PLAYING SAXOPHONE AND ITS POTENTIAL HEALTH RISKS Objectives: Main purpose of this study is to provide comprehensive review of health issues related to saxophone playing. The aim of this study is to collect available resources focused on saxophone players teaching methods, analyse them and compare them with existing findings of medical science. Also to try to find answers to asked research questions and to verify or disprove stated hypotheses, on the basis of acquired datas and principles eventually trying to arrange some possible outlines to complement teaching methods or preventative-compensational excercises for saxophone players. Methods: Method of this thesis is literature research using available Czech and foreign literary resources. For this purpose there have been used electronic archives as Pubmed, Ebsco, Springer, Wiley and Science Direct, monographic publications and scholarly papers from periodicals. This work is divided into few main parts. Introductional part contains basic review of health issues related to instrumental musicians, methodics contained in saxophone schools written in the Czech language, aims and methods of this thesis. Theoretical part is more widely focused on methodics, principles and mechanics of saxophone players' education. The main part is dedicated to possible...

A esquizofrenia é uma desordem neuropsiquiátrica de importância significativa para as pesquisas na área da saúde, porém, apesar de ser alvo de inúmeros estudos clínicos e básicos ainda são levantadas muitas dúvidas a respeito de sua etiologia, fisiopatologia e tratamento. Nos últimos anos, hipóteses que relacionam a esquizofrenia a alterações em sistemas neurotransmissores têm sido bem relevantes. Atualmente a hipótese glutamatérgica complementa a dopaminérgica, já que o bloqueio de receptores glutamatérgicos do tipo NMDA induz sintomas do tipo psicóticos em indivíduos saudáveis e exacerba ou precipita sintomas da esquizofrenia em indivíduos portadores da doença, sugerindo que um estado hipofuncional desses receptores possa causar alterações secundárias em outros sistemas neurotransmissores e provocar tanto os sintomas positivos e negativos quanto os déficits cognitivos da doença. O canabidiol (CBD) é um composto derivado da Cannabis sativa que não apresenta os efeitos psicotomiméticos e os sintomas colaterais geralmente provocados pela utilização da planta e que são, em sua maioria, atribuídos ao delta-9-tetrahidrocanabinol (THC). Recentemente os estudos a respeito da participação do sistema endocanabinóide em diversos estados fisiológicos e, também em transtornos psiquiátricos, apontam o uso terapêutico de canabinóides como uma estratégia promissora para o controle e prevenção de alguns sintomas ligados a transtornos psicóticos. O perfil antipsicótico do CBD já foi comprovado em modelos experimentais e até em análises clínicas, indicando que esse composto é capaz de prevenir estados psicóticos transitórios, provocados tanto pelo THC quanto pela ketamina, em modelos de psicose induzida. O objetivo deste trabalho foi incrementar as informações já existentes sobre o perfil antipsicótico proposto para o CBD, porém, em três tipos de tarefas comportamentais em roedores, que representam três classes de sintomas do tipo psicóticos que se assemelham aos sintomas da esquizofrenia: atividade locomotora, inibição pré-pulso do reflexo de sobressalto (PPI) e teste de interação social. No modelo utilizado, a S(+)-ketamina (KET) é eficaz na indução de comportamentos que representem sintomas do tipo psicóticos - provocou hiperlocomoção, déficit no filtro sensório-motor e prejuízo no comportamento social. Esses são foram reduzidos quando realizado pré-tratamento com clozapina, com exceção do teste de interação social. Os efeitos do CBD são de acordo com o que é descrito na literatura, apresentando uma curva em U farmacológica característica e diferentes efeitos 6 de acordo com a dose empregada. A análise no monitor de atividades indica que o pré- tratamento com CBD na dose de 30 mg/kg previne a hiperlocomoção induzida por KET, contrastando com o pré-tratamento com CBD na dose de 60 mg/kg, que provoca o aumento do comportamento exploratório após a administração de KET. No PPI, o CBD na dose de 30 mg/kg previne o déficit provocado pela administração de KET, demonstrando-se eficaz para o tratamento de prejuízos cognitivos que acompanham as psicoses; e aumenta o reflexo de sobressalto quando associado a KET. Porém, no teste de interação social, não foram detectadas diferenças significativas. Portanto, com esses resultados, demonstrou-se que o CBD pode ser realmente efetivo para o tratamento de determinados sintomas dos transtornos psicóticos, assim como indicado em alguns trabalhos já desenvolvidos. / Schizophrenia is a psychiatric disorder of significant importance for research in health care, however, despite being the target of numerous clinical and basic studies, there are still many doubts raised about its etiology, pathophysiology and treatment. In recent years, schizophrenia hypotheses that relate to changes in neurotransmitter systems have been very relevant. Currently, the glutamatergic hypothesis complements the dopaminergic, since blockade of NMDA glutamate receptors induces psychotic symptoms in healthy individuals and exacerbate them in patients with schizophrenia, suggesting that a hipofuncional state of these receptors may cause secondary changes in other neurotransmitter systems, leading to positive and negative symptoms and also to cognitive deficits of the disease. Cannabidiol (CBD) is a compound derived from Cannabis sativa that does not show neither the psychotomimetic effects nor side effect symptoms typically caused by the plant use, which are mostly attributed to delta-9-tetrahydrocannabinol (THC). Recently studies about the involvement of the endocannabinoid system in various physiological states and also in psychiatric disorders, suggest the therapeutic use of cannabinoids as a promising strategy for the prevention and control of some symptoms linked, for example, to anxiety, epilepsy and psychotic disorders. The antipsychotic profile of CBD has been confirmed in experimental 7 models and even in clinical trials, indicating that this compound is capable of preventing transient psychotic states caused both by THC and S (+)-ketamine (KET) in psychosis-induced models. The objective of this study was to enhance the existing information on the antipsychotic profile proposed for the CBD, however, three types of behavioral tasks were made for the analysis of three classes of psychotic-like symptoms in rodents, which are manifested through hyperlocomotion (positive symptoms), impairment in social interaction (negative symptoms) and a deficit in sensorimotor gating (cognitive deficits). The effects achieved with CBD are in accordance with the described in literature, a characteristic Ushaped curve and different pharmacological effects according to dose used. The analysis in the open field reveals that animals pretreated with CBD at a dose of 30 mg/kg shows a reduction in KET-induced hyperlocomotion, contrasting with the effects of CBD at a dose of 60 mg/kg, that enhances exploratory behavior after KET injection. In the PPI, the CBD at a dose of 30 mg/kg prevented the deficit caused by KET administration, showing effectiveness for the treatment of cognitive impairments that accompany psychosis; and enhances startle reflex when associated to KET. Therefore, with these results, it was demonstrated that CBD may be really effective for the treatment of certain symptoms of psychotic disorders, in accordance to some already developed studies.

A dependência de drogas é um transtorno multifatorial complexo que se desenvolve em uma minoria de indivíduos que fazem uso dessas substâncias. Memórias associativas entre a droga e o contexto funcionam como gatilho para disparar comportamentos não adaptativos de busca e consumo, além de recaídas após períodos de abstinência. Subjacentes a essas mudanças comportamentais, existem modificações nas subunidades de receptores glutamatérgicos do tipo AMPA em estruturas envolvidas com memória (Hipocampo) e recompensa (Núcleo Accumbens). Por isso, estratégias que enfraqueçam a associação do contexto com a droga e que aprofundem o conhecimento dos circuitos envolvidos nesses comportamentos são de extrema relevância terapêutica. A memória quando evocada pode passar por dois processos pós-evocação: a extinção, em que uma nova memória é formada inibindo uma prévia associação, e a reconsolidação, em que a memória original entra em um estado lábil e suscetível a modificações, em que é possível enfraquecê-la através da inibição de sua reconsolidação. A reconsolidação da memória mostra-se uma estratégica mais eficaz e duradoura em relação à extinção, já que a memória original é modificada. Como modelo animal para o estudo da memória na dependência de drogas, o condicionamento de preferência por local (CPL) é bastante utilizado e sabe-se que é possível enfraquecer a preferência através do bloqueio da reconsolidação. Porém, são escassos os estudos que investigaram a existência da reconsolidação no modelo de sensibilização locomotora, que parece ocorrer, na maioria dos casos, em condição dependente do contexto de aquisição do comportamento, embora existam exemplos que demonstrem sua independência. As questões a serem respondidas neste trabalho são (a) se é possível reverter conjuntamente a preferência por local e a sensibilização locomotora à morfina (5 mg/kg) em ratos Wistar adultos machos, inibindo-se a síntese proteica com cicloheximida (CHX) i.p. logo após uma sessão de reativação contextual da memória no CPL, (b) se a reversão dos comportamentos reflete alterações (já descritas por outros autores) em GluA1, GluA1p (Ser845) e GluA2, no Hipocampo dorsal (HPCd) e no Núcleo Accumbens (NAc), e (c) se o mesmo tratamento em ambas estruturas reverte os dois parâmetros avaliados – comportamental e neuroquímico – de forma diferente ou igual. Nossos resultados mostraram ser possível reverter a preferência por local e a sensibilização locomotora por inibição sistêmica de síntese proteica, e que o condicionamento com exposição à morfina induz alterações nas subunidades analisadas de AMPA, conforme verificado no HPCd e NAc, embora a CHX não tenha produzido um efeito tão bem definido. Os animais que receberam infusões centrais no HPCd e NAc (central) não exibiram preferência por local, nem sensibilização. Em conjunto, nossos resultados mostraram, pela primeira vez em um mesmo desenho experimental, que é possível reverter diferentes aspectos da memória de recompensa (preferência e sensibilização) por meio do bloqueio da reconsolidação. / Drug addiction is a complex and multifactorial disorder that develops in a few people who use these substances. Associative memories between the drug and context of use act as a trigger for maladaptive behavior such as drug seeking and drug use, in addition to relapse after an extended period of withdrawal. Underlying these behavioral changes are modifications in glutamatergic reception (AMPA) in structures involved with memory (Hippocampus) and reward (Nucleus Accumbens). Therefore, strategies that weaken the drug and context association and deepen knowledge of circuits involved in these behaviors are extremely relevant therapeutically. When retrieved, a memory can undergo two distinct processes post-retrieval: extinction, in which a new memory inhibiting a previous association is generated, and reconsolidation, in which the original memory can enter a labile state and is susceptible to modifications, when it can be weakened by inhibition of its reconsolidation. Reconsolidation of memory has been shown to be a more effective and long lasting strategy in relation to extinction, since the original memory is modified. An animal model for studying drug addiction, conditioned place preference (CPP) is largely used and it is well known that it is possible to weaken preference by disrupting reconsolidation. However, there are few studies that investigate the existence of reconsolidation in a locomotor sensitization paradigm, which seems to occur in a condition dependent on context of acquisition, although some works report its independence. The questions answered in this work were (a) if it is possible to reverse both, context preference and locomotor sensitization to morphine (5mg/kg) by protein synthesis inhibition (CHX) after a contextual memory reactivation session in CPP, (b) if the disruption of behaviors reflects a reversal of changes of GluA1, GluA1p (Ser845) e GluA2 in dorsal Hippocampus (dHPC) and Nucleus Accumbens (NAc) and (c) if the same treatment in these structures differentially reverts the two parameters assessed. Our results indicate that it is possible to revert context preference and locomotor sensitization via systemic disruption of protein synthesis and that morphine conditioning induces changes in AMPA subunits in dHPC and NAc, although CHX did not have an evident effect on molecular reversal. Animals cannulated in dHPC and NAc core did not induce preference or sensitization. Taken together, our results demonstrated, for the first time, using the same experimental design that is possible to revert different aspects of reward memory (preference and sensitization) by disrupting the reconsolidation process.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-07-25T11:03:30Z No. of bitstreams: 2 Dissertação - Isis Gabrielli Barbieri de Oliveira - 2017.pdf: 1486050 bytes, checksum: fcc7f785120d547ad310a16b98732ea1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-07-25T11:04:15Z (GMT) No. of bitstreams: 2 Dissertação - Isis Gabrielli Barbieri de Oliveira - 2017.pdf: 1486050 bytes, checksum: fcc7f785120d547ad310a16b98732ea1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-07-25T11:04:15Z (GMT). No. of bitstreams: 2 Dissertação - Isis Gabrielli Barbieri de Oliveira - 2017.pdf: 1486050 bytes, checksum: fcc7f785120d547ad310a16b98732ea1 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-06-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The presence of circadian rhythms in organisms is a biological event, indispensable to the process of adaptation to the environment and fundamental for the survival of the species. The loss of the phase relationship between the biological rhythms and the behavior leads impairment of the body function. Thus, the aim of this study was to evaluate the effects of the forced locomotor activity desynchronization on the cardiovascular and metabolic parameters. Male Wistar rats, aged approximately 60 days, were distributed into two experimental groups: control group (CTR) submitted to the light/dark cycle (LD) of 24h-T24 (n=12) and desynchronized group (DSC) submitted to the LD cycle of 22h -T22 (n = 18) for eight weeks. Records of the locomotor activity were made daily to both groups. Food ingestion, water intake and body weight were monitored weekly. Following of this period the animals were allocated into two experimental protocols. In the first protocol the CTR and DSC animals were submitted to records of mean arterial pressure (MAP) and heart rate (HR), as well as pharmacological tests of baroreceptor reflex function and cardiac autonomic control, such as intrinsic pacemaker heart rate (IPHR); vagal and sympathetic effects and sympathetic-vagal index (SVI). In the second protocol, CTR and DSC animals were fasted for at least 12 hours, anesthetized and euthanized by decapitation to collect blood, liver and adrenal glands for posterior analysis of plasma glucose, triglycerides, total cholesterol, VLDL, HDL, LDL; the expression of proteins involved in the insulin signaling cascade (IR-β; IRS-2; PI3K; AKT), the gluconeogenic enzyme - PEPCK, SOD-1 and CAT; and morphometry. Although there was no significant difference in feed and water intake between groups, a higher weight gain of DSC animals was observed from week 7 onwards. In relation to the pattern of locomotor activity, DSC animals presented lower levels on total locomotor activity with a predominance of its activity during the light phase of the LD cycle. Although we did not observe significant alterations in the basal MAP and HR levels between the groups, the DSC animals showed reduction of the baroreflex sensitivity by the bradycardic index, as well as a higher cardiac sympathetic effect. No differences were observed between the groups for the other parameters of cardiac autonomic control. Regarding the biochemical parameters, we observed in the DSC animals, a reduction in HDL cholesterol associated with an increase in LDL cholesterol, which promoted a high index of Castelli I and II, compared to the CTR. There were no differences in plasma levels of glucose, triglycerides, total cholesterol and VLDL. DSC animals also showed an increase in weight and in the total area of the adrenal glands. In addition, we observed decreased IRβ, IRS-2, PI3-K and Akt proteins, as well as increased expression of the gluconeogenic enzyme PEPCK in DSC animals, suggesting hepatic insulin resistance. Finally, we observed a reduction in the expression of the SOD-1 and CAT enzymes in the DSC animals in relation to the CTR animals. Summarizing, our results suggest that a 22h symmetrical photoperiod (T-22) promotes lower baroreflex sensitivityand increased sympathetic effect on the heart. In addition, metabolic disorders such as hepatic insulin resistance and increased hepatic oxidative stress were observed in the desynchronized rats. / A presença de ritmos circadianos nos organismos é um evento biológico, indispensável ao processo de adaptação ao meio e fundamental para a sobrevivência das espécies. A perda de relação de fase entre os ritmos biológicos e o comportamento promovem prejuízo às funções orgânicas. Diante disso, o objetivo deste estudo foi avaliar os efeitos de uma dessincronização forçada da atividade locomotora nos parâmetros cardiovasculares e metabólicos. Ratos Wistar machos, com idade aproximada de 60 dias, foram distribuídos em dois grupos experimentais: grupo controle (CTR) submetido ao ciclo claro/escuro (CE) de 24h - T24 (n=12) e grupo dessincronizado (DSC) submetido ao ciclo claro/escuro (CE) de 22h - T22 (n=18) por oito semanas. Registros da atividade locomotora foram feitos diariamente para ambos os grupos. O consumo alimentar, ingestão de água e o peso corporal foram monitorados semanalmente. Ao final deste período os animais foram alocados em dois protocolos experimentais. No primeiro protocolo os animais CTR e DSC foram submetidos a registros da pressão arterial média (PAM) e frequência cardíaca (FC), bem como testes farmacológicos da função do reflexo barorreceptor e controle autonômico cardíaco, tais como frequência cardíaca intrínseca de marcapasso (FCIM); efeitos vagal e simpático e índice simpático-vagal (ISV). No segundo protocolo os animais CTR e DSC foram deixados em jejum de no mínimo 12 horas, anestesiados e eutanasiados por decapitação para coleta de sangue, fígado e glândulas adrenais para posterior análise dos níveis plasmáticos de glicose, triglicerídios, colesterol total, VLDL, HDL, LDL; da expressão de proteínas envolvidas na cascata de sinalização da insulina (IR-β; IRS-2; PI3K; AKT), enzima gliconeogênica – PEPCK, SOD-1 e CAT; e da morfometria. Embora não houve diferença significativa no consumo de ração e água entre os grupos, observou-se maior ganho de peso dos animais DSC a partir da 7ª semana. Em relação ao padrão da atividade locomotora os animais DSC apresentaram menor atividade locomotora total e um predomínio da mesma durante a fase clara do ciclo CE. Apesar de não observamos alterações significativas nos níveis de PAM e FC basais entre os grupos, os animas DSC apresentaram redução da sensibilidade barorreflexa pelo índice bradicárdico, assim como maior efeito simpático cardíaco. Não foram observadas diferenças entre os grupos para os demais parâmetros de controle autonômico cardíaco. Quanto aos parâmetros bioquímicos, observamos, nos animais DSC, redução do colesterol HDL associado a uma elevação do colesterol LDL, o que promoveu elevados índice de Castelli I e II comparados aos CTR. Não houve diferenças nos níveis plasmáticos de glicose, triglicerídios, colesterol total e VLDL. Os animais DSC também apresentaram aumento no peso e na área total das glândulas adrenais. Além disso, observamos diminuição das proteínas IRβ, IRS-2, PI3-K e Akt, bem como aumento da expressão da enzima gliconeogênica PEPCK nos animais DSC, sugerindo resistência hepática à insulina. Por fim observamos redução na expressão das enzimas SOD-1 e CAT nos animais DSC em relação aos animais CTR. Sumarizando, nossos resultados sugerem que um fotoperíodo simétrico de 22h (T-22) promove menor sensibilidade barorreflexa, maior efeito simpático sobre o coração. Além disso, foram observados distúrbios metabólicos, como resistência à insulina hepática e aumento do estresse oxidativo hepático, nos ratos dessincronizados.

De nombreux patients parkinsoniens souffrent de troubles du sommeil, et à un stade avancé de troubles de la marche dopa-résistants. Des résultats expérimentaux et cliniques orientent vers un dysfonctionnement de la région locomotrice mésencéphalique (MLR) formée des noyaux pédonculopontin (PPN) et cunéiforme (CuN). La stimulation cérébrale profonde du PPN chez les patients parkinsoniens ayant des troubles de la marche modifiant aussi l'architecture du sommeil, un dysfonctionnement de ce noyau pourrait expliquer en partie ces symptômes. Afin d'étudier l'anatomie et le rôle du PPN et du CuN à l'état normal et à l'état parkinsonien, ce projet a associé une étude comportementale et anatomique de la MLR. Axe comportemental. Nous avons analysé les troubles du sommeil dans un modèle primate de maladie de Parkinson avancée, puis l'effet du traitement dopaminergique et de la mélatonine, et d'une lésion cholinergique du PPN surajoutée. Les troubles du sommeil sont similaires à ceux observés chez les patients, et améliorés par la L-dopa et la mélatonine. La lésion du PPN aggrave les troubles du sommeil en aigu, puis améliore la qualité du sommeil à distance. Axe anatomique. Nous avons défini l'hodologie du PPN et du CuN chez le singe et l'homme en fonction des trois territoires anatomo-fonctionnels des ganglions de la base. Le PPN intègre des informations très diverses (sensori-motrices, associatives et limbiques), le CuN est impliqué dans un réseau limbique. L'innervation cholinergique du PPN sur le NST a été caractérisée en microscopie optique et électronique chez le singe et l'homme, afin de préciser leur implication dans les effets cliniques de la stimulation du NST. / Parkinsonian patients suffer from disabling sleep disorders, and at an advanced stage gait disorders become resistant to dopaminergic treatment. Evidence from experimental and clinical studies consider the implication of the mesencephalic locomotor region (MLR), associating the pedunculopontine (PPN) and the cuneiform nuclei (CuN). Deep brain stimulation in this regionto treat doparesistant gait disorders in parkinsonian patients, was shown to improve sleep parameters. Dysfunction of this network could explain part of the pathophysiology of these symptoms. In order to have an anatomo-functional study of the PPN and the CuN at normal and parkinsonian state, this project has associated a behavioral axis in monkeys and an anatomic axis in monkeys and humans. Behavioral study. Sleep disorders have been analyzed in an advanced Parkinson disease primate model. These symptoms were improved with dopaminergic treatment and melatonin.After a cholinergic PPN lesion, there was an acute worsening of the symptoms, which improved three weeks after. Anatomic study. We analyzed the connections between the PPN and the CuN relating to the three anatomo-functional territories of the basal ganglia in monkeys and humans. The PPN integrated information from the three territories (sensori-motor, associative and limbic), compared to the CuN which connected to limbic territories. We then studied the subthalamic cholinergic innervation from the PPN at optic and ultra-structural level in monkeys and humans, comparing it with the dopaminergic innervation. Our results showed a homogeneous cholinergic innervation of the subthalamic nucleus (STN) compared to the heterogeneous dopaminergic innervation.

Les rythmes biologiques aident les organismes vivants à programmer la plupart des processus comportementaux dans la fenêtre temporelle la plus appropriée. Les données de la littérature sur la rythmicité du chat domestique sont rares et conflictuelles. Pour approfondir nos connaissances sur le sujet, nous avons utilisé de récentes technologies de télémétrie pour enregistrer et caractériser les rythmes journaliers d'activité locomotrice et de prises alimentaire chez des chats en fonction des saisons et des conditions d’hébergement. Les rythmes des chats étaient modifiés par la photopériode et la présence humaine. Suivant une périodicité de 24 heures, ils ont affiché une bimodalité dans leurs rythmes quotidiens, avec des creux d'activité locomotrice et de consommation au milieu de la journée et de la nuit. Les deux périodes principales d'activité/alimentaires correspondaient à l'aube et au crépuscule à chaque saison, indépendamment de leur horaire, confirmant la nature intrinsèque crépusculaire de l'espèce. Le rythme alimentaire des chats était plus variable au cours du cycle que celui de leur activité locomotrice, rappelant ainsi le caractère opportuniste de ce prédateur. Les chats ont présenté une plasticité comportementale caractérisée par des rythmes plus faibles et un comportement d'exploration plus nocturne en milieu extérieur qu’en milieu intérieur, au sein duquel ils étaient plus enclins à la routine. Nos résultats ouvrent la voie au développement de solutions nutritionnelles et des recommandations d’hébergement adaptées aux rythmes du chat en respectant les besoins physiologiques de l’animal. / Biological rhythms are of importance for living organisms as they help to schedule most behavioural processes within the most suitable temporal window. Literature on daily rhythmicity is scarce and conflicting regarding domestic cats. To sharpen our knowledge on the subject, we used advanced telemetry technologies to record and characterise the daily rhythms of locomotor activity and feeding in cats according to the seasons and housing conditions. The cats were sensitive to photoperiod and to human presence. Along 24-hour periodicity, they displayed bimodality in their daily patterns, with mid-day and mid-night troughs of locomotor activity and food consumption. The two main activity/eating periods corresponded to dawn and dusk at each season, regardless of the twilight timings, confirming the crepuscular intrinsic nature of the species. The feeding rhythm of the cats was more variable daily than their locomotor activity one, recalling the opportunistic character of this predator. Cats displayed plasticity in their behaviour, such as weaker daily rhythms and more nocturnal exploratory behaviour outdoors, compared to indoors where they were more prone to routine. Our results open new avenues for developing nutritional and housing guidelines fitted to the rhythms of the cats according to their way of life.

El cáncer de mama es la neoplasia más frecuente entre las mujeres de todo el mundo. Su tratamiento quirúrgico puede ocasionar secuelas musculoesqueléticas. La cinesiterapia puede ayudar a paliar estas secuelas. Objetivos: Los objetivos de nuestro ensayo fueron evaluar la eficacia y la seguridad terapéutica de un tratamiento cinesiterápico domiciliario frente a uno hospitalario. Pacientes y método. Se realizó un ensayo clínico prospectivo y aleatorizado. Incluyó 66 mujeres. 3 mujeres abandonaron el estudio. 32 realizaron tratamiento hospitalario y 31 tratamiento domiciliario. Se evaluó a las mujeres mediante un goniómetro, y las escalas de Constant y Murley, QLQ-C30, BR23 y FACT-B+4 y EVA. Resultados. No se hallaron diferencias estadísticamente significativas entre los grupos a las 12 semanas de finalizar el tratamiento cinesiterápico en ninguna de las variables estudiadas. Conclusiones. La funcionalidad del hombro, el dolor y la calidad de vida relacionada con la salud no presenta diferencias estadísticamente significativas entre los dos grupos de tratamiento cinesiterápico estudiados. / Breast cancer is the most common cancer in women around the world. Physiotherapy after breast cancer surgery can improve shoulder function and quality of life (QOL). Patients and Methods. 66 patients with limph node excission, were enrolled. Patients were randomized to either group A or B (31 patients in Group A developed a home program exercises and 32 patients in Group B developed an exercises program at hospital), during 4 weeks. The patients were evaluated before surgery, after surgery, 4 and 12 weeks after finishing the treatment. The primary outcome was shoulder mobility. Secondary outcomes were Constant Score, Quality of life and pain. Results. There were no differences between treatment groups, in mobility, pain, QOL, and Constant Score at 12 weeks after exercises treatment. Conclusion. There are not statistically significant differences in shoulder mobility, pain, QOL and security between groups of exercises treatment, in women with breast cancer and lymph node dissection.

Este trabajo estudia la prevalencia de desórdenes musculoesqueléticos y trastornos del sueño en dentistas de nuestro medio; pretende determinar su relación con factores ocupacionales específicos propios de la profesión odontológica, y establecer las necesidades preventivas en nuestro entorno sociodemográfico para esta profesión. Material y método: Se utiliza un cuestionario autoadministrado enviado por correo postal o electrónico, que incluye datos de filiación, preguntas sobre el ambiente laboral, características y ritmo de trabajo, dolores musculoesqueléticos, y calidad del sueño. La muestra de estudio fueron 220 dentistas pertenecientes al Colegio de Odontólogos y Estomatólogos de la Región de Murcia, que fueron los que devolvieron el cuestionario debidamente cumplimentado, de los 845 a los que se les envió, una vez excluidos los de aquellos con menos de 12 meses de ejercicio profesional. Resultados: Encontramos una alta prevalencia de dolores musculoesqueléticos en los dentistas encuestados: 28,2% en cuello y hombros, 18,2% en lumbares, 15,5% en cabeza, 11,4% en dorsales, y 7,3% en manos y muñecas. Hay una relación positiva y estadísticamente significativa entre el número de horas de trabajo y el índice de dolor corporal. También existe entre las horas de trabajo al día y el dolor lumbar, de cuello y hombros. Sin embargo, no se ha encontrado relación entre índice de dolor corporal y la carga física de trabajo (número de pacientes por jornada y tiempo por paciente). Tampoco se ha podido encontrar relación significativa entre índice de dolor corporal y los años de ejercicio. De hecho, a mayor edad y más años de ejercicio, se encuentra significativamente menos dolor de cuello y hombros. En nuestro estudio no se encuentra relación de la edad y los años de ejercicio con la corrección postural durante el trabajo, con lo que la puesta en práctica de principios ergonómicos por mayor experiencia y conocimiento de tales principios, no es un hecho en nuestra muestra. Se observa una relación negativa estadísticamente significativa (p=0.020) entre el índice de dolor corporal y corrección postural. Concretamente, hay menor dolor de lumbares, y de pies y tobillos, al corregir las malas posturas. Trabajar más horas de pie o sentado no está relacionado significativamente con frecuencia de síntomas dolorosos. Parece que lo más conveniente es alternar la postura para relajar las lumbares al sentarse. A más años de ejercicio profesional, hay significativamente menor calidad del sueño, como síntoma de causa ocupacional, ya que esta relación es independiente de la edad. La calidad del sueño no mejora al mejorar la postura de trabajo adoptada. Se ha visto una fuerte relación entre la ansiedad percibida por el dentista en el desarrollo de su trabajo y el dolor de lumbares. A mayor frecuencia de esta percepción, peor calidad del sueño. Aquellos que practicaban algún deporte regularmente, padecían significativamente menor ansiedad, lo que induce a recomendar la actividad física para mitigar la prevalencia de dolor lumbar en dentistas. Los dentistas más sedentarios referían significativamente (p=0.019) mayor dolor. Los sujetos que habían estado de baja por enfermedad tenían un índice de dolor corporal significativamente más elevado (p=0,003). Los diagnósticos y las bajas por trastornos musculoesqueléticos no se asocian a los parámetros relacionados con trastornos del sueño estudiados. / Aim: The aim of this work is to study the prevalence of musculoskeletal disorders and sleep disorders in dentists of our environment ; It’s focus on determinating their relation to specific occupational factors specific to the dental profession and to establish preventive needs in our demographic environment for this profession. Material and methods: A self-administered questionnaire sent by mail or email, including personal data, questions about the work environment, characteristics and patterns of work, musculoskeletal pain, and sleep quality is used. The sample were 220 dentists belonging to the College of Dentistry of Murcia, who were those who returned the completed questionnaire from 845 to which they were sent, those with less than 12 months of practice where not included in this study. Results: We found a high prevalence of musculoskeletal pain in dentists surveyed: 28.2% in neck and shoulders, 18.2 % at the lumbar area, 15.5 % in head, 11.4% in the dorsal zone, and 7.3 % in hands and wrists. There is a positive and statistically significant relationship between the number of hours worked and the rate of body pain. Also between the hours of work a day and back, neck and shoulders pain. However, no relationship was found between the index of body pain and physical workload (number of patients per day and time dedicated to each of them). The relationship between pain and years of exercise could have not been proved. In fact, the older the dentist is and the more years on duty he has been, the less neck and shoulder pain they normally have. This fact has been found to be statistically significant. In our study, no relationship was found between age and years of professional practice, and postural correction during work. This means that the implementation of ergonomic principles because of having greater experience and knowledge of these principles is not a fact in our sample. A statistically significant negative relationship (p=0.020) between the index of body pain and postural correction is observed. Specifically, there is less pain in the lower back, feet and ankles, when bad postures are corrected. The frequency of painful symptoms is not significantly related to the number of hours working no matter if standing or sitting. It seems that it is best to alternate both of them to relax the lower back when working sitted. The more years of practice dentist have the less sleep quality is reported. This is considered a symptom of occupational cause, and this relationship is independent of age. Sleep quality is not improved by improving working postures. It has been a strong relationship between the anxiety dentists perceive during their work and lumbar pain. The higher this perception is the worse sleep quality is revealed. Those who practice sport regularly, suffered significantly lower anxiety. This fact lead us to recommend physical activity to relieve back pain prevalence in dentists. The more sedentary life dentists had, the greater pain they referred. These two facts are significantly related (p=0.019). Subjects who had been on sick leave had a significantly higher rate of body pain (p = 0.003). Diagnoses and sick leaves due to musculoskeletal disorders are not associated with the parameters related to sleep disorders studied.

Bone injury is a major health problem nowadays. Bone tissue engineering is a promising strategy to solve it. In this field many reports pointed out the role of scaffolds containing a calcium phosphate glass, such as G5, in the promotion of bone regeneration. These kinds of biomaterials release Ca2+ during degradation. Moreover, extracellular calcium (Ca2+0) is able to activate a special extracellular receptor called Calcium Sensing Receptor (CaSR), which can modulate migration, chemotaxis and differentiation. In that sense, present work aims to evaluate the role of extracellular calcium and CaSR as key factor in the induction of bone regeneration. We isolated endothelial progenitor cells (EPCs) and Mesenchymal Stromal cells (MSCs) from young rat’s bone marrow and they were stimulated with 10 mM Ca2+0. Results provided strong evidences about the role of Ca2+0 and CaSR in the modulation of chemotaxis, and angiogenic differentiation on EPCs, whilst on MSCs calcium exerted osteoinduction and proliferation through the CaSR. Furthermore, using biodegradable releasing calcium composite (PLA/G5) was measured the ability of that kind of biomaterials in the induction of bone and blood vessels formation in vivo. Finally, using a shell-less chick embryo model was compared the effect of the Ca2+0 and the ionic compound released by PLA/G5, demonstrating that the released Ca2+0 is the key factor in the promotion of angiogenesis and bone formation in vivo. The knowledge developed during this project will be a valuable tool to enhance the efficiency of biomaterials used in bone tissue engineering

La finalidad de esta tesis es describir el aprendizaje combinado para mejorar las habilidades visuoespaciales. Los estudiantes de Fisioterapia participantes fueron distribuidos aleatoriamente en un grupo de retroalimentación visual y textual (VT), y en otro grupo que solo recibió la textual (T). Durante las 10 semanas que duró el aprendizaje combinado, las sesiones presenciales fueron filmadas y las participaciones en el entorno virtual registradas para evaluar la interacción. Los estudiantes cumplimentaron un cuestionario mixto que incluía preguntas sobre la interactividad y la transferencia del conocimiento antes de iniciar el proceso experimental y al finalizarlo. Además, para complementar estos datos, los estudiantes participaron en sesiones de discusión grupal después de la experiencia. Los resultados de este estudio contribuyen a reforzar que la retroalimentación visual y textual de casos reales en vídeo facilita la transferencia de conocimiento en el aprendizaje combinado de las habilidades visuoespaciales. Palabras clave: educación superior, aprendizaje combinado, casos reales, retroalimentación, transferencia de conocimiento y habilidades visuoespaciales. / The purpose of this dissertation was to describe the blended learning for improving visuospatial skills. Undergraduate physiotherapy students who participated in the 10-weeks blended learning sessions, were randomized into visual-textual (VT) or textual (T) feedback groups. The face-to face sessions were filmed and virtual learning participations were collected to identify students’ interaction during the learning process. The students completed a mixed questionnaire asking them about interactivity and transfer of knowledge before starting the experiment and at the end. The data were complemented with a focus group at the end of the learning process. This study aims to contribute new insight regarding the instructional visual and textual feedback design of case-based instruction, in a visuospatial skills-blended learning programme to improve transfer of learning for beginners. Keywords: higher education, blended learning, case method (teaching technique), feedback (response), transfer of training and visuospatial abilities.