BakgrundKnäledsartros är en av de vanligaste orsakerna till funktionsnedsättning. Träning är en viktig del i grundbehandlingen och behandlingseffekten av träning har ansetts vara liten till moderat. Att identifiera subgrupper för att anpassa behandlingen har rekommenderats. Mekanisk Diagnostik och Terapi enligt McKenzie (MDT) är en metod för att klassificera och anpassa behandling utifrån mekanisk respons. Derangement är en klassifikation som innebär en direkt och varaktig positiv respons på smärta och/eller funktion till följd av statiska eller upprepade rörelser. Syfte Syftet med denna studie var att undersöka påverkan på smärta och aktivitetsförmåga vid omhändertagande enligt MDT för personer med knäledsartros vars besvär kunde klassificeras som derangement i knä. Metod En reversal single-case design användes. Utfallsmått var smärta i vila och i rörelse enligt Numeric Rating Scale (NRS) och aktivitetsförmåga enligt Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS). Data analyserades visuellt och med två standarddeviationsmetoden (2 SD). Resultat Två deltagare med knäledsartros vars besvär kunde klassificeras som derangement i knä deltog i studien. Ingen genomgående påverkan på smärta i vila visades för någon av deltagarna. Minskning av smärta i rörelse visades till viss del för båda deltagarna. Ökad aktivitetsförmåga visades för deltagare 2, men inte genomgående för deltagare 1. Slutsats Få deltagare gjorde det svårt att dra några tydliga slutsatser. Studien visade en tendens till förbättring av smärta i rörelse och aktivitetsförmåga. Ingen påverkan på smärta i vila visades. / Introduction Knee osteoarthritis is one of the most common causes of disability. Exercise is an important part of management and the treatment effect of exercise has been considered to be small to moderate. It has been recommended to identify subgroups to adapt the treatment. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is a method for assessment and treatment based on mechanical response. Derangement is a classification where sustained or repeated movements cause a direct and lasting positive response on pain and/or function. Objective The objective of this study was to investigate the impact on pain and disability for management according to MDT for people with knee osteoarthritis whose condition could be classified as derangement in knee. Method A reversal single-case design was used. Outcome measures were pain at rest and pain in movement according to the Numeric Rating Scale (NRS) and disability according to the Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOSPS). Data was analyzed visually and with the two standard deviation band method (2 SD). Results Two participants with knee osteoarthritis whose condition could be classified as derangement in knee participated in the study. No effect on pain at rest was shown altogether for any of the participants. An improvement on pain in movement was shown to some extent for both participants. An improvement on disability was shown for participant 2, but not altogether for participant 1. Conclusions Few participants made it difficult to draw any clear conclusions. The study showed a tendency to improvement on pain in movement and disability. No impact on pain at rest was shown.

Orientador: Daniele Cristina Cataneo / Coorientador: Marcus Vinicius Danieli / Resumo: Avaliar, através de estudo clínico randomizado e cego, a eficácia do plasma rico em plaquetas (PRP) e do ácido tranexâmico (ATX) na artroplastia total do joelho com relação à queda do nível da hemoglobina, ao controle da dor pós-operatória, ao ganho de flexão do joelho e ao ganho de função do membro inferior. Metodologia: foram selecionados 84 pacientes que seriam submetidos à prótese total do joelho e randomizados. Em 23 desses pacientes foi aplicado o ATX, em 20 pacientes o PRP, em outros 20 pacientes o PRP associado ao ATX e em 21 pacientes apenas o soro fisiológico antes do fechamento da cápsula articular. Foram realizadas dosagens de hemoglobina sérica (mg/dL) no pré-operatório, e 24 e 48 horas após a cirurgia, aplicado o questionário Western Ontario and McMaster Universities (WOMAC), a escala numérica (EN) da dor e medido o ganho de flexão do joelho até o segundo ano pós-operatório. A análise estatística comparou os resultados a fim de comprovar haver diferença entre os grupos em cada um dos momentos da avaliação. Resultados: houve diferença estatística significante (p < 0,01) na medida da queda da hemoglobina com 48 horas de pós-operatório entre os grupos em que o ATX foi utilizado em comparação ao grupo controle e ao grupo PRP, sem diferença entre os grupos com ATX isolado ou associado ao PRP. Na mensuração da dor houve significativa vantagem nos grupos que utilizaram o ATX nas avaliações com 24 e 48 horas de pós-operatório e no grupo que utilizou o PRP iso... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Not available / Doutor

In 1697 Massachusetts settler Hannah Duston was taken captive by a group of Abenaki Indians. Duston and her companions escaped captivity by using a tomahawk to kill ten of her captors. Within her captivity narrative, Duston inhabits the role of captor rather than captive, providing a literary framework for reading and understanding the process of Indian Removal in the nineteenth century. Like white captives in the early colonial period, Native Americans in the nineteenth century faced pressure to assimilate, forced marches through unfamiliar territory, and acts of shocking violence like the Wounded Knee Massacre. During this time period, the United States government and army as well as white settlers took on the role of captors, keeping Indian tribes in captivity with these tactics. Understanding the period of Indian Removal as a type of captivity narrative increases our understanding of the shocking violence that accompanied the Indian Removal Policy. As a literary genre, captivity narratives created a national narrative of violence between white settlers and Indian tribes. The struggle for domination in the genre thus became the central struggle of the United States as white Americans embraced and advanced the fight against Native Americans for land and cultural supremacy in North America.

Thesis: M.S., Massachusetts Institute of Technology, Department of Mechanical Engineering, 1977 / Includes bibliographical references. / by Steven F. Manzi. / M.S. / M.S. Massachusetts Institute of Technology, Department of Mechanical Engineering

Study Objective Although data from the Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1-4 trials have shown a similar postoperative bleeding risk between rivaroxban and enoxaparin in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), anecdotal observations from local institutions have suggested that postoperative bleeding rates seemed higher in patients who received rivaroxaban than those reported in the RECORD trials. Thus, the objective of this pilot study was to assess postoperative bleeding events observed in clinical practice in patients receiving rivaroxaban after undergoing THA and TKA and to compare their results with those published in the RECORD trials. Design Retrospective cohort study with a comparator group of patients from the RECORD 1-4 trials. Setting Two institutions within a regional health care system. Patients Four hundred forty adults who received at least one dose of rivaroxaban 10 mg daily after undergoing THA or TKA in the two institutions between August 2011 and October 2013 (cohort group), and 6183 patients who received rivaroxaban in the RECORD 1-4 trials (comparator group). Measurements and Main Results Postoperative bleeding was assessed in the cohort patients versus the patients in the RECORD trials. The primary outcome, occurrence of any postoperative bleeding, was a composite of major and clinically relevant nonmajor bleeding as defined in the RECORD trials. Any postoperative bleeding occurred in 6.8% of the cohort patients versus 3.2% of the RECORD trial patients (p<0.0001); 1.4% of the cohort patients versus 0.38% of the RECORD trial patients suffered a major bleed (p=0.013). Within defined major bleeding, bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin level decrease of at least 2 g/dl or transfusion of 2 units or greater of packed red blood cells were reported in 0.68% versus 0.19% (p=0.073) and 0.68% versus 0.13% (p=0.032), respectively, of the cohort patients versus the RECORD trial patients. Conclusion Overall, any postoperative bleeding in the cohort patients occurred significantly more frequently than that observed in the RECORD trial patients. The major bleeding rate was also significantly higher in the cohort patients, influenced by higher rates of bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin decrease of at least 2 g/dl or transfusion of two units or greater of packed red blood cells. These findings from our pilot study are thought provoking and, thus, invite further investigation.

BACKGROUND: Tranexamic acid (TXA) has become highly utilized in total joint arthroplasties for its anti-fibrinolytic effect. Recently, intra-articular application of TXA has become popular for its avoidance of systemic distribution within the body. With a more direct application to the surgical site, there is interest to see if topical application will provide hemostasis without increasing rates of venous or arterial thrombotic events and infections. In particular, there is lack of published data describing the safety of TXA in patients who have a significant disposition towards thromboembolic events. METHODS: This study was a retrospective chart-review (RCR) to assess the safety and efficacy of intra-articular TXA (IA-TXA) in total knee and hip arthroplasty patients. IA-TXA 2g/50mL NS was administered to patients who were contraindicated for IV-TXA usage based on our hospital’s guidelines (history of VTE events, mitral or aortic valve replacement with additional risk factors for stroke, active cancer, genetic or acquired thrombophilia, significant cardiac disease, serum creatinine > 2.8 mg/dL). Primary efficacy outcomes were total blood loss on post-operative day 1 (POD1), overall perioperative blood loss, and changes in hemoglobin/hematocrit values over the hospital stay. Primary safety outcomes were the incidence of arterial or venous thrombosis and wound infections. The study compared patients who received IA-TXA (study group) to patients who did not receive TXA (control group). The study included TKA patients=156 (Control=72 Study=83), anterior THA patients=57 (Control=20 Study=37), and posterior THA patients=59 (Control=27 Study=32). RESULTS: TKA patients administered IA-TXA showed a significant decrease in POD1 blood loss compared to the control group [305.84 mL, p = 0.004]. Additionally, the control patients showed significantly lower levels of overall hematocrit than those who had received IA-TXA [0.9 units, p = 0.041]. However, IA-TXA did not cause a reduction in blood loss in either the anterior or posterior THA patients. No statistically significant differences existed between treatment and control groups for transfusion rates or post-operative complications (VTE events and infections). CONCLUSION: IA-TXA 2g/50mL is effective in reducing blood loss in TKA patients; however, further research is needed regarding IA-TXA use in THA patients. The lack of efficacy in THA may have been related to the dosage used, the volume instilled, the timing of administration, or technique of administration.

Sport-related injuries (SRI) can be foreseen and averted when mechanisms and risk factors are completely understood. An appreciation of the relationship between sport-related concussion (SRC) and lower extremity musculoskeletal injuries (LEMI) is emerging amid professional and collegiate athletes. However, findings of such a relationship in adults may not be generalizable to younger populations, and the literature has not addressed this relationship in adolescents. The purpose of this cross-sectional quantitative study was to examine the relationship between SRC and LEMI in high school athletes. The dynamic model of etiology in sport injury provided the study's conceptual framework. A de-identified secondary dataset of high school athletic injuries was obtained from the Athletic Training Practice Based Rehab Network and analyzed with descriptive and inferential statistics. Concussions, knee sprains, and ankle sprains represented about 12%, 17%, and 70%, respectively, of the 1,613 cases in the dataset. Chi-square tests revealed that SRCs, and the number of SRCs, were associated with knee sprains [(p < .001), Cramer's V = .148] and ankle sprains [(p < .001), Cramer's V = .545]. This study may promote positive social change by prompting further retrospective and prospective studies to clarify whether a relationship exists between SRC and LEMI in high school athletes, and if so, whether this relationship is causal in nature. New knowledge may be used to guide practices and policies to reduce sports injuries in high school athletes, which may lead to fewer SRIs among adolescents, fewer school absences, more physical activity, and better health and well-being throughout the lifespan, thereby promoting a more active, productive, and healthy society.

Gait, pain, and self-efficacy alterations in osteoarthritis (OA) patients may be precursors for pathological alterations and are important variables to examine in an aquatic therapy study aimed at improving mobility. A greater understanding of these alterations will be useful for the treatment of OA and the prevention of OA progression. The purpose of this thesis was twofold: to review the effects of certain land and aquatic therapies on gait kinematics and mobility of people with osteoarthritis, and to examine the effects of short-term aquatic treadmill exercise on gait kinematics, perception of pain, and mobility in OA patients. A direct comparison of water versus land treadmill exercise was used to determine the acute effectiveness of aquatic therapy on gait kinematics, pain, and self-efficacy. Fourteen participants diagnosed with osteoarthritis of the knee performed three consecutive exercise sessions for each mode of exercise. Gait kinematics, pain, and self-efficacy were measured before and after each intervention. Angular velocity gain score during stance for left knee extension was significantly higher for aquatic treadmill exercise compared to land treadmill exercise by 38.1% (p = 0.004). Similarly, during swing, the gain scores for angular velocity were also greater for left knee internal rotation and extension by 65% and 20%, respectively (p = 0.004, p = 0.008). During stance, the joint angle gain score for left hip flexion was greater for land exercise by 7.23% (p = 0.007). Similarly, during swing, the angular velocity gain score for right hip extension was significantly greater for aquatic exercise by 28% (p = 0.01). Only the joint angle gain score for left ankle abduction during stance was significantly higher for land exercise by 4.72% (p = 0.003). No other joint angle gain scores for either stance or swing were significantly different for either aquatic or land treadmill exercise (p = 0.06-0.96). Perceived pain was 100% greater for land than aquatic treadmill exercise (p = 0.02) and self-efficacy gain scores were not different between conditions (p = 0.37). The present study demonstrated that an acute training period on an aquatic treadmill did influence joint angular velocity and arthritis-related joint pain. Although acute effects of training (i.e., pain, angular velocity) improve after aquatic rather than land training, it is unclear whether or not aquatic exercise is a better long-term alternative to land exercise, and further longitudinal research is needed to examine gait kinematic changes after an increased training period of aquatic exercise.

Title: The Effect of Expertise in Elite Artistic Gymnasts on Postural Control Objective: The main aim of this thesis is to assess the level of postural stability in elite artistic gymnasts using NeuroCom Smart EquiTest System dynamic computer posturograph and to compare the measured data with a control group of people who do not do any elite sport activity. Methods: In this quantitative observational study were involved 32 probands aged 18-28 years. The probands were divided into two groups. The experimental group consisted of elite male and female gymnasts (n=16) in the selected age range of 18-27 years, with a mean age 21,38 years. The control group consisted of the people who do not do any elite sport activity (n=16) in the age range of 22-28 years, with a mean age of 25,08 years. The experimental group was further divided into individuals with a history of knee injury (n=8) in the age range 18-27 years, with mean age of 22,01 years and without injury (n=8) in the age range 19-24 years with mean age of 20,75 years. The NeuroCom Smart EquiTest System was chosen to objectively assess postural stability. The actual measurements were performed in the kinesiology laboratory at the Faculty of Physical Education and Sport, Charles University. Five protocols were selected from the whole set of tests:...

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18199号 / 人健博第16号 / 新制||人健||2(附属図書館) / 31057 / 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 足立 壯一, 教授 三谷 章 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM