Les modifications de la morphologie du cortex cérébral induites par la maladie d'Alzheimer à ses stades précoces contribuent à l'intérêt croissant à l'égard des biomarqueurs de la morphologie corticale. Ceux-ci permettraient notamment une meilleure compréhension de l'impact de cette pathologie sur l'anatomie cérébrale et une détection plus précoce de la maladie. L'originalité de notre travail par rapport au reste de la littérature est de s'intéresser à la morphologie des surfaces interne (interface substance blanche / substance grise) et externe (interface substance grise / liquide cérébro-spinal) du cortex cérébral. Dans cette perspective, nous avons développé des méthodes d'estimation de la courbure et de la dimension fractale des surfaces corticales. A partir de ces biomarqueurs morphologiques et de l'épaisseur corticale dont la méthode d'estimation a été précédemment développée dans le laboratoire, nous avons exploré l'impact de la maladie d'Alzheimer sur la morphologie du manteau cortical et nous avons évalué leur apport individuel et celui de leur association au diagnostic précoce de la maladie. Nos résultats montrent une influence significative de la pathologie sur la morphologie des sillons et sur celle des circonvolutions des surfaces corticales interne et externe. En termes d'application diagnostique, nous montrons que prises isolément, l'épaisseur corticale présente une meilleure capacité prédictive que la courbure corticale, nous ne constatons en revanche aucune capacité prédictive de la dimension fractale. Par contre, nous montrons que l'utilisation conjointe de l'épaisseur corticale et de la courbure permet une amélioration significative du diagnostic précoce. / Morphological alterations of the cortical mantle in early stage of Alzheimer's disease have led to an increasing interest towards morphological biomarkers of the cerebral cortex. By providing a quantitative measure of the cortical shape, morphological biomarkers could provide better understanding of the impact of the disease on the cortical anatomy and play a role in early diagnosis. Therefore, as a primary goal in this study, we developed cortical surface curvature and fractal dimension estimation methods. We then applied those methods, together with the estimation of cortical thickness, to investigate the impact of Alzheimer's disease on the cortical shape as well as the contribution of cortical thickness and cortical curvature to the early diagnosis of Alzheimer's disease. The originality of this work lies in the estimation of sulcal and gyral curvature of the internal (gray matter/white matter boundary) and external (gray matter/cerebrospinal fluid boundary) cortical surfaces in addition to the fractal dimensions of these boundaries. Our results showed significant impact of Alzheimer's disease on sulcal and gyral shapes of the internal and external cortical surfaces. In addition, cortical thickness was found to have better ability than cortical curvature for the early diagnosis of Alzheimer's disease; no significant ability for the early diagnosis was found using fractal dimension. However, we found significant improvement in early diagnosis by combining cortical thickness and cortical curvature.

Des oxydes semi-conducteurs, en particulier TiO2 commercialement disponible ou des échantillons mésoporeux synthétisés, ont été testés comme photocatalyseurs de l'oxydation ménagée et aérobie d'alcools dans l'acétonitrile sous UV. L'alcool benzylique a été oxydé principalement en benzaldéhyde (rendement = 60%) en présence de TiO2-P25. Malheureusement, ce catalyseur tend à se désactiver. Le rôle du dioxygène dans le processus d'oxydation a été souligné après avoir testé différents solvants. Les alcools aliphatiques ont également été étudiés. Ainsi, le cyclohexanol a donné principalement de la cyclohexanone (rendement = 70%). Parallèlement, une approche colloïdale a été développée pour déposer les nanoparticules d'oxyde de titane sur des supports de silice mésoporeux SBA-15 transparents aux UV afin d'éviter les phénomènes d'agrégation lors des tests. Après optimisation de leur synthèse (quantité d'eau, nature de l'acide et de l'alcool), des nanoparticules sphériques non cristallines stables de 5 nm de diamètre ont été obtenues. En utilisant la méthode d'imprégnation à "deux solvants", ces dernières ont été introduites avec succès dans les mésopores de deux échantillons de SBA-15, l'un avec un diamètre moyen des pores de 6 nm, l'autre de 8. Les analyses MET ont souligné que le matériau SBA-15 avec les pores les plus grands a conduit à l'incorporation de davantage de nanoparticules. A priori, les interactions silice / oxyde de titane dans les matériaux résultants semblent favorables puisque les quantités inférieures de TiO2 dans les tests de photocatalyse correspondants ont conduit à de meilleurs taux de conversion que ceux obtenus avec P25 ou la suspension mère de colloïdes. / A series of metal oxides semiconductors, including commercially available TiO2 or synthesized mesoporous samples, were tested as photocatalysts for the aerobic mild oxidation of alcohols in acetonitrile under UV. Benzyl alcohol, used as a reference, was oxidized mainly into benzaldehyde. Best yield (60%) was obtained with TiO2-P25. Unfortunately, this catalyst tended deactivate with time. The role of dioxygen solubility in the oxidation process was emphasized through the test of different solvents. Aliphatic alcohols were also studied. Among them, cyclohexanol gave mainly cyclohexanone with a yield of 70%. Parallely, a colloidal approach was developed for the deposition of titanium oxide nanoparticles on UV transparent mesoporous silica supports in order to take advantage of their important specific surface area and avoid aggregation phenomena during the photocatalysis tests. After optimizing the synthesis protocol (amount of water, nature of the acid and alcohol), spherical, non-crystalline stable nanoparticles with 5 nm diameter were obtained. Using the “two-solvents” impregnation method, these particles were successfully introduced in the mesopores of two SBA-15 silica samples differing by their mean pore diameter (either 6 or 8 nm). TEM measurements emphasized that the SBA-15 material with the largest pores led to the incorporation of more nanoparticles in its mesopores. Clearly, silica/ titanium dioxide interactions in the resulting materials appeared to play a positive role since lower amounts of TiO2 in the corresponding photocatalysis tests led to improved conversion rates of benzylalcohol compared to those performed with P25 or the parent suspension of colloids.

Submitted by MARIANA PINTO SIRIMARCO null (mpsirimarco@yahoo.com.br) on 2016-04-08T03:04:00Z No. of bitstreams: 1 VERSÃO FINAL 2 08-04.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-04-08T16:39:33Z (GMT) No. of bitstreams: 1 sirimarco_mp_me_bot.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) / Made available in DSpace on 2016-04-08T16:39:33Z (GMT). No. of bitstreams: 1 sirimarco_mp_me_bot.pdf: 1774461 bytes, checksum: 13e24ee503bed7a9ca8d50a2f58cd2aa (MD5) Previous issue date: 2016-02-29 / JUSTIFICATIVA – desde agosto de 2011 o Serviço Especializado de Diabetes e Gravidez da Faculdade de Medicina de Botucatu/Unesp (SEDG-FMB/Unesp) adotou o novo protocolo diagnóstico para o DMG recomendado pela ADA/IADPSG. Entretanto, o Perfil Glicêmico (PG) continuou associado ao TOTG 75g, para diagnosticar a Hiperglicemia Gestacional Leve (HGL), reconhecida e tratada em nosso Serviço como se fosse DMG. A controvérsia sobre o custo-benefício do novo protocolo da ADA/IADPSG e a dúvida sobre a necessidade de manutenção do PG no protocolo do Serviço justificam o presente estudo. OBJETIVOS – avaliar o impacto do novo protocolo da ADA/IADPSG na prevalência de HGL e de DMG, na ocorrência de resultados perinatais adversos (RPNA) e na associação TOTG 75g e PG para diagnóstico de HGL no SEDG-FMB/Unesp. MÉTODO – estudo de corte transversal, incluindo gestantes, e seus recém-nascidos (RN), submetidas aos protocolos diagnósticos e que realizaram pré-natal e parto no Serviço, antes (janeiro de 2008 a 14 de agosto de 2011) e após (15 de agosto de 2011 a dezembro de 2014) à mudança do protocolo, definindo uma amostra por conveniência. Considerando os dois períodos, foram comparadas a prevalência de DMG e de HGL e a ocorrência de RN-GIG, macrossomia, primeira cesárea e tempo de internação dos RN. Na análise estatística foram utilizados análise de Poison e teste t-Student, teste do Qui-quadrado ou Exato de Fischer e cálculo de risco (RR e IC 95%) para os desfechos avaliados. O limite de significância estatística foi de 95% (p < 0,05). RESULTADOS – o NOVO protocolo resultou em aumento no número de mulheres com DMG e deixou de identificar 17,3% do total de gestantes, que mantiveram o diagnóstico de HGL, apesar do TOTG 75g normal. O novo protocolo ADA/IADPSG não influenciou o desfecho perinatal. CONCLUSÕES – esses resultados reforçam a validade da manutenção do PG no protocolo diagnóstico do SEDG-FMB/Unesp. Para concluir sobre o custo-benefício do NOVO protocolo, são necessários grandes estudos, multicêntricos e com tamanho amostral adequado. / BACKGROUND - since August 2011 the Specialized Center of Diabetes and Pregnancy of the Botucatu Medical School / Unesp (SEDG-FMB / Unesp) has adopted a new diagnostic protocol for Gestational Diabetes Mellitus (GDM) recommended by the ADA / IADPSG guidelines. However, the glycemic profile (GP) remained associated with the 75g OGTT to diagnose Mild Gestational Hyperglycemia Lite (MGH), recognized and treated in our department as if it were GDM. The controversy over the cost-effectiveness of the new ADA / IADPSG guideline and doubt about the need for GP maintenance in the service protocol justify this study. OBJECTIVES - To assess the impact of the new ADA / IADPSG guideline in the prevalence of MGH and GDM, in the incidence of adverse perinatal outcomes (APNO) and in the association 75g OGTT and PG for diagnosis of MGH at the SEDG-FMB / Unesp. METHOD - cross-sectional study, including pregnant women and their newborns (NB) that underwent diagnostic protocols and had their prenatal care and delivery at the service before (January 2008 to August 14, 2011) and after (15 August 2011 to December 2014) the protocol modification, defining a convenience sample. Considering the two periods, the prevalence of GDM and MGH and the occurrence of LGA-NB, macrosomia, first cesarean delivery and NB hospital stay were compared. For statistical analysis, Poison analysis and Student's t test, chi-square or Fisher's exact test were used and risk estimate (RR and 95% CI) for the assessed outcomes. The statistical significance threshold was 95% (p <0.05). RESULTS - The new protocol resulted in a increase in the number of women with GDM, but failed to identify 17.3% of pregnant women who maintained the diagnosis of MGH, despite normal 75g OGTT. The new ADA / IADPSG guideline did not influence the perinatal outcome. CONCLUSIONS - These results reinforce the validity of maintaining the GP in the diagnosis protocol at the SEDG-FMB / Unesp. To conclude on the cost-effective of the new protocol, large multicenter studies with adequate sample size are required

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Exposure of rodents to stimuli like neonatal handling, have been described to cause behavioral and physiological benefits in adulthood. On the other hand, exposure to adults to stressful environments can result in emotional and neuropsychiatric pathologies. This study aimed to investigate the possible influence of two forms of neonatal handling as tactile stimulation (TS) and maternal separation (MS) on the emotional status of rats exposed to chronic mils stress (CMS) grouped housing, lights on overnight, damp sawdust and others. Furthermore, we aimed to evaluate if neonatal TS could modify anxiolytic effects observed with a low dose of a benzodiazepine drug in adult rats. In the first study, male Wistar pups were submitted daily to TS or MS, from postnatal day one (PND1) to PND21, for 10 min. Unhandled (UH) animails remained in next without any manipulation. In adulthood (PND67), half the animals of each group were exposed to the CMS for 3 weeks and observed in sucrose preference (SP), elevated plus-maze (EPM) and defensive burying test (DBT), followed by euthanasia for biochemical and hormonal assessments. CMS reduced SP, increased anxiety on EPM and DBT and increased adrenal weight. In addition, some parameters of antioxidant defenses in plasma, hippocampus and cortex were altered with exposure to CMS, whereas an increase in protein oxidation in hippocampus and cortex also were observed. In contrast, both forms of neonatal handling were able to prevent changes in SP, anxiety behavior on DBT and adrenal weight CMS-induced. Furthermore, they also prevented alterations in antioxidant defenses in plasma, hippocampus and cortex and protein oxidation in hippocampus. Only TS prevented CMS-induced anxiety symptoms on EPM and protein oxidation in cortex. Furthermore, TS was associated with lower levels of cortisol than in UH rats before and after CMS exposure. Since TS presented better results, we performed a second experiment only with this neonatal handling. In adulthood, the animals received a single administration of diazepam (DZP) (0.25 mg/kg body weight-i.p.) or vehicle (V) and were submitted to behavioral evaluations. DZP treatment reduced anxiety-like behaviors in EPM and increased exploration in EPM, staircase and open field tasks only in TS group. Considering UH animals, DZP treatment only increased exploration in staircase test. TS animals treated with DZP presented reduced anxiety-like behaviors in many parameters of EPM test, increased exploratory behavior in staircase and open field tasks and less immobility in DBT. The results of this study showed the protective role of neonatal handling, especially TS, which may enhance ability to cope with stressful situations in adulthood and affect the response for benzodiazepine substances during this period. / A exposição de roedores a estímulos como o manuseio neonatal, tem sido descrita por causar alterações comportamentais e fisiológicas benéficas na vida adulta. Já a exposição de animais adultos a ambientes estressantes, pode resultar em prejuízos emocionais e patologias neuro-psiquiátricas. Este estudo objetivou investigar a possível influência de dois tipos de manuseio neonatal, estimulação tátil (ET) e separação materna (SM), sobre o estado emocional de ratos após exposição ao estresse crônico e moderado (ECM) superlotação, distúrbio do ciclo claro/escuro, serragem molhada entre outros. Também objetivamos avaliar se a ET neonatal poderia modificar os efeitos ansiolíticos observados com uma baixa dose de fármaco benzodiazepínico nos animais adultos. No 1º estudo, filhotes machos de ratos Wistar foram submetidos diariamente à ET ou SM desde o dia pós-natal 1 (DPN1) até o DPN21, durante 10 minutos. Os animais não manuseados (NM) permaneceram no ninho sem nenhuma manipulação. Na vida adulta (DPN67), metade dos animais de cada grupo foram expostos ao ECM durante 3 semanas e observados no teste de preferência pela sacarose (PS), labirinto em cruz elevado (LCE) e teste defensivo de cavocar (TDC), seguido de eutanásia para avaliações bioquímicas e hormonais. O ECM reduziu a PS, aumentou a ansiedade no LCE e TDC e aumentou o peso das adrenais. Alguns parâmetros de defesas antioxidants em plasma, hipocampo e córtex foram alterados pela exposição ao ECM, enquanto um aumento da oxidação proteica em hipocampo e córtex também foram observados. Ambas as formas de manuseio neonatal foram capazes de prevenir as mudanças na PS, ansiedade no TDC e peso das adrenais. Também preveniram as alterações nas defesas antioxidants em plasma, hipocampo e córtex e a oxidação proteica no hipocampo. Apenas a ET preveniu a ansiedade induzida pelo ECM no LCE e a oxidação proteica no córtex. Além disso, a ET foi associada aos menores níveis de cortisol comparado aos ratos NM antes e após a exposição ao estresse. Uma vez que a ET apresentou melhores resultados, realizamos um 2º experimento apenas com essa forma de manuseio neonatal. Na vida adulta, os animais receberam uma única administração de diazepam (DZP) (0.25 mg/Kg peso corporal-i.p.) ou veículo (V), e foram submetidos às avaliações comportamentais. O tratamento com DZP reduziu comportamentos de ansiedade no LCE e aumentou a exploração no LCE, no teste da escada e campo aberto apenas no grupo ET. Considerando os animais NM, o tratamento com DZP apenas aumentou a exploração no teste da escada. Os animais do grupo ET tratados com DZP apresentaram menor ansiedade em vários parâmetros do LCE, maior comportamento exploratório no teste da escada e campo aberto e menor imobilidade no TDC. Os resultados do presente estudo demonstraram o papel protetor do manuseio neonatal, especialmente da ET, a qual pode melhorar a habilidade para lidar com situações estressantes na vida adulta e afetar a resposta a substâncias benzodiazepínicas nesse período.

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-06-08T11:55:52Z No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T18:03:42Z (GMT) No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-13T18:03:48Z (GMT) No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) / Made available in DSpace on 2017-06-13T18:12:18Z (GMT). No. of bitstreams: 1 DissFAAM.pdf: 2168613 bytes, checksum: c80ea0c2ce14ed6b12536e4420bd312e (MD5) Previous issue date: 2017-02-23 / Outra / Background: Little is known about how the change in walking speed in longitudinal studies can predict the occurrence of falls in older adults with mild cognitive impairment. Objetives: To identify if there are differences in the gait speed of Cognitively Preserved (CPr) elderly persons, elderly persons with Mild Cognitive Impairment (MCI) and with Alzheimer`s Disease (AD) in mild stage, in a 6-month period. To verify if the change in the gait speed (ΔGS= Final Gait speed – Initial Gait speed) predicts the occurrence of falls in elderly with MCI and AD in mild stage. Methods: 110 elderly people participated in the study. Out of these: 40 with CPr, 36 with MCI and 34 with AD in the mild stage. Initially the 10-meter walk test was applied and a fall schedule was given. A 6-month follow-up was carried out, by means of monthly telephone calls to the volunteers and the filling of a fall schedule. After six months, the 10-meter walk test was applied and the fall schedule was retrieved. Results: The MCI and AD groups of elderly in mild stage presented lower gait speed compared to the elderly in the CPr group at the two assessment moments. There was no significant difference in delta gait speed amongst the groups. In the age-adjusted univariate logistic regression analysis, the delta failed to predict falls in the elderly with MCI or in elderly with AD. Conclusion: Older adults with MCI and AD in the mild stage were identified as having lower gait speed compared to CPr sujeitos. Changing in the gait speed over a six-month period does not predict the occurrence of falls in elderly with MCI or AD in mild stage. / Contextualização: Pouco se tem conhecimento sobre como a mudança da velocidade da marcha em estudos longitudinais, pode predizer a ocorrência de quedas em idosos com comprometimento cognitivo em estágios iniciais. Objetivos: a) identificar se há diferenças na velocidade da marcha entre idosos preservados cognitivamente (PrC) com transtorno neurocognitivo leve (TNL) e com doença de Alzheimer (DA) na fase leve ao longo de seis meses; b) Verificar se a mudança da velocidade da marcha (ΔVM= velocidade final - velocidade inicial) prediz a ocorrências de quedas em idosos com TNL e DA nesse período. Método: Participaram do estudo 110 idosos. Destes 40 PrC, 36 com TNL e 34 com DA. Inicialmente foi aplicado o teste de caminhada de 10 metros e entregue um calendário de quedas. Realizou-se um seguimento de seis meses por meio de ligações mensais para os voluntários e preenchimento do calendário de quedas. Após seis meses, aplicou-se novamente o teste de caminhada e o calendário de quedas foi resgatado. Resultados: Os idosos dos grupos com TNL e com DA apresentaram velocidades de marcha menor quando comparados com os idosos do grupo PrC, nos dois momentos de avaliação (p<0,001). Não houve diferença significativa no delta da velocidade da marcha entre os grupos (p=0,063). Na análise de regressão logística univariada, ajustado para idade, o ΔVM não conseguiu predizer quedas em idosos com TNL (p=0,185) nem em idosos com DA (p=0,232). Conclusão: Identificou-se que os idosos com TNL e DA na fase leve tem velocidades da marcha menores quando comparados com idosos PrC. A mudança da velocidade da marcha em um período de seis meses não prediz a ocorrência de quedas em idosos com TNL, nem idosos com DA na fase leve.

Submitted by Aelson Maciera (aelsoncm@terra.com.br) on 2017-06-26T17:52:34Z No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-27T19:44:07Z (GMT) No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-06-27T19:45:05Z (GMT) No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) / Made available in DSpace on 2017-06-27T19:52:05Z (GMT). No. of bitstreams: 1 TeseJHA.pdf: 1814260 bytes, checksum: 140f576789c3cbb7e3aa416fc5dc4416 (MD5) Previous issue date: 2017-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introduction: Recent studies reported mobility deficits and higher prevalence of falls in older people with cognitive impairment, even in mild stages of impairment. However, differences in mobility during simple and dual task situations between older people with preserved cognition (PC), mild cognitive impairment (MCI) and Alzheimer’s disease (AD) (mild stage) are still not clear. Sophisticated mobility tools and dual task activities with new, functional and challenging secondary tasks could be effective in identifying subtle motor changes. Moreover, a better understanding about the relationship between cognitive and motor changes and the fall risk factors in older people with MCI and AD could provide new knowledge about the physiopathology of MCI and AD and could help in better planning of screening, prevention and interventions of falls, MCI and AD. Objective: to analyze mobility, functional dual task and falls in older people with PC, MCI and mild AD. Method: The sample was composed by 40 community-dwelling older people with PC, 40 MCI and 38 mild AD. All volunteers performed an assessment, including anamneses, history of falls in the past year, cognition (Addenbrooke’s cognitive Examination-revised version and Frontal Assessment Battery), dual task (Timed up and go test-TUG associated with the motor-cognitive task of calling a phone number) and functional mobility (10-meter walk test and TUG). The TUG phases (sit-to-stand, walking forward, turn, walking back and turn-to-sit) were assessed using a system of movement analysis (Qualisys motion system). Still, the occurrence of falls was collected prospectively in a 6-month follow up using falls calendar and monthly calls in older people with MCI and AD. Sociodemographic and clinical, level of physical activity, functional status, functional mobility, cognitive and depressive variables were analyzed as potential fall risk factors. For statistical analysis, a significance level of α=0.05 was adopted and the SPSS software was used (20.0). Results: Older people with cognitive impairment (MCI and mild AD) presented more falls (retrospective data) compared to people with PC, and specific characteristics (place, consequences) about history of falls between groups were identified. Regarding dual task and 10-meter walk tests, only measures of dual task test distinguished older people with mild AD from PC and MCI and no measure could differ MCI and PC groups. In relation to functional mobility (kinematic data), all TUG phases could differentiate older people with AD from PC, except the sit-to-stand phase. The walking forward phase differed older people with PC from MCI, specifically on range of motion variables during stance phase. The walking back, turn and turn-to-sit phases distinguished older subjects with AD from MCI. Regarding the association between cognitive domains and mobility, different cognitive domains predicted the 10-meter walk test and the isolated cognitive-motor task measures among groups. The visuospatial domain was independently associated with TUG (total time) in MCI and AD groups and with the dual task test in all three groups. No significant associations were found between the walking TUG phases and cognitive domains in any group. However, executive function deficits was associated with impairments of transition TUG phases in the three groups. The visuospatial domain was identified as an independent predictor of turn-to-walk and turn-to-sit measures in the AD Group. During the 6-month follow-up, 52,6% of MCI people and 51,4% of AD people fell at least once. After multivariate analysis, the dual task test and the turn-to-sit phase were able to independently predict falls in older people with MCI and AD, respectively. Conclusion: The dual task test used was able to distinguish older people with AD from PC and MCI. The analysis of transition and also the walking TUGT phases separately is essential in the identification of mobility patterns among cognitive profiles of older people. Still, the findings demonstrate the importance of considering the influence of specific cognitive domains in daily mobility tasks in order to improve rehabilitation and prevention of cognitive and mobility disturbances. The prediction of visuospatial domain on postural transition tasks may provide insight into why people with AD have an elevated fall risk. The modifiable fall risk factors found can be used to detect risk of falls, as well as improving interventions for preventing falls in older adults with MCI and AD, with focus on exercises involving dual task and transition postural activities. / Introdução: Estudos recentes identificaram prejuízos em tarefas de mobilidade e maior prevalência de quedas em idosos com comprometimento cognitivo, mesmo em estágios leves. Porém, as diferenças na mobilidade em situações simples e de dupla tarefa entre idosos preservados cognitivamente (PC), com comprometimento cognitivo leve (CCL) e doença de Alzheimer (DA) na fase leve ainda não são claras. Nesse sentido, instrumentos sofisticados que avaliem a mobilidade e atividades de dupla tarefa com tarefas secundárias funcionais e desafiadoras podem ser sensíveis para identificar pequenas mudanças motoras. Ainda, um melhor entendimento da relação existente entre as alterações cognitivas e motoras e os fatores de risco a quedas em idosos com CCL e DA forneceriam novos conhecimentos dos distúrbios e poderiam auxiliar em melhoras no planejamento do rastreio e tratamento de CCL, DA e quedas em idosos. Objetivo: Analisar a mobilidade, dupla tarefa funcional e quedas em idosos preservados cognitivamente, com CCL e DA na fase leve. Método: A amostra foi composta por 40 idosos da comunidade PC, 40 CCL e 38 DA na fase leve. Todos os sujeitos participaram de uma avaliação, com os seguintes itens: anamnese, histórico de quedas no último ano, cognição (Bateria de Avaliação Frontal e Exame Cognitivo de Addenbrooke-versão revisada), dupla tarefa (teste Timed up and go-TUG associado à tarefa cognitivo-motora de discar um número de telefone) e mobilidade funcional (teste de velocidade de marcha de 10 metros e teste TUG). As fases do teste TUG levantar-se, marcha ida, retornar, marcha volta e virar-se para sentar foram avaliadas a partir do sistema de análise de movimento Qualisys motion system. Ainda, a ocorrência de quedas foi coletada ao longo de seis meses por meio de calendário e telefonemas mensais nos Grupos CCL e DA. Variáveis sociodemográficas e clínicas, gasto calórico semanal, status funcional, mobilidade funcional, cognição e depressão foram analisadas como potenciais fatores de risco para quedas. Para análise estatística, adotouse um nível de significância de α = 0,05 e utilizou-se o software SPSS (20.0). Resultados: Os idosos com distúrbio cognitivo (CCL e DA leve) apresentaram mais quedas (dados retrospectivos) quando comparados a idosos PC, e características específicas das quedas (local, consequências) entre os grupos foram identificadas. Quanto aos testes de dupla tarefa e velocidade de marcha, somente medidas do teste de dupla tarefa distinguiram idosos com DA leve de PC e CCL e nenhuma medida conseguiu diferir os grupos CCL e PC. Em relação à mobilidade funcional (dados cinemáticos), todas as fases do TUG conseguiram diferenciar idosos com DA de PC, exceto a fase levantar-se. A fase marcha ida diferiu idosos PC de CCL, especificamente em variáveis de amplitude de movimento durante a fase de apoio da marcha. As fases marcha volta, retornar e virar-se para sentar diferiram idosos com DA de CCL. A respeito da associação entre domínios cognitivos e mobilidade, diferentes domínios cognitivos previram as medidas dos testes velocidade de marcha de 10 metros e tarefa cognitivo-motora isolada entre os grupos estudados. O domínio visuo-espacial foi independentemente associado com o TUG (tempo total) nos grupos CCL e DA e com o teste de dupla tarefa nos três grupos. Não houve associação significativa entre as fases de marcha do TUG e os domínios cognitivos em nenhum grupo. No entanto, déficit nas funções executivas foi associado com prejuízo nas fases de transição do TUG nos três grupos. O domínio visuo-espacial foi identificado como um preditor independente das medidas das fases retornar e virar-se para sentar no Grupo DA. Durante o seguimento de seis meses, 52,6% das pessoas com CCL e 51,4% de DA caíram. Após análise multivariada, o teste de dupla tarefa e a fase virar-se para sentar do TUG foram capazes de predizer quedas de forma independente em idosos com CCL e DA leve, respectivamente. Conclusão: O teste de dupla tarefa utilizado foi capaz de distinguir idosos com DA de PC e CCL. Não somente as fases de transição do TUG, como também as análises das fases de marcha separadamente, são essenciais na diferenciação dos padrões de mobilidade entre perfis cognitivos de idosos. Ainda, os achados demonstram a importância de considerar a influência de domínios cognitivos específicos em tarefas de mobilidade do dia a dia a fim de melhorar o rastreio e a reabilitação de distúrbios cognitivos e de mobilidade. A predição do domínio visuoespacial em tarefas de transição postural pode fornecer novas informações sobre os motivos do maior risco de quedas em DA. Os fatores de risco modificáveis encontrados no trabalho podem ser usados para detectar o risco de quedas, assim como melhorar intervenções para prevenir quedas em idosos com CCL e DA, com o enfoque em exercícios envolvendo atividades de dupla tarefa e de transição postural.

Made available in DSpace on 2016-12-12T17:32:58Z (GMT). No. of bitstreams: 1 Resumo Fernanda Faria.pdf: 82029 bytes, checksum: 25840142efbe3cd3067167076476b919 (MD5) Previous issue date: 2015-06-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: Chronic kidney disease (CKD) is a systemic disease, which can compromise several organs and tissues in its advanced stage. In CKD patients on hemodialysis (HD) is commonly observed the decline in physical activity and the specific involvement of the respiratory system that can be affected by both the disease and by the treatment. Pulmonary congestion is a frequent change in patients with CKD. However there are no studies that have analyzed the influence of mild pulmonary congestion in physical activity of daily living (PADL) by an activity monitor. Objective: The objective of this study was to investigate the influence of mild pulmonary congestion in physical activity of daily living of patients with CKD undergoing HD, as well as to know the behavior of these patients compared to PADL in the days of HD and non HD. Methods: This was a cross-sectional study that evaluated 30 patients with CKD stage 5, of both sexes, mean age 49 ± 15 years. Patients were evaluated on two different days and all the evaluations were conducted in pre- HD period. On the first day, patients underwent the examination of thoracic ultrasound to assess pulmonary congestion. On the second day, they underwent the following ratings: anthropometry, pulmonary function test, test respiratory muscle strength, grip strength, functional classification of symptoms and physical functioning domain of the questionnaire of quality of life. The evaluation of AVFD was held for 7 consecutive days, from Monday to Sunday for 12 hours. Results: the linear regression was observed that mild pulmonary congestion influenced PADL (F = 0.009 p = 7.97). The active time and the number of steps were significantly lower (p <0.05) HD in days (113 ± 55 and 161 ± 69, respectively) compared to those without HD days (3286 ± 1798 and 4422 ± 2202, respectively) . The PADL correlated with physical functioning domain (r = 0.35; p = 0.05). In multiple regression analysis, the variables that explain the domain "physical functioning" were age (B = -0.96 p <0.001), functional classification of symptoms (B = -13.48 p <0.001), and grip strength Manual (B = 1.07 p = 0.005). Conclusion: mild pulmonary congestion influences PADL CKD patients in stage 5, contributing to the injury of PADL. Patients are less active in hemodialysis day than in those without hemodialysis days. / Introdução: A doença renal crônica (DRC) é uma doença sistêmica, que pode comprometer diversos órgãos e tecidos na sua fase avançada. Em pacientes com DRC em hemodiálise (HD) é comumente observado o declínio do nível de atividade física e o acometimento específico do sistema respiratório que pode ser afetado tanto pela doença como pelo tratamento. A congestão pulmonar é uma alteração frequente nos pacientes com DRC. Contudo não há estudos que tenham analisado a influência da congestão pulmonar leve na atividade física de vida diária (AFVD) por meio de um monitor de atividades. Objetivo: O objetivo do presente estudo foi verificar a influência da congestão pulmonar leve na atividade física de vida diária dos pacientes com DRC submetidos a HD, assim como, conhecer o comportamento desses pacientes em relação à AFVD nos dias de HD e sem HD. Métodos: Tratou-se de um estudo com delineamento transversal no qual foram avaliados 30 pacientes com DRC estágio 5, de ambos os sexos e idade média de 49 ± 15 anos. Os pacientes foram avaliados em dois dias distintos e todas as avaliações foram realizadas no período pré-HD. No primeiro dia, os pacientes realizaram o exame de ultrassom torácico para avaliar a congestão pulmonar. No segundo dia, foram submetidos às seguintes avaliações: antropometria, prova de função pulmonar, prova de força muscular respiratória, força de preensão manual, classificação funcional de sintomas e o domínio funcionamento físico do questionário de qualidade de vida. A avaliação da AVFD foi realizada durante 7 dias consecutivos, de segunda a domingo por 12 horas diárias. Resultados: na análise de regressão linear observou-se que a congestão pulmonar leve influenciou a AFVD (p=0,009 F=7,97). O tempo ativo e o número de passos foram significativamente menores (p<0,05) nos dias de HD (113 ± 55 e 161 ± 69; respectivamente) quando comparados aos dias sem HD (3286 ± 1798 e 4422 ± 2202; respectivamente). A AFVD apresentou correlação com o domínio funcionamento físico (r= 0,35; p= 0,05). Na análise de regressão múltipla as variáveis que explicam o domínio funcionamento físico foram: idade (B= -0,96 p<0,001), classificação funcional de sintomas (B= -13,48 p<0,001), e força de preensão manual (B= 1,07 p=0,005). Conclusão: a congestão pulmonar leve influencia a AFVD de pacientes com DRC em estágio 5, contribuindo para o prejuízo da AFVD. Os pacientes são menos ativos nos dias de hemodiálise do que nos dias sem hemodiálise.

Orientador: Iracema de Mattos Paranhos Calderon / Resumo: JUSTIFICATIVA – desde agosto de 2011 o Serviço Especializado de Diabetes e Gravidez da Faculdade de Medicina de Botucatu/Unesp (SEDG-FMB/Unesp) adotou o novo protocolo diagnóstico para o DMG recomendado pela ADA/IADPSG. Entretanto, o Perfil Glicêmico (PG) continuou associado ao TOTG 75g, para diagnosticar a Hiperglicemia Gestacional Leve (HGL), reconhecida e tratada em nosso Serviço como se fosse DMG. A controvérsia sobre o custo-benefício do novo protocolo da ADA/IADPSG e a dúvida sobre a necessidade de manutenção do PG no protocolo do Serviço justificam o presente estudo. OBJETIVOS – avaliar o impacto do novo protocolo da ADA/IADPSG na prevalência de HGL e de DMG, na ocorrência de resultados perinatais adversos (RPNA) e na associação TOTG 75g e PG para diagnóstico de HGL no SEDG-FMB/Unesp. MÉTODO – estudo de corte transversal, incluindo gestantes, e seus recém-nascidos (RN), submetidas aos protocolos diagnósticos e que realizaram pré-natal e parto no Serviço, antes (janeiro de 2008 a 14 de agosto de 2011) e após (15 de agosto de 2011 a dezembro de 2014) à mudança do protocolo, definindo uma amostra por conveniência. Considerando os dois períodos, foram comparadas a prevalência de DMG e de HGL e a ocorrência de RN-GIG, macrossomia, primeira cesárea e tempo de internação dos RN. Na análise estatística foram utilizados análise de Poison e teste t-Student, teste do Qui-quadrado ou Exato de Fischer e cálculo de risco (RR e IC 95%) para os desfechos avaliados. O limite de signifi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: BACKGROUND - since August 2011 the Specialized Center of Diabetes and Pregnancy of the Botucatu Medical School / Unesp (SEDG-FMB / Unesp) has adopted a new diagnostic protocol for Gestational Diabetes Mellitus (GDM) recommended by the ADA / IADPSG guidelines. However, the glycemic profile (GP) remained associated with the 75g OGTT to diagnose Mild Gestational Hyperglycemia Lite (MGH), recognized and treated in our department as if it were GDM. The controversy over the cost-effectiveness of the new ADA / IADPSG guideline and doubt about the need for GP maintenance in the service protocol justify this study. OBJECTIVES - To assess the impact of the new ADA / IADPSG guideline in the prevalence of MGH and GDM, in the incidence of adverse perinatal outcomes (APNO) and in the association 75g OGTT and PG for diagnosis of MGH at the SEDG-FMB / Unesp. METHOD - cross-sectional study, including pregnant women and their newborns (NB) that underwent diagnostic protocols and had their prenatal care and delivery at the service before (January 2008 to August 14, 2011) and after (15 August 2011 to December 2014) the protocol modification, defining a convenience sample. Considering the two periods, the prevalence of GDM and MGH and the occurrence of LGA-NB, macrosomia, first cesarean delivery and NB hospital stay were compared. For statistical analysis, Poison analysis and Student's t test, chi-square or Fisher's exact test were used and risk estimate (RR and 95% CI) for the assessed outcomes.... (Complete abstract click electronic access below) / Mestre

Cognitive impairment is considered as essential feature of non-motor symptoms in Parkinson's disease (PD). It is a result of underlying pathological processes in the brain of PD patients and it leads to decreased quality of life. In this thesis an analysis of the structure and profile of cognitive impairment is presented with special emphasis on executive functions and memory. We take diagnostic entities developed for the description of PD cognitive spectrum such as mild cognitive impairment (PD-MCI) and dementia (PD-D) as examples of heterogeneity and different severity of cognitive impairment in PD. However, neuropsychological methods in Czech version that would measure these diagnotic units were not adequatly validated. In the experimental part we test a hypothesis, if gait disorder with falls in PD is interconnected with cognitive impairment, and if PD-fallers have more severe cognitive deficit than PD-non-fallers. On the basis of nine validity or normative data studies we show psychometric properties and clinical utility of several basic neuropsychological methods in the Czech population for memory (Rey Auditory Verbal Learning Test, California Verbal Learning Test, Second Edition, Memory For Intentions Screening Test and Enhanced Cued Recall Test), sustained attention and executive functions...

Neuropsychological aspects of preclinical stages of neurodegenerative diseases are an extensively studied topic in neuropsychological research. Neuropsychological assessment can be helpful for the estimation of conversion risk in individual cases. The focus of neuropsychological research shifted from the evaluation of dementia to mild cognitive impairment (MCI) or even to the detection of cognitive change before significant cognitive decline. In the theoretical part is presented a contemporary outline of preclinical stages of neurodegenerative diseases. The construct of MCI is the most studied topic in the prodromal stage of neurodegeneration and this part is dedicated to comprehensive analysis of MCI. The empirical research includes five studies on screening methods of cognitive abilities, memory and verbal fluency tests. We present normative and validity data in older adults and show their detection potential in MCI or preclinical stages of neurodegenerative diseases. Furthermore, we tried to show the detection potential of different memory measures in patients with MCI and estimate the relations between hippocampal atrophy and memory performance. Key words mild cognitive impairment, dementia syndrome, Alzheimer's Disease, neuropsychological assessment, diagnostic procedures