Objetivo: Determinar a influência do resultado imediato da angioplastia infrainguinal no sucesso clínico em 24 meses. Métodos: Foi realizado um estudo observacional prospectivo, que avaliou 40 angioplastias percutâneas infrainguinais, realizadas no período de abril de 2007 a fevereiro de 2011. Foram incluídos somente os casos com sucesso técnico e angiográfico intraoperatório. Todos os pacientes eram portadores de isquemia crítica de membro inferior decorrente unicamente de obstrução arterial crônica infrainguinal. Ultrassom com Doppler colorido (UDC) foi realizado um dia antes da cirurgia e no pós-operatório imediato. Foram registradas as velocidades de pico sistólico (VPS) nas artérias tibial anterior, tibial posterior e fibular na topografia do tornozelo. O gradiente de VPS pré e pós-operatório (GVPS) foi analisado e comparado prospectivamente quanto à melhora clínica em 2 anos, conforme os padrões recomendados pela SVS/ISCS. Foram utilizados os valores da artéria com a melhor variação perioperatória e da média das 3 artérias. Sucesso clínico foi definido como ausência de dor de repouso ou cicatrização de lesão. Resultados: Fizeram parte do estudo 19 mulheres e 20 homens, com média de idade de 68,5 ± 8,1 anos. Após 2 anos de seguimento, 26/40 lesões tiveram sucesso clínico sem novas intervenções cirúrgicas. Tempo de cicatrização variou de 4 a 111 semanas (mediana = 21,5 semanas). Lesões TASC II A/B tiveram sucesso clínico maior que TASC II C/D em 1 ano de seguimento (p<0,05), mas não em 2 anos (p=0,11). Entre os 14 casos de insucesso clínico, 6 foram submetidos a nova angioplastia e 4 a enxerto arterial. Três pacientes com angioplastia pérvia não tiveram cicatrização de lesão. Um paciente teve recorrência da úlcera no retorno de 24 meses. A perviedade primária foi de 62,5% ± 7,7% em 2 anos; e o salvamento de membro, de 92,5% ± 4,2% no mesmo período. Houve aumento de VPS, no leito distal, identificado pelo UDC. A variação de VPS foi de 44,4 cm/s, na melhor artéria, e de 21,9 cm/s, na média das artérias, para os casos de sucesso clínico. Para os casos de insucesso clínico, a variação foi de 45,3 cm/s, na melhor artéria, e de 24,7 na média das artérias. A comparação por UDC pré-operatória e pós-operatória imediata, através de VPS, não mostrou diferença estatística entre o grupos em 2 anos de seguimento. Conclusão: o aumento de fluxo pela avaliação por UDC, no pós-operatório imediato, não está relacionado com a resolução dos sintomas em 24 meses / Purpose: to evaluate the impact of the initial result of Percutaneous angioplasty (PA), objectively assessed with duplex-ultrasound, in the two-years clinical outcome. Methods: Between February 2007 and April 2011 thirty-nine patients with femoropopliteal atherosclerotic disease successfully treated by PA were included (40 limbs). One patient had both limbs treated in different occasions, and was considered as 2 cases for analysis. All patients had critical ischemia with rest pain and ischemic ulcers due to infrainguinal obstructions alone. The patients were submitted to duplex-ultrasound examination on the day before and on the first or second day after the procedure. Peak systolic velocities (PSV) was recorded in the anterior tibial, posterior tibial and fibular arteries at the level of distal third of the leg. All patients were followed for 2 years. Comparison between good and bad groups were based on VPS, including the perioperative gradient (GPSV) of the artery with highest variation and the mean of the VPS in the 3 arteries. After 2-years good result were defined as good when the patient had no pain and complete healing of a previous ulcer or minor amputations. It was considered as bad result when a second intervention was required or when unhealed lesions were present at the end of the 2-year period. Results: Mean age was 68,5 ± 8,1 years-old. In 26 cases the long-term result was good. Healing time ranged from 4 to 111 weeks (median 21.5). Bad long-term results were observed in 14 cases. Three lesions had persisted unhealed despite patent angioplasty. One case has ulcer recurrence at 24 months appointment. In 10 cases a second procedure was carried out (redo angioplasty in 6 and bypass in 4). TASCII A/B registered better clinical success then TASCII C/D (p<0,05) at 1-year follow-up but not at 2-years (p=0,11). Two-year limb salvage was 92,5% ± 4,2%. Primary patency was 62,5% ± 7,7% in 2-years. GVPS was 44,4 cm/s (highest artery) and 21,9 cm/s (mean PSV) in success group. GVPS was 45,3 cm/s (highest artery), and 24,7cm/s (mean VPS). The quality of the initial result, as measured by GPSV, was not associated with a good or bad long-term success (p>0,05). Conclusion: once the procedure was successfully performed, the degree of increase in flow is not related to the long-term durability and ulcer healing

This master thesis if focused on the phenomenon of hydrological drought in the Šumava (Bohemian/Black Forrest) region. Hydrological drought is defined on seven hydrological stations (Modrava (CZ), Rejštějn (CZ), Sušice (CZ), Zwiesel (DE), Teisnach (DE), Chamerau (DE), Kalteneck (DE)) during period 1931-1937 and 1949-2014. The aim is in finding suitable hydrological dought indexes and other methods and apply them od the data. Results are compared each other and also are compared with studies that were proceed in non-mountainous region. For hydrological drought evaluation the threshold concept and method according Gumbel 1963 were used and deficite volumes were calculated. Seasonality graphs and graphs for nuber of drought days in hydrological years were constructed, For trends defining, Mann.Kendall and Hisch-Slack tests were used. Hydrological drought sesonality is different on german and czech side, it means effect of exposition towards southwest winds. Hydrological drought is concetrated in autumn at german stations and in winter on czech stations. Number of drought episodes decreases with decreasing elevation. There were found significant decreasing trends in drought episodes occurance in time. Monthly trends aren't so clear. On czech side there is significant decreasing trend in winter months,...

This study aims to evaluate the effects of functional electrical stimulation on motor and functional abilities of paretic upper limb in patients after stroke. Specifically detects the immediate effect of functional electrostimulation on the increase of the active range of motion, reduction of the hand spasticity degree and the improvement of functional performance. The research covered a total of 6 patients after first stroke in the basin aretria middle cerebral artery. The research sample had a homogeneous distribution of the paresis heaviness from light, moderate, to severe. The research was conducted in total of three weeks, every working day, 60 minutes a day, with 30 minutes of indicated electrostimulation and 30 minutes of testing of monitored parameters. Patients were evaluated using the Modified Frenchay scale, Modified Tardieu scale and the range of motion goniometer. Research showed in 60 observations that the functional electrical stimulation has immediate and significant effect on increasing the active range of dorsal flexion motion of the wrist (p-value 0.043). The average improvement on 95% interval estimation is 0.08. During the monitoring of the improvement of the active range of wrist dorsal flexion motion between input and output examination there was no statistically significant...

Estimativa das forças musculares de diabéticos pode apoiar a compreensão das estratégias mecânicas e musculares que esses pacientes adotam para preservar a habilidade de realizar a marcha e garantir sua independência à medida que lidam com seus déficits neurais e musculares devido a diabetes e à neuropatia. O objetivo do presente estudo foi estimar a distribuição da força muscular do membro inferior durante a marcha em pacientes diabéticos com e sem neuropatia diabética, bem como compará-los com indivíduos saudáveis. Dados de força de reação do solo (100 Hz) e cinemática tridimensional do tornozelo, joelho e quadril (100 Hz) de 10 diabéticos neuropatas (GDN), 10 diabéticos não neuropatas (GD) e 10 indivíduos saudáveis (GC) foram utilizados como variáveis de entrada para o modelo musculoesquelético computacional gait 2392 (23 graus de liberdade e 92 atuadores musculoesqueléticos) no software OpenSim. O modelo genérico padrão foi dimensionado para se adequar à antropometria de cada indivíduo coletado, antes da execução das simulações. O modelo musculoesquelético dos indivíduos diabéticos neuropatas apresentou força isométrica máxima reduzida em 30% para os extensores do tornozelo e 20% para os dorsiflexores do tornozelo, buscando aproximar o modelo da redução de força muscular distal consequente à neuropatia diabética exibida por pacientes. As séries temporais da força dos músculos dos membros inferiores foram calculadas usando o procedimento de otimização estática. As forças musculares máximas foram calculadas durante intervalos do ciclo de marcha em que a ação dos músculos é fundamental para execução da tarefa. Os picos de força foram comparados entre os grupos de indivíduos utilizando MANOVA para os grupos musculares flexores e extensores das articulações do quadril, joelho e tornozelo, seguidas de ANOVA e pós-hoc de Newman-Keuls (p < 0,05). GDN apresentou maior pico de força dos músculos flexores de joelho (bíceps femoral cabeça curta/ p < 0,001, semitendinoso/ p < 0,001 e semimenbranoso/ p < 0,001) na fase de propulsão, em relação à GD e GC. GDN também apresentou menor pico de força dos músculos gastrocnêmio medial e sóleo, bem como maior pico de força para gastrocnêmio lateral comparado a GD e GC, nesta mesma fase. GD exibiu menor pico de força dos músculos extensores de quadril (semitendinoso e semimembranoso) ao final da fase de balanço e músculos abdutores do quadril durante a fase de apoio, bem como maior pico de força para os músculos extensores de joelho (vasto medial e lateral/ p = 0,004) no início da fase de apoio, comparado a GDN e GC. Os pacientes diabéticos com e sem neuropatia adotam distintas estratégias de distribuição de força muscular, apesar da piora progressiva em seu estado de saúde. Ambos os grupos diabéticos demonstraram alterações na produção de força dos músculos extensores de tornozelo, com redução do pico de força do sóleo (GD) e gastrocnêmio medial (GDN), entretanto, apenas o GDN aumentou o pico de força dos isquiotibiais (flexores de joelho) na fase de propulsão. GD apresentou redução expressiva da produção de força do glúteo médio, o que pode sugerir prejuízo para a estabilização látero-lateral da pelve. Pode-se considerar incluir programas de treinamento de resistência de músculos proximais relacionados à articulação do joelho em uma rotina de reabilitação para pacientes diabéticos. Outras inclusões potenciais em protocolos de reabilitação são o treino de marcha e a prática de exercícios funcionais com foco na ativação dos músculos isquiotibiais / Muscle force estimation could support a better understanding of the mechanical and muscular strategies that diabetic patients adopt to preserve walking ability and to guarantee their independence as they deal with their neural and muscular impairments due to diabetes and neuropathy. Our aim was to estimate and compare the lower limb\'s muscle force distribution during gait in diabetic patients with and without diabetic neuropathy. Data from ground reaction force (AMTI OR61000 force plate at 100Hz) and three-dimensional kinematics of ankle, knee and hip (eight-camera Optitrack® at 100 Hz) of 10 neuropathic (DNG), 10 diabetic non-neuropathic (DG) and 10 healthy individuals (CG) were used as input variables for the musculoskeletal model gait 2392 (23 degrees of freedom and 92 musculoskeletal actuators) in the OpenSim software. The standard generic model was scaled to fit the anthropometry of each individual collected, prior to the execution of the simulations. The musculoskeletal model of neuropathic individuals presented maximum isometric force reduced in 30% for ankle extensors and 20% for ankle dorsiflexors to mimic the atrophy of ankle muscles due to diabetic neuropathy. The force time series of lower limb muscles were calculated using the static optimization procedure. The peak muscle forces were calculated during selected time bands of the gait cycle. The peak force was compared between groups using MANOVA for the flexor and extensor muscle groups of hip, knee and ankle joints followed by ANOVA and post-hoc of Newman-Keuls (p < 0.05). DNG showed higher knee flexors peak force (biceps femoris short head / p < 0,001, semitendinous / p < 0,001 and semimenbranous / p < 0,001) during push-off, compared to DG and CG. DNG also presented lower peak force for gastrocnemius medialis and soleus, as well as higher peak force for gastrocnemius lateralis compared to DG and CG in the same gait phase. DG exhibited lower peak force for the hip extensor muscles (semitendinous and semimembranous) in the final swing and hip abductor muscles during stance, as well as higher peak force for the knee extensor muscles (vastus medialis and lateralis / p=0,004) in the early stance compared to DNG and CG. Diabetic patients with and without neuropathy appear to adopt different muscle force distribution strategies in spite of the progressive worsening in their health condition. While reducing ankle extensor forces, DG increased knee extensor muscle forces at early stance and reduced the hamstrings force at the end of swing phase, whereas DNG increased the hamstrings muscle forces at push-off. A resistance training program for the proximal muscles related to the knee joint could be considered in a rehabilitation routine for diabetic patients. Other potential inclusions in rehabilitation protocols consist of gait retraining and practicing functional exercises focusing on the activation of the hamstring muscles

When implementing a managed healthcare intervention among a working population, evidence-based healthcare is critical. In the current study, the change of work posture of sewing-machine operators from seated to stand-up (the intervention) was managed within a physiotherapy and ergonomics programme (programme) in Johnson Controls Automotive S.A. (Pty) Ltd (company) without local evidence to guide the postural transition. The management of the intervention, implemented over a period of 4.5 years, presented the opportunity for a retrospective longitudinal study. The study determined the impact of the change in work posture on the incidence of work-related musculoskeletal disorders (WRMSDs) from June 2004 to January 2009 (period). The role of the physiotherapist in the programme was to deliver manual therapy to all sewing-machine operators with WRMSDs, and to provide a clinical - ergonomics service, as a member of a multidisciplinary team, to the company. The population of sewing-machine operators (n=123) was described in terms of personal factors (e.g. age, medical history, musculoskeletal history, and body mass index (BMI)), ergonomic risk factors (e.g. work posture, force and duration) and overall incidence of WRMSDs. The associations of risk factors (personal and ergonomic) with WRMSDs, and work posture with WRMSDs among sewing-machine operators were statistically determined. The majority of the population (97.6%) was female, with mean age 42.3± 8 years. At baseline, 17.9% were hypertensive, 3.3% had arthritis, 6.5% were diabetic, and the mean BMI was 29.7 kg/m² (22% of BMIs was normal). The largest proportion of the sewing-machine operators were sewing cloth and leather (79.7%) (compared to sewing cloth and vinyl), and the remainder performed forceful precision stitching (20.3%), including headrest covers, airbags and top stitching on the final product. Job rotation took place between forceful precision stitching and straight stitching (for 36.6% of the sewing-machine operators).p> The intervention was implemented within the study period. At baseline 100% of sewing machine operators were sewing in the seated work posture. Early in the study, 17.9% of them changed their work posture from seated to stand-up, 30.1% changed to the stand-up work posture in January 2007, and 34.9% a year later. The last 17.1% remained seated till the last year of the study period. From July 2008, 100% of the sewing-machine operators were sewing in the stand-up work posture. The results indicated two strong associations of risk factors and a change in work posture with WRMSDs. Obesity (specifically morbid obesity) was a personal risk factor for upper limb disorders and working in the stand-up work posture was protective for spinal disorders, compared to working in the seated work posture. Furthermore, the results indicated a high incidence of disorders (specifically of the spinal area and upper limb) during the first three months of the programme, as well as an increased incidence of lower leg disorders for the first and consecutive month of the change in work posture from seated to standing up. Lower limb disorders were specifically associated with obesity. The increase of lower limb disorders during the postural adaptation phase was temporary, and was addressed within the programme with proper shoe wear, silicone innersoles, supportive stockings and exercises. The combination proved to be effective in preventing and/or managing lower limb disorders. The outcome of the current study provided evidence on the incidence of WRMSDs, and associations between risk factors and work posture, and WRMSDs among sewing machine operators managed within the programme. / Dissertation (MPhysT)--University of Pretoria, 2013. / Physiotherapy / unrestricted

Sorted patterned ground are a group of periglacial microforms which create more or less symmetrical forms due to frost action and especially repeated freeze-thaw cycles. The origin of sorted patterned ground in the Giant Mts. is presumed in late Pleistocene and they are suggested to be recently inactive (with the exception of sorted circles). Their occurrence is linked to the topmost localities with flat surfaces and intense wind action which causes low snow cover and allow deep soil freezing. The submitted diploma thesis deals with the influence of site characteristics (such as microclimatic extremity, terrain morphology and lithology) on morphology and sorting degree of sorted patterned ground. Field research was carried out along a transect tracing the microclimatic extremity gradient (represented by altitude and so-called relative snow height) in area of Mt. Luční hora in the eastern part of the Giant Mts. which in relatively homogeneous from the viewpoint of lithology and wind exposure. The transect was further extended across the Modré sedlo Saddle to the Mt. Studniční hora where there also occur various types of fossil sorted patterned ground or quasi- active sorted circles in the Modré sedlo Saddle, respectively. However, there is a variability of lithological as well as altitude...

The Action Research Arm Test (ARAT) is a standardized tool, which is used for fine and gross motor skills evaluation of hemiparetic patients after stroke. It is widely used abroad thanks to its excellent psychometric properties and easy administration. It is also used in many foreign studies to evaluate the function of upper extremity, especially for neurological patients. Unfortunately, so far it has been used only sporadically in the Czech Republic. In the theoretical part of this thesis the ARAT and the Modified Frenchay Scale (referred as "MFS") is described. In the practical part, the MFS is compared with the ARAT. The main aim of this diploma thesis is a pilot comparison of sensitivity of upper limb motor skills evaluation done by ARAT and MFS. Thirty patients after stroke were tested in the Rehabilitation Center Kladruby in three weeks. They were further divided into three intervention groups according to the severity of the paresis (light, medium, heavy). The analysis of the results shows that the sensitivity of both diagnostic tools is statistically comparable. According to the Spearman correlation coefficient, the ARAT and the MFS correlate very strongly in range of 0.96-0.98. The greatest differences were measured in the group of patients with moderate hemiparesis. In this group, the...

Introduction: Shoulder pain cases represents about 7% to 50% in the population and its prevalence in athletes between 15 and 19 years old is about 43.5%. Additionally, another pathology in the upper limb is scapular dyskinesia, caused by the scapular´s movements and position alteration. Objective: To determine association between scapula-vertebral distance and shoulder pain in athletes from a private university in Lima. Materials and Methods: Cross-sectional analytical study - preliminary. The study population were athletes from a private university in Lima. The shoulder pain variables were measured by four orthopedic tests Jobe, Patte, Gerber, and Hawkins Kennedy, where shoulder pain (YES) is considered when at least one of the tests is positive and no shoulder pain (NO) when all tests are negative. And the scapular-vertebral distance variables were evaluated in three positions, by the lateral scapular sliding test (LSST); measured in (cm). Results: 51 athletes from climbing, rugby, volleyball, and basketball sports were evaluated in this study. The age ranged was 19 to 21 years. The scapula-vertebral distance of the right side was mayor than the left. 17.65% had shoulder pain. The frequency of training and sex associated with shoulder pain (p<0.05). The scapula-vertebral distance from athletes who had shoulder pain was higher than those without it (p<0.05). Conclusion: Was found association between scapula-vertebral and shoulder pain in athletes from a private university in Lima. Its recommended doing more researches with a considerable sample to reach an adequate statistical power. / Introducción: El dolor de hombro representa casos de 7% al 50% en la población, su prevalencia en deportistas entre 15 y 19 años es de 43,5%. Adicionalmente, otra patología en la extremidad superior es la disquinesia escapular, generada por la alteración de la posición y el movimiento de la escápula. Objetivo: Determinar si existe asociación entre la distancia escápulo-vertebral y el dolor de hombro en deportistas de una universidad privada de Lima. Materiales y métodos: Estudio transversal analítico - preliminar. La población fueron deportistas de una universidad privada de Lima. Las variables fueron, dolor de hombro medido por cuatro test ortopédicos Jobe, Patte, Gerber y Hawkins Kennedy, donde se considera dolor de hombro (SI) cuando al menos de unos de los test da positivo y no dolor de hombro (NO) cuando todos los tests dan negativo, respecto a la variable distancia escápulo-vertebral evaluada en tres posiciones, por la prueba de deslizamiento escapular lateral (LSST) medido en (cm). Resultado: Se evaluaron 51 deportistas de escalada, rugby, vóley y básquetbol. La edad tuvo un rango de 19 a 21 años. La distancia escápulo-vertebral del lado derecho fue mayor que el izquierdo. El 17.65% de la población si tuvo dolor de hombro. La frecuencia de entrenamiento y el sexo estuvieron asociados con el dolor de hombro (p<0.05). La distancia escápulo-vertebral de los que tenían dolor de hombro era mayor que en los que no tenían dolor (p<0.05). Conclusiones: Si se encontró asociación entre la distancia escápulo vertebral y el dolor de hombro en los deportistas de una universidad privada de Lima. Se recomienda realizar estudios con mayor tamaño de muestra para alcanzar un adecuado poder estadístico. / Tesis

The absence of a practice guideline for peripheral artery disease (PAD) in the cardiology department creates differing practice preferences among providers, leading to deviations in practice among staff. Variations in practice can affect the quality of care that is provided to patients. This project was guided by research statements indicating that there was a difference in the screening approach for PAD among health practitioners at preimplementation and postimplementation and that an 85% compliance with the guideline would signify consistency in the provision of care. Rogers' theory of diffusion of innovations was used to facilitate the adoption of the guideline. This project helped close the gap between research (adoption of a guideline) and practice (compliance in the use of evidence in clinical practice). Using random medical record reviews and pretest-posttest design, the results of the project showed that patterns of using the PAD guideline in practice at preimplementation significantly differed compared to postimplementation. The rates of screening for the compliance of the PAD guideline showed approximately an eightfold increase. The adoption of the PAD guideline has implications for policy, because adopting the PAD guideline helped standardize the care, improve effectiveness of care in nursing practice, evaluate quality through use of research, and promote social change by improving patient outcomes.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21306号 / 人健博第62号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 恒藤 暁, 教授 坂井 義治 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM