focal prévia, doença arterial troncular dos membros inferiores e presença de sopro carotídeo. A incidência de estenose carotídea hemodinamicamente significativa (>50%) foi de 48%, e crítica (>70%) de 32%. Mostraram-se fatores de risco estatisticamente significativos, antecedentes de Diabetes melito, sintomatologia neurológica focal prévia, presença de sopro carotídeo e presença. de alterações arteriais tronculares dos membros inferiores. Concluiu-se que no grupo estudado houve aumento significativo de ' risco para estenose carotídea hemo dinamicamente significativa e crítica, em relação à população geral. Desta forma, justifica-se o rastreamento ultra-sonográfico para doença carotídea, principalmente quando os fatores de risco significativos se fizerem presentes / Abstract: Carotid disease is well known as the main individual cause of stroke and also the third cause of death in the USA, which makes it extremely necessary to develop ways of performing its early diagnosis, although these new methods must be practical and economically viable to be used in countries which are in process of development. During 18 months, 50 patients with coronary disease were evaluated (35 male, 15 female; average age of 67.2 years old). Coronary artery bypass graft was previously indicated to alI of them. Using duplex utrasonography it was evaluated the incidence and degree of stenosis of the carotid arteries. It was also evaluated the probabability associated with risk factors enumerated in the literature, such as diabetes mellitus, arterial systemic hypertension, smoking, previous focal neurologic symptoms, lower extremity arterial disease and cervical bruit. It was found that 48% of the cases presented hemodynamically significative carotid stenosis (>50%) and that 32% of the patients showed critic carotid stenosis (>70%). Diabetes mellitus, previous focal neurologic symptoms, cervical bruit and lower extremity arterial disease were considered statisticaly significant risk factors. It was conc1uded that there was a significative increase in the risk of presênting hemodynamically significative or critic carotid stenosis in the group of patients studied when compared to the rest of the population, what justifies the use of ultrasonographic screening for carotid disease, mainly , when significant risk factors are present / Mestrado / Cirurgia / Mestre em Cirurgia

Background: Pyrimethamine and sulfadiazine (P-S) combination is effective and considered the mainstay therapy for cerebral toxoplasmosis (CT). Alternative treatment regimens are available, but their relative efficacy and tolerability are not well known. Particularly, trimephoprim-sulfamethaxozole (TMP-SMX) shows potential advantages (i.e., tolerability, posology, parenteral formulation, cost, and accessibility) but its use is infrequent when P-S is available. Methods: We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies comparing different regimens for the treatment of HIV-associated CT. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. Results: Nine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). Treatment with P-S has the same or better clinical efficacy than P-C or TMP-SMX in terms of partial or complete response clinical response (P-C vs P-S: RR 0.87, 95%CI 0.70-1.08; TMP-SMX vs P-S: RR 0.97, 95%CI 0.78-1.21) and radiological response (P-C vs P-S: RR 0.92, 95%CI 0.82-1.03). Safety profile in terms of skin rash (P-C vs P-S: RR 0.81, 95%CI 0.56-1.17; TMP-SMX vs P-S: RR 0.17, 95%CI 0.02-1.29), liver impairment (P-C vs P-S: RR 0.48, 95%CI 0.24-0.97) and drug discontinuation due to adverse events (P-C vs P-S: RR 0.32, 95%CI 0.07-1.47) were worse with P-S regimen. Conclusion: The available evidence fails to identify any one superior regimen for the treatment of CT. However, P-S regimen has worse safety profile than P-C or TMP-SMX. Although current evidence does not allow a definitive recommendation, use of TMP-SMX for treatment of HIV-associated CT is consistent with the available data. More large studies comparing alternative therapies are needed. / IDWeek, Evento que se llevó a cabo del 7 -11 de Octubre de 2015, en la ciudad de San Diego, CA, EE.UU. Evento Sesión HIV: Other Opportunistic Infections in HIV. Saturday, October 10, 2015. Room: Poster Hall

Cerebral palsy (CP) is the most common cause of physical disability in childhood. Today, most children with CP survive into adulthood with life expectancies similar to typically developing (TD) adults. One of the biggest challenges during the lifespan of individuals with CP is healthy aging; to prevent or minimize the secondary effects of CP on the musculoskeletal system (e.g. bone deformities due to spasticity) as well as to improve functional status and quality of life. There is currently no treatment that is able to cure the brain damage which causes CP, but a variety of options exist to address spasticity, the most prevalent primary condition which is estimated to be present in 80% of people with CP. One of these options is the neurosurgical procedure of Selective Dorsal Rhizotomy (SDR) which entails selective sectioning of dorsal rootlets in the lumbosacral area, diminishing spasticity through reducing muscle tone. SDR gained increasing acceptance following the work of Peacock and Arens in the 1980s, and although a large number of studies have demonstrated the benefits of this procedure, they largely comprise relatively short-term follow-up assessments in children and adolescents. There is thus a need for long-term follow-up studies focussed on all facets of daily living (International Classification of Function, Disability and Health (ICF) model domains: body structure and function, activity and participation) and quality of life in adults with CP who underwent SDR in their childhood. The aim of this doctoral thesis was to address this need, and provide information that might help guide parents, caregivers and clinicians in their clinical decision-making process for a child with CP. This aim was addressed through three key investigations. First, the status of adults with CP and spastic diplegia - related to all domains of the ICF-model and health-related quality of life - was determined more than 25 years after SDR. Second, changes in gait pattern, spinal deformities and level of activities and participation in adults with CP were determined nine years after a similar assessment. Third, associations between results in the different ICFmodel domains along with personal and environmental context factors. This PhD thesis forms part of a longitudinal investigation tracking the health and wellness of adults with CP. The former studies were performed in 2008 and consequently a recent follow-up was conducted in 2017 in the same CP cohort. All participants underwent SDR according to the Peacock method (strict selection criteria were adhered) at Red Cross War Memorial Children’s Hospital in Cape Town, South Africa, between 1981 and 1991. This PhD thesis is based on four studies, with the first being a cross-sectional study conducted in 2017 (Chapter 2) and the other three are nine-year follow-up studies (comparing findings in 2017 with studies conducted in 2008 (Chapter 3 - 5). Each study included a matched TD group, except for the spine study (Chapter 4). Participants were observed and assessed for functioning, health, disability and quality of life based on a physical examination, gait analysis, functional mobility tests, spine radiographs and several questionnaires. With respect to the ICF-model Body structure and function domain, adults with CP showed sustained reduction in muscle tone and minimal signs of spasticity in their gait pattern, with no increased prevalence of scoliosis, hyperkyphosis or hyperlordosis, and did not experience limitation of daily activities due to pain. Some challenges were found regarding ROM, muscle strength, selectivity and back pain but they were comparable with what would be expected in adults with CP who did not undergo SDR. Concerning, the Activity domain, the majority of the cohort was independent in functional mobility and the accomplishment of daily activities with no increased risk for falls. They were as satisfied with accomplishing daily activities as the TD adults, though as might be expected, they were found to be less content with their level of mobility. Regarding Participation domain, the adults with CP greater than 25 years post-SDR were independent and satisfied with their attainment of social roles. Most were married or had a relationship, lived independently (with or without partner), finished higher education and were engaged in paid employment. The perceived health-related quality of life was similar to that of TD adults in most of the health concepts (physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning and mental health), except for physical functioning. No increased prevalence of anxiety and depression was found, which was in line with the reported mental health findings of the health-related quality of life questionnaire. This suggests that while adults with CP have on-going physical challenges following SDR, this might not directly impact their mental health and levels of anxiety and depression. The majority of the cohort viewed the SDR they had undergone as worthwhile due to mobility and functional walking gains. Importantly, no changes were found over the nine-year interval in overall gait, functional mobility, spinal deformities, pain and level of accomplishment and satisfaction in daily activities and social participation. This indicates stability of function which is remarkable since functional decline might be expected in adults with CP while aging. However, correlations were found between functional mobility and daily activities and social participation as well as between functional mobility and strength. This highlights the possible importance of resistance training and maintaining walking ability to enable daily activities and social participation and prevent functional deterioration in the future.

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This practicum is the result of our participation with a grant of national significance from the Developmental Disabilities Office. The project's inquiry is to describe the aging and aged developmentally disabled and to develop professional curricula based upon the findings. There are three major objectives for the grant: 1) to conduct a comprehensive survey of the aging and the aged population, 2) to develop curricula for the training of health-care professional and 3) to consult at the supervisory level with national, state and community agencies. The developmentally disabled population studied by the grant includes cerebral palsied individuals over twenty-one years of age and mentally retarded individuals over forty years of age.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to compare the maxillary dental arch form and palatal vault form between 98 cerebral palsied and 76 normal children. All subjects were divided into three categories based on their dental eruption. The cerebral palsy subjects were further divided into the regional classifications of diplegia, paraplegia, hemiplegia, and quadriplegia, and the descriptive classifications of spasticity, athetosis, and mixed. The maxillary dental arch form was described by an index number which reflected intercuspid width, intermolar width, anterior-posterior length, and degree of divergence of the posterior segments. The palatal vault form v1as described by the angle of divergence of the palatal walls at an established reference point from a cross-sectional view. All measurements were made from study models and Xerox photocopies of study model cross-sections. In addition, those occlusal discrepancies that were thought to influence arch form, i.e., posterior unilateral and bilateral crossbite, anterior crossbite, anterior open bite, and posterior dental asymmetry were tabulated. Statistical analysis of the results revealed no significant difference in maxillary dental arch form between the cerebral palsied and normal children. The same held true for palatal vault form. Significant differences did occur between primary, mixed, and permanent dentitions for both cerebral palsied and non-handicapped groups. The results suggest that the neuromuscular handicap has little effect on the form of the maxillary dental arch. On the basis of this study, it appears that there is no particular type of maxillary arch form that is peculiar to cerebral palsy.

Indiana University-Purdue University Indianapolis (IUPUI) / The purpose of this study was to provide information concerning occlusion and related problems in cerebral palsied children. A group of 124 cerebral palsied children between the ages of 6 and 12 years were examined at the Cerebral Palsy Dental Clinic, Indiana University. The occlusion was evaluated according to Angle's classification. In addition, a recording was made of overjet, over-bite, open bite, cuspid relationships, crossbite and midline discrepancies. The examination included a clinical evaluation of the swallowing pattern of each child. The cerebral palsy classification and I.Q. scores were recorded for each cerebral palsied child after a comprehensive review of his medical record. These findings were compared with a control group of 141 similar aged non-cerebral palsied children examined at Indiana University, Pedodontic department. The cerebral palsied group had an average increased overjet of 0.8 mm. and an average decreased overbite of 0.5 mm., representing an upward and outward positioning of the maxillary anterior segment. Anterior open bite was present in a similar percentage of both groups, but in the cerebral palsied group the measurement recorded was more than twice as great as that recorded in the control group. Forty-four per cent of the cerebral palsied children exhibited bruxism, more than twice the percentage of cases recorded in the control group. The cerebral palsied children exhibited bruxism most frequently in the day time, and was most common in the athetoid group. Other measurements recorded were not significantly different between the two groups. From this study one can conclude that malocclusion and factors affecting occlusion are not found with greater frequency in cerebral palsied children.

This document only includes an excerpt of the corresponding thesis or dissertation. To request a digital scan of the full text, please contact the Ruth Lilly Medical Library's Interlibrary Loan Department (rlmlill@iu.edu).

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