As cobras são um grupo de vertebrados extremamente bem sucedido. Apesar da aparente simplicidade, elas conseguiram ocupar uma grande diversidade de habitats. O esqueleto axial das serpentes apresenta relação com vários aspectos da vida que puderam ter tido influência direta em seu sucesso evolutivo. Além disso, a forma dos elementos vertebrais possui valor taxonômico, fato que desperta particular interesse, visto que a maior parte do registro fóssil deste grupo é constituído por elementos vertebrais desarticulados. A morfometria geométrica utiliza informações sobre a posição de pontos em duas ou três dimensões, localizados sobre estruturas anatômicas para análise estatística da variação da forma. Esse conjunto de técnicas tem se mostrado eficaz em avaliar variações da forma que não seriam diagnosticadas por métodos tradicionais. O presente trabalho buscou avaliar as vértebras do esqueleto pré-cloacal de Serpentes no contexto da morfometria geométrica, considerando as influências ecológicas e filogenéticas sob estas estruturas, e investigando ainda a utilidade taxonômica da forma vertebral. Os resultados apresentados aqui sugerem a existência de uma padronização do esqueleto axial de serpentes que é conservada ao longo da história evolutiva desse grupo. Análises ecomorfológicas demonstram que a forma vertebral é fortemente influenciada por hábitos de vida como fossorialidade e constrição. A despeito da ausência de sinal filogenético, as análises de classificação de elementos vertebrais dissociados demonstram que a forma vertebral pode ser utilizada para a diagnose de vértebras isoladas. Esses resultados reforçam a necessidade de realização de análises de variação longitudinal para a identificação correta de material fóssil referente a este grupo. / Snakes are an extremely successful group of vertebrates. Despite their apparent morphological simplicity, they managed to occupy a great diversity of habitats. The axial skeleton of snakes has relationships with various aspects of their life history that could have had direct influence in the evolutionary success of these animals. Furthermore, the shape of the vertebrae is recognized as being of taxonomic value, a fact that elicits a special interest, since the majority of the fossil record of this group is composed of disarticulated vertebral elements. Geometric morphometrics methods use information about the position of landmarks in two or three dimensions, placed over anatomical structures for statistical analyses of shape variation. This group of techniques has been shown to identify shape variations that would not be diagnosed through traditional methods. The present work sought to evaluate the vertebrae of the pre-cloacal skeleton of Serpentes in the context of geometric morphometrics, evaluating the influences of ecology and phylogeny over the shape of these structures, and also investigating the taxonomic usefulness of vertebral shape. Results presented here suggest the existence of a patterning of the axial skeleton that is conserved throughout the evolutionary history of the group. An ecomorphological analysis demonstrates that the vertebral shape is highly influenced by life-history traits such as fossoriality and constriction. Despite the absence of phylogenetic signal, analyzes of classification of dissociated vertebral elements show that the vertebral shape can be used to diagnose isolated vertebrae. These results reiterate the necessity of performing studies of longitudinal variation in order to correctly identify fossil material associated with this group.

O objetivo neste estudo foi avaliar a possível relação entre os estágios de maturidade óssea avaliados em radiografias de mão e punho e das vértebras cervicais em telerradiografias em norma lateral, em indivíduos com idade média de 13 anos e 6 meses e desvio padrão de 2 anos e 3 meses (variando de 8 anos e 6 meses a 16 anos e 11 meses). A casuística foi composta por 209 conjuntos radiográficos (radiografias de mão e punho e telerradiografias em norma lateral) tomados na mesma data para cada indivíduo . Dois avaliadores, devidamente treinados e calibrados classificaram por estágios de maturidade óssea todas as radiografias, as de mão e punho segundo Helm et al, e a avaliação das vértebras cervicais nas telerradiografias em norma lateral, segundo O’Reilly e Yaniello (1988) e Baccetti, Franchi e McNamara (2002). Considerando a classificacão de Helm et al (1971) como padrão áureo, teste de correlação de Spearman foi aplicado para verificar relação com os dois métodos que avaliam as vértebras cervicais. Os resultados indicam que houve forte correlação entre os métodos de avaliação das vértebras cervicais e de mão e punho (Rs= 0,906 para O’Reilly e Yaniello(1988) e Helm et al. (1971) e Rs= 0,889 para Baccetti, Franchi e McNamara Jr (2002) e Helm et al. (1971), para todos p<0,001). A análise estatística descritiva indicou que houve maior número de ocorrências concordantes na identificação do início e do pico máximo do surto. Com base nesses resultados pode-se concluir que a avaliação da maturidade óssea pelas vértebras cervicais oferece confiabilidade para a identificação do início e pico do surto de crescimento puberal, mas não para a identificação dos estágios na fase descendente, portanto, continuar usando a radiografia de mão e punho ainda se faz imprescindível quando é necessária a identificação de algum potencial de crescimento restante . / The purpose of this study was to evaluate the possible relationship between the stages of skeletal maturation analyzed by means of hand-wrist radiography and cervical vertebrae in lateral cephalograms, from individuals with mean age of 13 years and 6 months, S.D. 2 years and 3 months (ranging from 8 years and 6 months to 16 years and 11 months). The sample was composed by 209 radiography sets (hand-wrist radiography and lateral cephalograms) taken in the same date for each individual. Two investigators, properly trained and calibrated, classified all the hand-wrist radiography relating them to the skeletal maturation according to Helm et al. The cervical vertebrae evaluation was performed in lateral cephalograms by means of the O'Reilly and Yaniello and Baccetti, Franchi and McNamara method. Considering the classification of Helm et al as “gold standard’, Spearman test correlation was applied to verify relationship with the two methods that evaluate the cervical vertebrae. The results indicated that there was strong correlation among the methods of evaluation of the cervical vertebrae and hand-wrist radiography (Rs =0,906 for O'Reilly and Yaniello and Helm et al and Rs = 0,889 for Baccetti et al and Helm et al, for all p <0,001). The descriptive statistical analysis indicated that there was larger number of concordant occurrences in the identification of the onset and maximum peak of the adolescent growth spurt. Based on these results, it can be concluded that the evaluation of the skeletal maturation by means of the cervical vertebrae method can offer reliability only for the identification of the onset and peak of adolescent growth spurt. Thus, is still indispensable to continue using the hand-wrist radiography when it is necessary the identification of some potential remaining growth.

Orientador: João Batista de Miranda / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T07:18:16Z (GMT). No. of bitstreams: 1 Cavali_PauloTadeuMaia_D.pdf: 2639722 bytes, checksum: 55b4478f11151611236860d14a52b44f (MD5) Previous issue date: 2012 / Resumo: Existe uma grande variabilidade de resultados nos estudos prévios que analisam os parâmetros do alinhamento sagital (PAS) em indivíduos normais e em pacientes com doenças degenerativas da coluna lombar. A maioria desses estudos relacionam os PAS somente com o sintoma de dor lombar crônica, em grupos de pacientes com diferentes doenças degenerativas lombares, o que dificulta a aplicação clínica desses dados tanto na avaliação diagnóstica como na indicação terapêutica. O objetivo deste estudo caso-controle foi analisar as relações dos PAS com os diferentes sintomas entre um grupo de pacientes com diagnóstico de estenose lombar e um grupo controle e as mesmas relações entre os subgrupos de pacientes diferenciados por sintoma. Foram colhidos os dados da história, exame clínico, ressonância magnética e de exames radiográficos de 23 pacientes com estenose lombar (denominado grupo estenose) e de 17 indivíduos saudáveis (denominado grupo controle). Os PAS utilizados foram: cifose torácica (CT), lordose lombar (LL), eixo sagital vertical (C7-T1), listese anteroposterior (OAP), lordose lombo-pélvica total (LLT) e regional (LLR), eixo sagital em T1, T4 eT9 (ES1, ES4 e ES9 respectivamente), inclinação sagital T1-L5 (IST1-L5), "offset sagital" T1 e T9 (OST1 e OST9), "tilt pélvico" (TP), "slope sacral" (SS), morfologia pélvica (MP), ângulo sacro-femoral (ASF), distância sacro-femoral (DSF) e "overhang" (OVHG). Na Fase 1 do estudo, os dados do PAS foram correlacionados entre os indivíduos do grupo controle e grupo estenose e, na Fase 2, entre os subgrupos do grupo estenose diferenciados por sintomas como lombalgia, radiculopatia, claudicação neurogênica e dor, medida pela Escala Analógica de Dor (EAD). Na Fase 1, observou-se que os pacientes do Grupo Estenose (GE) como um todo tiveram menores valores de LLT (p = 0,006) e LLR em L1, L2 e L3 (p = 0,026) e os pacientes do GE com sintoma de radiculopatia, além dos dados acima, tiveram aumento do TP (p = 0,004), quando comparados ao Grupo Controle (GC). Na Fase 2, o Subgrupo Lombalgia obteve maiores valores de CT (p = 0,035) e LLR (p = 0,028) e uma diminuição do TP (p = 0,029), OST1 (p = 0,022), DSF (p = 0,014) e OVHG (p = 0,035) em relação aos outros pacientes do GE que não se queixavam de lombalgia e, no Subgrupo Radiculopatia, houve a diminuição da LLR (p < 0,047). Este estudo demonstra que há correlações significativas dos sintomas e dos PAS entre o GE e o GC e também entre os Subgrupos do GE diferenciados por sintomas. Estes dados indicam uma melhor interpretação clínica dos PAS, assim como podem sugerir a terapêutica mais adequada / Abstract: There is a great variation in the results of previous studies analyzing sagital alignment parameters (SAP) in normal individuals and in patients with degenerative diseases of the lumbar spine. Most studies associate SAP only with chronic lumbar pain, in groups of patients with different lumbar degenerative diseases, which makes it difficult to apply these data clinically both in diagnostic evaluation and in therapeutics. The objective of this prospective, diagnostic case-control study was to examine the relationship between sagittal balance parameters and different symptoms of spine disease in patients with lumbar canal stenosis (LCS) and controls and the same associations between subgroups of patients with different symptoms. We collected clinical history, clinical exam data from 23 patients with spinal stenosis and 17 healthy volunteers (controls). Magnetic resonance imaging (MRI) and x-rays allowed the measurement of sagittal axis parameters. The SAP analyzed were thoracic kyphosis, lumbar lordosis, sagittal axis, anterior-posterior listesis, total and regional lumbar-pelvic lordosis, sagittal axis in T1, T4 and T9, pelvic tilt, sacral slope, pelvic morphology, sacro-femoral angle, sacro-femoral distance and overhang. In the first phase of the study, SAP data were correlated between controls and patients, and in the second phase, the subgroups inside the group of patients with stenosis were compared for symptoms as lumbar pain, radiculopathy, neurogenic claudication and pain, measure by the visual analogue scale (VAS). In the first phase, it was observed that the stenosis patients presented lower values of total lumbopelvic lordosis (p = 0.006) and regional lordosis L1, L2 and L3 (p < 0.026). Those with stenosis and radiculopathy also had higher values of pelvic tilt (p = 0.004) and lower values for total lumbopelvic lordosis and regional lordosis in L1 and L2 (p < 0.05) than controls. All patients complaining of back pain had higher values of thoracic kyphosis (p = 0.035), regional lumbopelvic lordosis in L1 (p = 0.028), lower values for pelvic tilt (p = 0.029), sagittal T1 offset (p = 0.022), sacro-femoral distance (p = 0.014) and overhang (p = 0.035) compared to patients without the complaint. Patients with stenosis and radiculopathy were less prone to have regional lordosis in L2, L3 and L4 (p = 0.047, p = 0.047 and p = 0.023 respectively). In conclusion, this study shows that there are significant correlations between symptoms and sagittal axis parameters between patients with and without spinal canal stenosis and also in subgroups of the patients with stenosis with different complaints.These data indicate a better clinical interpretation of SAP, as well as suggest a better therapeutic approach / Doutorado / Cirurgia / Doutor em Cirurgia

3-D computational modelling of the human spine provides a sophisticated and cost-effective medium for bioengineers, researchers, and ergonomics designers in order to study the biomechanical behaviour of the human spine under different loading conditions. Developing a generic parametric computational human spine model to be employed in biomechanical modelling introduces a considerable potential to reduce the complexity of implementing and amending the intricate spinal geometry. The main objective of this research is to develop a 3-D parametric human spine model generation framework based on a command file system, by which the parameters of each vertebra are read from the database system, and then modelled within commercial 3-D CAD software. A novel data acquisition and generation system was developed as a part of the framework for determining the unknown vertebral dimensions, depending on the correlations between the parameters estimated from existing anthropometrical studies in the literature. The data acquisition system embodies a predictive methodology that comprehends the relations between the features of the vertebrae by employing statistical and geometrical techniques. Relations amongst vertebral parameters such as golden ratio were investigated and successfully implemented into the algorithms. The validation of the framework was carried out by comparing the developed 3-D computational human spine models against various real life human spine data, where good agreements were achieved. The constructed versatile framework possesses the capability to be utilised as a basis for quickly and effectively developing biomechanical models of the human spine such as finite element models.

M.Tech. (Chiropractic) / Objective: The purpose of this study was to compare dry needling with cervical spine manipulation combined with dry needling, in the treatment of infraspinatus muscle myofascial trigger points. Study Design: This was a randomized experimental study Setting: The participants were treated at the University of Johannesburg chiropractic day clinic Subjects: 30 participants volunteered for the study. The participants were divided into groups by randomly drawing thirty numbers from a hat, and placing them into two groups: either dry needling combined with spinal manipulation (group 1) or dry needling only (group 2). Participants had to be between eighteen and fifty years old and they could have been male or female. Participants had to present with active infraspinatus muscle myofascial trigger points and also had to present with shoulder or lateral arm pain reproduced by infraspinatus trigger point palpation. Method: Participants were either treated using dry needling only or dry needling combined with spinal manipulation. There were seven consultations. The first six consultations were treatment consultations. Measurements were taken at consultations one, four and seven. Results: The results indicate statistically that participants who had dry needling on its own had a faster increased pressure pain tolerance and a faster decrease in resting electrical activity of the muscle over the treatment period than those that recieved dry needling in combination with spinal manipulation. We must emphasize however that this did not show in the numerical pain rating scale. Participants felt a relatively even relief of their pain in both groups. These overall results might have been skewed by outliers in groups and a small demographic study size. The rest of the results were statistically insignificant, however there was a clinically desired therapeutic effect noted in both groups throughout the study. Conclusion: Dry needling only and dry needling combined with spinal manipulation, individually have desired therapeutic effects in the treatment of infraspinatus myofascial trigger points. There is however no conclusive statistical results in this study that shows one treatment protocol to have a greater therapeutic effect when compared to the other. However this study size was small and therefore the results may have been coincidental.

M.Tech. (Chiropractic) / Purpose: Low back pain affects the general population worldwide. Low back pain is a multi-factorial problem with debate as to the exact aetiology of low back pain. Thus, this study examines the relationship between lumbar spine lordosis, body fat percentage, physical activity level, lumbar spine range of motion and the incidence of low back pain. Method: There was a total of one hundred female participants between and including eighteen and thirty-five years of age. These females were symptomatic or asymptomatic of mechanical low back pain. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. Participants were evaluated once. No treatment was administered. Procedure: Subjective responses were acquired through the Visual Analog Scale, the International Physical Activity Questionnaire and an Oswestry Low Back Pain and Disability Questionnaire. The objective evaluation included a physical examination and a lumbar spine regional examination. The participant’s height was measured using a stadiometer. The Bioelectrical Impedance Analysis (BIA) measured the participant’s weight, water content, lean tissue mass and body fat percentage. BMI was calculated from the weight and height recordings. Range of motion of the lumbar spine was measured with a Digital Inclinometer. A flexi curve ruler molded the lumbar spine lordosis of each participant, which was then traced onto a piece of paper to measure the magnitude of lumbar spine lordosis. Results: A clinical relationship did not exist between a hyperlordotic lumbar spine posture, the incidence of low back pain, body fat percentage and lumbar spine range of motion. A clinical relationship was evident between a hyperlordotic lumbar spine posture and the level of physical activity. Conclusion: Given that a clinical relationship exists between a hyperlordotic lumbar spine posture and the level of physical activity, physical activity specifically exercise to strengthen the abdominal muscles should be included in a treatment protocol to reduce the degree of lumbar spine lordosis if the degree is excessive.

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