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Orientador: Erika Veruska Paiva Ortolan / Coorientador: Trajano Sardenberg / Banca: Hamiltom da Rosa Pereira / Banca: Evandro Pereira Palácio / Resumo: Introdução: Nas últimas décadas a avaliação do estado de saúde pelo próprio doente tem sido priorizada em detrimento à avaliação somente do ponto de vista do médico. Qualidade de vida relacionada à saúde, capacidade funcional, escalas de dor e satisfação têm sido enfatizadas por possibilitarem a análise da situação de saúde e das manifestações da doença na vida do indivíduo em sua própria perspectiva, complementando os dados clínicos e objetivos. O "3D Assessment of Hand Function" é um questionário que avalia dor, função e aparência em pacientes com doenças das mãos, de fácil e rápida aplicação. Objetivos: Traduzir para o português brasileiro, realizar a adaptação transcultural e validar o instrumento de avaliação de patologias da mão "3D Assessment of Hand Function". Métodos: O questionário foi traduzido e adaptado para a população brasileira de acordo com metodologia internacionalmente aceita, tendo sido subsequentemente aplicado na fase de pré-teste a 30 pacientes com lesão nas mãos. Após análise das dificuldades observadas no pré-teste, gerou-se a versão final em português. Em seguida, essa versão foi aplicada a 220 pacientes. A validação foi realizada através de teste e reteste em 23 pacientes. Os dados de tradução foram analisados descritivamente, a confiabilidade teste e reteste pelo Coeficiente de Correlação Intraclasse (ICC) e pelo coeficiente Kappa e a consistência interna pelo Alpha de Cronbach. Resultados: Algumas expressões foram adaptadas à população brasileira, a forma de apresentação do instrumento apresentou algumas alterações para melhor entendimento. Com relação aos resultados de consistência interna na avaliação geral de todos os itens, o Alpha de Cronbach foi de 0,608 considerado razoável, os valores de Coeficiente de Correlação Intraclasse (ICC) para o item 1(função) de 0,796 com intervalo de confiança (IC) de... / Abstract: Introduction: In recent decades the assessment of health status by the patient has been prioritized over the assessment only the doctor's point of view. Quality of life related to health, functional capacity, pain scales and satisfaction have been emphasized by allow for an analysis of the health situation and the symptoms of the disease in the individual's life in their own perspective, complementing the clinical and objective data. The 3D Assessment of Hand Function is a questionnaire which assesses pain, function and appearance in patients with diseases of the hands, quick and easy application. Objectives: Translate into Brazilian Portuguese, perform the cross-cultural adaptation and validation of the assessment tool of hand pathologies "3D Assessment of Hand Function". Methods: The questionnaire was translated and adapted to the Brazilian populations according to internationally recommended methods, was subsequently applied in the pre-test phase the 30 patients with injuries on the hands. After analyzing the difficulties observed in the pre-test, was generated the final version in Portuguese. This version was administered to 220 patients. The validation was performed through test and retest in 23 patients. The translation data were analyzed descriptively, the test and retest reliability by intraclass correlation coefficient (ICC) and the Kappa coeficiente and the internal consistency Cronbach's Alpha. Results: Some expressions have been adapted to the Brazilian population, as instrument of presentation showed some changes to better understanding of it. Regarding the internal consistency of results in the overall assessment of all items, Cronbach's alpha was 0.608 considered reasonable, the intraclass correlation coefficient values (ICC) for item 1(function) of 0.796 with a confidence interval (CI) of 95% (0.519 to 0.913); item 2 (pain) of 0.880 95% CI (0.670 to 0.941) and item 3 (appearance) of 95 0.907% (0.781 to 0.961). The Kappa ... / Mestre

Made available in DSpace on 2015-12-10T14:23:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-05-29. Added 1 bitstream(s) on 2015-12-10T14:30:05Z : No. of bitstreams: 1 000847992.pdf: 590057 bytes, checksum: e4211c42ce2d2169de05854080805e78 (MD5) / Introdução: Nas últimas décadas a avaliação do estado de saúde pelo próprio doente tem sido priorizada em detrimento à avaliação somente do ponto de vista do médico. Qualidade de vida relacionada à saúde, capacidade funcional, escalas de dor e satisfação têm sido enfatizadas por possibilitarem a análise da situação de saúde e das manifestações da doença na vida do indivíduo em sua própria perspectiva, complementando os dados clínicos e objetivos. O 3D Assessment of Hand Function é um questionário que avalia dor, função e aparência em pacientes com doenças das mãos, de fácil e rápida aplicação. Objetivos: Traduzir para o português brasileiro, realizar a adaptação transcultural e validar o instrumento de avaliação de patologias da mão 3D Assessment of Hand Function. Métodos: O questionário foi traduzido e adaptado para a população brasileira de acordo com metodologia internacionalmente aceita, tendo sido subsequentemente aplicado na fase de pré-teste a 30 pacientes com lesão nas mãos. Após análise das dificuldades observadas no pré-teste, gerou-se a versão final em português. Em seguida, essa versão foi aplicada a 220 pacientes. A validação foi realizada através de teste e reteste em 23 pacientes. Os dados de tradução foram analisados descritivamente, a confiabilidade teste e reteste pelo Coeficiente de Correlação Intraclasse (ICC) e pelo coeficiente Kappa e a consistência interna pelo Alpha de Cronbach. Resultados: Algumas expressões foram adaptadas à população brasileira, a forma de apresentação do instrumento apresentou algumas alterações para melhor entendimento. Com relação aos resultados de consistência interna na avaliação geral de todos os itens, o Alpha de Cronbach foi de 0,608 considerado razoável, os valores de Coeficiente de Correlação Intraclasse (ICC) para o item 1(função) de 0,796 com intervalo de confiança (IC) de... / Introduction: In recent decades the assessment of health status by the patient has been prioritized over the assessment only the doctor's point of view. Quality of life related to health, functional capacity, pain scales and satisfaction have been emphasized by allow for an analysis of the health situation and the symptoms of the disease in the individual's life in their own perspective, complementing the clinical and objective data. The 3D Assessment of Hand Function is a questionnaire which assesses pain, function and appearance in patients with diseases of the hands, quick and easy application. Objectives: Translate into Brazilian Portuguese, perform the cross-cultural adaptation and validation of the assessment tool of hand pathologies 3D Assessment of Hand Function. Methods: The questionnaire was translated and adapted to the Brazilian populations according to internationally recommended methods, was subsequently applied in the pre-test phase the 30 patients with injuries on the hands. After analyzing the difficulties observed in the pre-test, was generated the final version in Portuguese. This version was administered to 220 patients. The validation was performed through test and retest in 23 patients. The translation data were analyzed descriptively, the test and retest reliability by intraclass correlation coefficient (ICC) and the Kappa coeficiente and the internal consistency Cronbach's Alpha. Results: Some expressions have been adapted to the Brazilian population, as instrument of presentation showed some changes to better understanding of it. Regarding the internal consistency of results in the overall assessment of all items, Cronbach's alpha was 0.608 considered reasonable, the intraclass correlation coefficient values (ICC) for item 1(function) of 0.796 with a confidence interval (CI) of 95% (0.519 to 0.913); item 2 (pain) of 0.880 95% CI (0.670 to 0.941) and item 3 (appearance) of 95 0.907% (0.781 to 0.961). The Kappa ...

Fibrotic diseases account for an estimated 45% of the total number of deaths in the developed world (Wynn 2007). Tendons are an excellent model for studying the dysregulated response which leads to fibrosis, as tendons have an organized, parallel matrix, in which tissue defects could easily be distinguished. Wong et al. (2006b) demonstrated the presence of a bell-shaped region around sutures in tendons that was devoid of cells in histological sections. The mechanisms of the formation of this acellular zone, that was also noted in cornea and cartilage (Matsuda et al. 1999; Hunziker and Stähli 2008), were unknown. It was hypothesized that the acellular zone was formed by cell death and that suturing caused alterations to the extracellular matrix of sutured regions of tendon, which made the acellular zone refractory to cellular re-population. The acellular zone was tracked in sutured tendons for up to a year to determine the temporal properties of the acellular zone. Electron microscopic and time lapse studies were carried out to determine if the acellular zone formed by cell migration or cell death. Microarray analysis was conduced to confirm this and to reveal potential molecular targets for future studies. The extracellular matrix of sutured tendons was studied by electron, atomic, scanning and polarized light microscopy and mechanical measurements were obtained using nanoindentation. It was concluded that the acellular zone formed within 24 hours and persisted for up to a year. Tension and size of the suture's grasp were also shown to be important for acellular zone formation. Cell death was the main effector of acellular zone formation. Microarray analysis showed evidence of upregulation of inflammatory mediators and programmed necrosis pathways. The sutured extracellular matrix was denser, more disorganized and had a lower Young's modulus than unsutured regions of the same tendon. These differences in the properties of the extracellular matrix of sutured tendons may be the cause of the persistence of the acellular zone.

Flexor tendon injuries in zone II of the hand (i.e. between the distal volar crease and the distal interphalangeal joint) can be costly for both the afflicted individual and society because of the high cost of a long rehabilitation period, complicated by tendon ruptures or scarring with adhesion formation, causing impaired range of motion. The aim of the present thesis was to characterize more fully the deep flexor tendon, the tendon sheath and their response to injury in a rabbit model in order to find potential targets to improve the outcome of repair. The intrasynovial rabbit deep flexor tendon differed from the extrasynovial peroneus tendon in the expression of collagens and transforming growth factor-β1 gene expression. Differences were also found in collagen III and proteoglycans between regions of the flexor tendon subjected to either compressive or tensile load. After laceration and subsequent repair of the flexor tendon, a shift in collagen gene expression from type I to type III occurred. Proteoglycans were generally increased with the notable exception of decorin, a potential inhibitor of the profibrotic transforming growth factor-β1 which was markedly increased during the first two weeks after repair in tendon tissue but remained unaltered in the sheaths. Both vascular endothelial growth factor and basic fibroblast growth factor mRNA levels remained essentially unaltered, whereas insulin-like growth factor-1 increased later in the healing process, suggesting potential beneficial effects of exogenous addition, increasing tendon strength through stimulating tenocyte proliferation and collagen synthesis. Matrix metalloproteinase-13 mRNA levels increased and remained high in both tendon and sheath, whereas there was only a transient increase of matrix metalloproteinase-3 mRNA in tendon. We could also demonstrate a significant increase of the proportion of myofibroblasts, mast cells and neuropeptide containing nerve fibers in the healing tendon tissue, all components of the profibrotic myofibroblast-mast cell-neuropeptide pathway. / Biomolecular aspects of flexor tendon healing

Orientador: Antônio José Maria Cataneo / Resumo: Introdução: O risco de sangramento em cirurgias realizadas na vigência de antitrombóticos preocupa o cirurgião, em contrapartida, a suspensão do agente antitrombótico aumenta o risco de trombose. Esse dilema levou a realização desta revisão. Objetivo: avaliar, por meio de revisão sistemática e metanálise, se há ou não necessidade de suspender medicamentos antitrombóticos orais (varfarina, fluindiona, acenocumarol, AAS e clopidogrel) para a realização de procedimentos eletivos de cirurgia do punho e da mão. Métodos: revisão sistemática de estudos experimentais ou observacionais que tenham avaliado cirurgias de mão e punho na vigência do agente antitrombótico. Foram pesquisadas as bases de dados LILACS, Pubmed, Embase, Cochrane e Scopus, sendo selecionados series com cinco ou mais cirurgias . Os desfechos avaliados foram: complicações graves (necessidade de tratamento cirúrgico) e leves (sem necessidade de tratamento cirúrgico). Resultados : foram selecionados 10 estudos observacionais para análise qualitativa envolvendo 2971 cirurgias. Seis desses estudos foram selecionados para análise quantitativa, envolvendo 319 cirurgias do punho e da mão realizadas na vigência de varfarina, fluindiona, acenocumarol, AAS e clopidogrel e 629 cirurgias realizadas em pacientes sem uso dos antitrombóticos. O risco de complicações leves foi maior nos pacientes que estavam recebendo antitrombóticos ( RR 1,55, IC 95% 1,02 a 2,35; I 2 = 23%, 948 cirurgias), e o risco de complicações graves foi sem... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction : The risks of bleeding in surgeries performed during the antithrombotic period are of concern to the surgeon, and on the other hand, the suspension of the antithrombotic agent increases the risk of thrombosis. This dilemma led to this review. Objective: to evaluate, through a systematic review, whether or not there is a need to suspend antithrombotic drugs (warfarin, fluindione, acenocumarol, ASA and clopidogrel) to perform elective procedures for wrist and hand surgery. Methods: systematic review of experimental or observational studies that have evaluated hand and wrist surgeries during the antithrombotic agent. The databases LILACS, Pubmed, Embase, Cochrane and Scopus were searched, being selected series with five or more surgeries. The outcomes evaluated were: severe complications (need for surgical treatment) and mild complications (no need for surgical treatment). Results: 10 observational studies were selected for qualitative analysis involving 2971 surgeries. Six of these studies were selected for quantitative analysis, involving 319 wrist and hand surgeries performed during warfarin, fluindione, acenocumarol, ASA and clopidogrel and 629 surgeries performed in patients without antithrombotic drugs. The risk of mild complications was greater in patients receiving antithrombotic drugs (RR 1.55, 95% CI 1.02 to 2.35, I 2 = 23%, 948 surgeries), and the risk of severe complications was similar in both groups (RR 1.83, 95% CI 0.32 to 10.29, I 2 = 0%, 948 surger... (Complete abstract click electronic access below) / Mestre

Submitted by FRANCISCO SIMOES DEIENNO (frandeienno@hotmail.com) on 2018-08-14T12:57:37Z No. of bitstreams: 1 Tese Final para Repositorio.pdf: 614767 bytes, checksum: 0f22aeef2c688aa8f97eb3c2d7bc5223 (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-14T17:14:35Z (GMT) No. of bitstreams: 1 deienno_fs_me_bot.pdf: 614767 bytes, checksum: 0f22aeef2c688aa8f97eb3c2d7bc5223 (MD5) / Made available in DSpace on 2018-08-14T17:14:35Z (GMT). No. of bitstreams: 1 deienno_fs_me_bot.pdf: 614767 bytes, checksum: 0f22aeef2c688aa8f97eb3c2d7bc5223 (MD5) Previous issue date: 2018-07-19 / Introdução: O risco de sangramento em cirurgias realizadas na vigência de antitrombóticos preocupa o cirurgião, em contrapartida, a suspensão do agente antitrombótico aumenta o risco de trombose. Esse dilema levou a realização desta revisão. Objetivo: avaliar, por meio de revisão sistemática e metanálise, se há ou não necessidade de suspender medicamentos antitrombóticos orais (varfarina, fluindiona, acenocumarol, AAS e clopidogrel) para a realização de procedimentos eletivos de cirurgia do punho e da mão. Métodos: revisão sistemática de estudos experimentais ou observacionais que tenham avaliado cirurgias de mão e punho na vigência do agente antitrombótico. Foram pesquisadas as bases de dados LILACS, Pubmed, Embase, Cochrane e Scopus, sendo selecionados series com cinco ou mais cirurgias . Os desfechos avaliados foram: complicações graves (necessidade de tratamento cirúrgico) e leves (sem necessidade de tratamento cirúrgico). Resultados : foram selecionados 10 estudos observacionais para análise qualitativa envolvendo 2971 cirurgias. Seis desses estudos foram selecionados para análise quantitativa, envolvendo 319 cirurgias do punho e da mão realizadas na vigência de varfarina, fluindiona, acenocumarol, AAS e clopidogrel e 629 cirurgias realizadas em pacientes sem uso dos antitrombóticos. O risco de complicações leves foi maior nos pacientes que estavam recebendo antitrombóticos ( RR 1,55, IC 95% 1,02 a 2,35; I 2 = 23%, 948 cirurgias), e o risco de complicações graves foi semelhante nos dois grupos (RR 1,83, IC 95% 0,32 a 10,29; I 2 = 0%, 948 cirurgias). Conclusões: Pacientes em uso de anticoagulantes orais ou antiplaquetários orais tem um risco maior de desenvolver complicações leves, isto é aquelas que não necessitam de reintervenção cirúrgica , quando submetidos a cirurgias do punho e da mão na vigência de tratamento antitrombótico. / Introduction : The risks of bleeding in surgeries performed during the antithrombotic period are of concern to the surgeon, and on the other hand, the suspension of the antithrombotic agent increases the risk of thrombosis. This dilemma led to this review. Objective: to evaluate, through a systematic review, whether or not there is a need to suspend antithrombotic drugs (warfarin, fluindione, acenocumarol, ASA and clopidogrel) to perform elective procedures for wrist and hand surgery. Methods: systematic review of experimental or observational studies that have evaluated hand and wrist surgeries during the antithrombotic agent. The databases LILACS, Pubmed, Embase, Cochrane and Scopus were searched, being selected series with five or more surgeries. The outcomes evaluated were: severe complications (need for surgical treatment) and mild complications (no need for surgical treatment). Results: 10 observational studies were selected for qualitative analysis involving 2971 surgeries. Six of these studies were selected for quantitative analysis, involving 319 wrist and hand surgeries performed during warfarin, fluindione, acenocumarol, ASA and clopidogrel and 629 surgeries performed in patients without antithrombotic drugs. The risk of mild complications was greater in patients receiving antithrombotic drugs (RR 1.55, 95% CI 1.02 to 2.35, I 2 = 23%, 948 surgeries), and the risk of severe complications was similar in both groups (RR 1.83, 95% CI 0.32 to 10.29, I 2 = 0%, 948 surgeries). Conclusions: Patients taking oral anticoagulants or oral antiplatelet agents may be at increased risk of developing mild complications , that is, those that do not require surgical reintervention, when undergoing hand and wrist surgeries during antithrombotic treatment

No description available.

Following microsurgical reconstruction of injured peripheral nerves, severed axons are able to undergo spontaneous regeneration. However, the functional result is always unsatisfactory with poor sensory recovery and reduced motor function. One contributing factor is the retrograde neuronal death, which occurs in the dorsal root ganglia (DRG) and in the spinal cord. An additional clinical problem is the loss of nerve tissue that often occurs in the trauma zone and which requires “bridges” to reconnect separated nerve ends. The present thesis investigates the extent of retrograde degeneration in spinal motoneurons and cutaneous and muscular afferent DRG neurons after permanent axotomy and following treatment with N-acetyl-cysteine (NAC). In addition, it examines the survival and growth-promoting effects of nerve reconstructions performed by primary repair and peripheral nerve grafting in combination with NAC treatment. In adult rats, cutaneous sural and muscular medial gastrocnemius DRG neurons and spinal motoneurons were retrogradely labeled with fluorescent tracers from the homonymous transected nerves. Survival of labeled neurons was assessed at different time points after nerve transection, ventral root avulsion and ventral rhizotomy. Axonal regeneration was evaluated using fluorescent tracers after sciatic axotomy and immediate nerve repair. Intraperitoneal or intrathecal treatment with NAC was initiated immediately after nerve injury or was delayed for 1-2 weeks. Counts of labeled gastrocnemius DRG neurons did not reveal any significant retrograde cell death after nerve transection. Sural axotomy induced a delayed loss of DRG cells, which amounted to 43- 48% at 8-24 weeks postoperatively. Proximal transection of the sciatic nerve at 1 week after initial axonal injury did not further increase retrograde DRG degeneration, nor did it affect survival of corresponding motoneurons. In contrast, rhizotomy and ventral root avulsion induced marked 26- 53% cell loss among spinal motoneurons. Primary repair or peripheral nerve grafting supported regeneration of 53-60% of the motoneurons and 47-49% of the muscular gastrocnemius DRG neurons at 13 weeks postoperatively. For the cutaneous sural DRG neurons, primary repair or peripheral nerve grafting increased survival by 19-30% and promoted regeneration of 46-66% of the cells. Regenerating sural and medial gastrocnemius DRG neurons upregulate transcription of peripherin and activating transcription factor 3. The gene expression of the structural neurofilament proteins of high molecular weight was significantly downregulated following injury in both regenerating and non-regenerating sensory neurons. Treatment with NAC was neuroprotective for spinal motoneurons after ventral rhizotomy and avulsion, and sural DRG neurons after sciatic nerve injury. However, combined treatment with nerve graft and NAC had significant additive effect on neuronal survival and also increased the number of sensory neurons regenerating across the graft. In contrast, NAC treatment neither affected the number of regenerating motoneurons nor the number of myelinated axons in the nerve graft and in the distal nerve stump. In summary, the present results demonstrate that cutaneous sural sensory neurons are more sensitive to peripheral nerve injury than muscular gastrocnemius DRG cells. Moreover, the retrograde loss of cutaneous DRG cells taking place despite immediate nerve repair would still limit recovery of cutaneous sensory functions. Experimental data also show that NAC provides a highly significant degree of neuroprotection in animal models of adult nerve injury and could be combined with nerve grafting to further attenuate retrograde neuronal death and to promote functional regeneration.

Compliance to strict home exercise programs is understood to be a mainstay of post-surgical flexor tendon rehabilitation. Therapists recognise the potential of poor compliance (overuse or under-use of prescribed exercise) and spontaneous movements during rehabilitation. Some therapists may suggest that compliance to specific exercise regimens and control of spontaneous or general movements are fundamentally important in optimising the rehabilitation outcomes and minimising the potential of adverse events. Yet there is little objective data to document the actual levels of exercise or spontaneous finger movement performed outside the clinical setting. The purpose of this study was to document both diary and instrumented methods of reporting finger movement during a 48hr period. Following surgical repair of the flexor tendon, subjects attending a private hand therapy clinic provided consent and reported subjective diary (n=16) data of sets and repetitions of exercise for up to 6 weeks post-operatively. Nine subjects also had instrumented data logged on 3 occasions during the first 6 weeks of rehabilitation and were not fully aware of the purpose of the instrumentation. All subjects were instructed to perform 10 passive followed by 10 active exercises every waking hour, for the first 6 weeks and were assessed on range of motion, DASH, pain and strength. Results demonstrated that patients reported, via their diaries, that they are on average 80% compliant. Parallel data logger information suggests that this figure is more likely to reflect 50% compliance. A significant (p< .05) increase in spontaneous movements in the last 2 weeks of the 6 week assessment period was detected. No significant correlation between patient's level of compliance or spontaneous movement and their outcome were detected.