Bladder incontinence in patients who suffer from sacral spinal cord injury can wreak havoc on one's quality of life. A 2012 survey suggests that patients who sustain spinal cord injury prioritize the recovery of bladder function over other faculties. With about 12,000 new spinal cord injury cases reported in the United States each year, finding ways to combat the disabilities that result from lower spinal cord dysfunction should be of utmost importance to the scientific research community. Prior to studying the effects of surgical reinnervation on the bladder after long-term decentralization, it was critical to understand the effects that decentralization had on the integrity of both smooth muscle and intramural nerves of the bladder, the function of which could determine the success of surgical reinnervation. Chapter 2 describes in vivo stimulation, ex vivo smooth muscle contractility studies, and immunohistochemical techniques that were used to assess the condition of the functional components of the bladder. Collective results showed that although pelvic plexus-induced stimulation decreased when decentralization included the bilateral transection of the L7 dorsal root, smooth muscle cells and intramural nerves maintained their function after long-term bladder decentralization. Thus, preservation of at least some nerve activity may allow for successful surgical reinnervation after long-term injury. Following confirmation of smooth muscle and intramural nerve viability after decentralization, we sought to determine if nerve transfer after long-term decentralization restores bladder function in canines. In Chapter 3, we detail both decentralization and surgical reinnervation procedures used in our model. Briefly, decentralization of the bladder included bilateral transection of hypogastric nerves, as well as all spinal roots caudal to L7, with a subset of animals undergoing additional transection of the dorsal root of L7. One year after decentralization, animals that showed consistent loss of sensory and motor function underwent surgical reinnervation, which included the bilateral transfer of part of the obturator nerve to the anterior vesical branch of the pelvic nerve and the semimembranosus branch of the sciatic nerve to the pudendal nerve. Behavioral observations, in vivo stimulation of transferred nerves, and retrograde tracing studies were used to explore the efficacy of reinnervation on both sensory and motor components of bladder function. Ultimately, results showed that the new neuronal pathways created by nerve transfer can restore bladder sensation and possibly motor function in lower motor neuron-lesioned canines. Beyond the effects of surgical reinnervation on bladder function, we were interested in taking a closer look at the mechanisms that dictate function after decentralization and reinnervation (Chapter 3). Based on our previous work that found that transfer of somatic nerves resulted in bladder smooth muscle expression of a nicotinic receptor subunit thought to be expressed primarily in striated muscles, we were interested in assessing changes in the profile of nicotinic receptors responsible for bladder function. Ex vivo smooth muscle contractility studies showed that response to nicotinic receptor agonists were not altered after decentralization or reinnervation. Furthermore, the α1 nicotinic receptor subunit was expressed in bladder smooth muscle across all surgical groups. Future studies are necessary to better elicit the physiological relevance of these nicotinic receptors in the bladder. Additionally, due to the complexity of surgical reinnervation, it was important to understand all contributions to bladder innervation (Chapter 4). We previously identified that cells in the ventral horns of spinal cord levels rostral to the sacral cord can directly innervate the bladder via retrograde tracing. Because these direct inputs were not in proximity of the spinal root transections made during decentralization, we wanted to know how decentralization and reinnervation impacted their effects on the bladder when stimulated. L2-mediated detrusor contractions were significantly decreased by transection of the hypogastric nerves, suggesting that many of the nerves originating from the L2 cord are sympathetic in nature; however, treatment with phentolamine did not completely eliminate the increase in pressure in response to L2 stimulation. Therefore, the remaining inputs likely act upon the bladder through a yet undefined pathway. The quantity of positively labelled cells did not change in sections of the L2 ventral horn across all surgical groups, suggesting no change in the contribution of direct inputs to bladder innervation. Finally, anatomical feasibility of the obturator and semimembranosus branch of the sciatic nerve transfers has been assessed in an unembalmed cadaver, the results of which have not yet been published. Overall, this research gives us reason to believe that surgical reinnervation is a viable option for patients who develop lower neurogenic bladder after injury to the sacral cord, cauda equina, or peripheral nerves mediating bladder function. / Biomedical Sciences

Urofacial syndrome (UFS; MIM# 236730) is a rare autosomal recessive condition characterised by urinary bladder and bowel voiding dysfunction with a pathognomonic abnormality of facial movement with expression. UFS can be caused by biallelic putative loss-of-function mutations in HPSE2, which encodes heparanase 2. Failure to discover HPSE2 mutations in all cases of UFS suggests genetic heterogeneity. The urinary tract features of UFS overlap those seen in the spectrum of non-syndromic non-neurogenic voiding dysfunction and vesicoureteric reflux (VUR). This overlap suggests there may be some aspects of pathogenesis in common. The project aimed to define the genotypic and phenotypic spectrum associated with mutations in HPSE2 by Sanger sequencing and multiplex ligation-dependent probe amplification (MPLA) in newly referred cases of UFS and making comparison to a review of mutations and phenotypes seen in the literature. This work discovered five further families with HPSE2 associated UFS increasing known mutations whilst, reinforced that this is an under-recognised condition and emphasised the previously under-reported feature of facial weakness. The failure to discover HPSE2 mutations in all cases referred provided further evidence of genetic heterogeneity. The project also aimed to discover further genes associated with UFS. Autozygosity mapping and whole exome sequencing was carried out in cases of UFS without mutations in HPSE2. This led to the recognition that UFS is also caused by biallelic putative loss-of-function mutations in LRIG2 encoding the leucine-rich repeats and immunoglobulin-like domains 2 (LRIG2) protein in three families. Failure to identify LRIG2 mutations in all HPSE2 negative families suggests further genetic heterogeneity. To address the question of whether the pathogenesis of UFS overlaps more common conditions with a similar spectrum of urinary tract abnormalities I aimed to examine whether pathogenic variants in HPSE2 and LRIG2 were seen in these phenotypes. Unexpectedly this led to the discovering of further families affected by UFS but failed to show an association of variants in UFS genes with non-syndromic urinary tract abnormalities. However, variants of potential interest were discovered. As part of work toward understanding the pathogenesis of UFS and designing a model to test the pathogenesis of sequence variants expression studies in a Xenopus tropicalis hpse2 knock-down model of UFS were carried out. The knock-down model provided valuable insight in to the likely pathogenesis of UFS with evidence pointing towards a congenital peripheral neuropathy with failure of correct nerve path finding. Understanding the pathogenesis of UFS has the potential to direct further research in to therapeutic intervention.

While it is recognised that the burden on the caregiver of a person who has suffered a neurological event is great, research into the experience of caregiving and the effects of cognitive-communicative difficulties on intergenerational families is lacking. Studies examining these experiences within a multicultural and multilingual setting such as South Africa are few. The effects of neurogenic communication disorders in family systems also require further investigation. This study explores parent caregivers’ experiences of caring for their once-independent adult child, who are now faced with the reality of parenting for the second time. A qualitative research design was employed. Eighteen parents of adult children who have suffered TBIs, strokes or brain tumours were interviewed. The data obtained were analysed by means of thematic analysis. Themes associated with caring for an adult child, specifically in the South African context, are identified and discussed. These themes related to the parent caregiver’s experience of loss – loss of their child due to physical and cognitivecommunicative difficulties as well as the loss of their own dreams and plans for the future. Multiple roles within intergenerational family systems, support and information are identified as significant factors in either minimising or exacerbating their experience of loss. These themes are explained within a Family Systems Theory framework and assist in identifying both positive and negative factors that impact on experiences of caring for an adult child. It stresses the importance of the implementation of sustainable programmes and support services specifically catering for parents of adult children with neurological communication disorders.

Estudo quantitativo, exploratório, descritivo e transversal, com objetivo de avaliar o manejo do intestino neurogênico e sua relação com a qualidade de vida (QV), satisfação e estilo de vida em pessoas com lesão medular traumática (LMT). Seguidos os preceitos éticos, a amostra foi composta por 81 adultos com LMT, de dois centros de reabilitação dos estados de São Paulo e Santa Catarina. Os dados foram coletados a partir de cinco instrumentos previamente validados (questionários sociodemográfico e de caracterização da LMT, Índice de Tratamento do Intestino e da Bexiga (BBTI) e dois data sets de função intestinal e QV desenvolvidos pela International Spinal Cord Society (ISCoS)). Foram realizadas análises descritivas e correlacionais. A maioria dos participantes era do sexo masculino, jovens, com idade média de 36 anos no momento da lesão, baixa escolaridade, beneficiários da previdência social, com baixa renda familiar (até três salários mínimos) e com a LMT no nível torácico. As principais causas da LMT foram acidentes de trânsito e queda, o tempo médio da LMT era de 4,7 anos. Os participantes utilizavam principalmente medidas conservadoras (massagem abdominal, manobra de Valsalva e estímulo dígito-anal) como método para esvaziamento intestinal. Cerca de 90% necessitava de até 30 minutos para o manejo intestinal, e tinha frequência de defecação acima de duas vezes por semana. Aproximadamente metade dos participantes relatou incontinência fecal. A independência para o cuidado intestinal não foi associada ao nível da LMT, no entanto esteve associada à satisfação com a rotina de cuidados intestinais e ao tempo da LMT, assim quanto maior o tempo de lesão, maior foi a independência para o manejo intestinal. Aproximadamente 40% e 35% referiram alterar suas rotinas diárias devido à incontinência fecal e constipação, respectivamente. O impacto na QV devido aos problemas intestinais foi relatado por 77,8% da amostra. Não houve diferença estatisticamente significativa entre QV geral, com a saúde psicológica e com a saúde física (p>0,05). A QV geral esteve associada ao tempo de LMT, e foi menor entre as pessoas que tiveram que alterar suas rotinas devido a perdas fecais e entre aquelas que precisavam utilizar fraldas. As pessoas satisfeitas com suas rotinas de cuidado intestinal apresentaram maior QV geral e maior satisfação com a saúde psicológica. Ainda há que se progredir na reabilitação intestinal das pessoas com LMT, desenvolvendo estratégias de capacitação para o manejo intestinal, com a finalidade de reduzir os fatores que impedem ou dificultam a pessoa com LMT a retornar para suas atividades sociais e laborais, acarretando prejuízos na vida pessoal e para a economia do país já que a maioria dessas pessoas era economicamente ativa e agora dependem da previdência social e dos serviços de saúde com mais frequência. Os achados deste estudo podem subsidiar a prática clínica nos serviços de reabilitação, considerando que um programa de reabilitação precocemente iniciado e individualmente planejado pode auxiliar a pessoa com LMT a ter um funcionamento intestinal adequado e consequentemente uma melhor QV, satisfação e estilo de vida / Quantitative, exploratory, descriptive and transversal study, with the aim to assess the management of the neurogenic intestine and its relationship with the quality of life (QOL), satisfaction and lifestyle on people with traumatic spinal cord injury (TSCI). In accordance with the ethical requirements, the sample was composed by 81 adults with TSCI, from two rehabilitation centers from the states of Sao Paulo and Santa Catarina. The data was collected from five previously validated instruments (socio-demographic questionnaires and of characterization of TSCI, Index of Bladder and Intestine Treatment (BBTI) and two data sets of intestinal function and QOL developed by the International Spinal Cord Society (ISCoS)). Descriptive and correlational analyses were carried out. Most of the participants were male, young, with an average age of 36 years at the time of the injury, low schooling, and social security beneficiaries with low family income (up to three minimum wages) and with the TSCI at thoracic level. The main causes of the TSCI were traffic accidents and falls, the average time TSCI was of 4.7 years. Participants used mainly conservative measures (abdominal massage, Valsalva maneuver and digital anal stimulus) as a method for bowel emptying. Around 90% needed up to 30 minutes for the intestinal management, and had defecation frequency above twice a week. Approximately half of the participants reported fecal incontinence. Intestinal care independence was not associated with the level of the TSCI, however it was associated with satisfaction with bowel care routine and to the time of TSCI, so the longer the time of injury, the greater the independence for the bowel management was. Approximately 40% and 35% reported altering their daily routines due to fecal incontinence and constipation, respectively. The impact on the QV due to intestinal problems was reported by 77, 8% of the sample. There was no significant statistical difference between general QOL with psychological health and physical health (p>0,05). General QOL was associated with the time of TSCI and was lower among the people who had to alter their routines due to fecal losses and among those who needed to use diapers. The people satisfied with their routines of intestinal care presented higher general QOL and higher satisfaction with their psychological health. There is still progress to be made in the intestinal rehabilitation of people with TSCI, developing training strategies for the intestinal management, with the purpose to reduce the factors that prevent people with TSCI to return to their social and labor activities, causing losses in personal life and for the country\'s economy since most of these people were economically active and now depend on social welfare and health services more frequently. The findings of thid study can provide clinical practice in rehabilitation services, considering that a rehabilitation program prematurely launched and individually planned can assist the person with TSCI to have proper bowel function and consequently a better QOL, satisfaction and lifestyle

A gastrosquise (G) é o defeito congênito de fechamento da parede abdominal, que causa inflamação intestinal. Avaliou-se aqui a expressão protéica e gênica de marcadores neurogênicos e oxidativos no intestino de fetos de ratas tratadas ou não com dexametasona - DMT. Estes foram divididos em grupos: não manipulado (controle; C), falso operado (sham; S) e operado (G). A atividade da mieloperoxidase (MPO) aumentou no grupo G vs. C, não sendo afetada pela DMT. A expressão RNAm do receptor NK2, mas não NK1, VPAC e TRPV1, foi reduzida nos grupos G e S vs. C, sendo esta revertida pela DMT. A iNOS, mas não nNOS e eNOS, foi maior no grupo G. A DMT não inibiu a iNOS mas aumentou a eNOS. COX-2 aumentou na G e não foi afetada pela DMT. A expressão protéica da SOD-1 ou 3-NT não diferiu entre grupos G e controle. O grupo G tratado com DMT exibiu maior nitração protéica. A IL-6 aumentou no grupo G versus C. Conclui-se que a inflamação no intestino de fetos com G origina-se de uma possível combinação entre mecanismos oxidativos, geração de prostanóides e fatores neurovasculares. / Gastroschisis (G) is a congenital defect of the abdominal wall closure resulting in perivisceritis. The role of neurovascular and oxidative mechanisms in this condition was investigated by analyzing the gene and proteic expressions of these markers in the gut of foetus from female rats treated or not with dexamethasone (DMT). Increased MPO activity was found in G vs. control (C) but not sham (S) group. Reduced mRNA expression of NK2 receptor was found in G and S groups. Neither NK1 nor both VIP and TRPV1 receptors expression changed among groups. Increased expression of iNOS and COX-2, but not nNOS, eNOS and COX-1, was seen in G group. DMT reversed the expression of NK2R and increased that of NK1R without affecting iNOS and COX-2 expression. Increased levels of IL-6 but neither SOD-1 nor 3-NT was found in G group. In conclusion, the inflammatory process observed in the gut of foetus with G arises through a combination of neurogenic mechanisms that act in concert with reactive oxygen species and generation of prostanoids to produce gut dysfunction.

Made available in DSpace on 2016-01-26T12:51:17Z (GMT). No. of bitstreams: 1 magalimenezesilva_dissert.pdf: 258973 bytes, checksum: 59f28aa35e5bc3cb97bf961ba595c7d3 (MD5) Previous issue date: 2007-08-22 / Dysphagia is a symptom of one or more underlying problems, being a swallowing disorder with abnormal or obstruction sensation which prevents the passage of solid or liquid, from the oral cavity to the stomach. According to its etiology dysphagia is classified as neurogenic, mechanic, age-bound, psychogenic and induced by drugs. Dysphagia patients need care due to the high risk of aspiration during feeding. Casuistic: Forty caregivers of dysphagia patients who were seen at Hospital de Base in S?o Jos? do Rio Preto in the period of May and June, 2002, who met the inclusion criteria, took part in the study. Methods: Study approved by the Ethics Committee. The patients were referred by the areas of clinical neurology, neurosurgery, general practice, geriatrics, gastroenterology to the Speech Therapy Service of Hospital de Base for evaluation and management. The caregiver answered a questionnaire prepared by the researcher herself about the caregiver?s profile and his knowledge about dysphagia. Results: The caregivers were mostly informal, young, literate, married, and female, without experience as caregiver. They showed little knowledge about dysphagia, rehabilitation, importance of oral feeding, thickness of adequate food, the importance of cough, the right posture, the use of enteral tube, risks and difficulties faced by the patients. Conclusion: The sample presented little knowledge relating dysphagia and the necessary care to a safe and effective feeding, showing the need for specific guidance from the very beginning of rehabilitation. / A disfagia ? um sintoma de um ou mais problemas subjacentes, sendo um dist?rbio de degluti??o com sensa??o de anormalidade ou de obstru??o que impede a passagem de s?lidos ou l?quidos, da cavidade oral para o est?mago. A etiologia da disfagia ? classificada como neurog?nica, mec?nica, decorrente da idade, psicog?nica e induzida por drogas. Pacientes disf?gicos necessitam de assist?ncia devido ao alto risco de aspira??o durante alimenta??o. Objetivo: Este trabalho teve como objetivo tra?ar o perfil dos cuidadores de pacientes com disfagia neurog?nica, identificando seus conhecimentos sobre a disfagia em rela??o alimenta??o e cuidados com os pacientes. Casu?stica: Participaram 40 cuidadores de pacientes disf?gicos atendidos no Hospital de Base de S?o Jos? do Rio Preto, no per?odo de maio e junho de 2002 e que atenderam aos crit?rios de inclus?o. M?todo: O estudo foi aprovado pelo Comit? de ?tica em Pesquisa. Os pacientes foram encaminhados pelos m?dicos especialistas das ?reas de neurologia cl?nica, neurocirurgia, cl?nica m?dica, geriatria e gastroenterologia ao Servi?o de Fonoaudiologia do Hospital de Base para avalia??o e conduta. O cuidador respondeu um question?rio elaborado pela pr?pria pesquisadora sobre o perfil do cuidador e o conhecimento do mesmo sobre disfagia. Resultados: Os cuidadores de pacientes com disfagia neurog?nica eram na maioria do sexo feminino, jovens, alfabetizados, casados, informais e sem experi?ncia como cuidador. Apresentaram pouco conhecimento sobre disfagia, reabilita??o, import?ncia da alimenta??o via oral, consist?ncia dos alimentos, utens?lios apropriados, import?ncia da tosse, postura adequada, utiliza??o de sonda enteral, riscos e dificuldades encontradas pelo paciente. Conclus?o: A amostra apresentou pouco conhecimento em rela??o a disfagia e aos cuidados necess?rios ? alimenta??o segura e eficiente, demonstrando necessidade de orienta??o espec?fica desde o in?cio da reabilita??o.

Estudo quantitativo, exploratório, descritivo e transversal, com objetivo de avaliar o manejo do intestino neurogênico e sua relação com a qualidade de vida (QV), satisfação e estilo de vida em pessoas com lesão medular traumática (LMT). Seguidos os preceitos éticos, a amostra foi composta por 81 adultos com LMT, de dois centros de reabilitação dos estados de São Paulo e Santa Catarina. Os dados foram coletados a partir de cinco instrumentos previamente validados (questionários sociodemográfico e de caracterização da LMT, Índice de Tratamento do Intestino e da Bexiga (BBTI) e dois data sets de função intestinal e QV desenvolvidos pela International Spinal Cord Society (ISCoS)). Foram realizadas análises descritivas e correlacionais. A maioria dos participantes era do sexo masculino, jovens, com idade média de 36 anos no momento da lesão, baixa escolaridade, beneficiários da previdência social, com baixa renda familiar (até três salários mínimos) e com a LMT no nível torácico. As principais causas da LMT foram acidentes de trânsito e queda, o tempo médio da LMT era de 4,7 anos. Os participantes utilizavam principalmente medidas conservadoras (massagem abdominal, manobra de Valsalva e estímulo dígito-anal) como método para esvaziamento intestinal. Cerca de 90% necessitava de até 30 minutos para o manejo intestinal, e tinha frequência de defecação acima de duas vezes por semana. Aproximadamente metade dos participantes relatou incontinência fecal. A independência para o cuidado intestinal não foi associada ao nível da LMT, no entanto esteve associada à satisfação com a rotina de cuidados intestinais e ao tempo da LMT, assim quanto maior o tempo de lesão, maior foi a independência para o manejo intestinal. Aproximadamente 40% e 35% referiram alterar suas rotinas diárias devido à incontinência fecal e constipação, respectivamente. O impacto na QV devido aos problemas intestinais foi relatado por 77,8% da amostra. Não houve diferença estatisticamente significativa entre QV geral, com a saúde psicológica e com a saúde física (p>0,05). A QV geral esteve associada ao tempo de LMT, e foi menor entre as pessoas que tiveram que alterar suas rotinas devido a perdas fecais e entre aquelas que precisavam utilizar fraldas. As pessoas satisfeitas com suas rotinas de cuidado intestinal apresentaram maior QV geral e maior satisfação com a saúde psicológica. Ainda há que se progredir na reabilitação intestinal das pessoas com LMT, desenvolvendo estratégias de capacitação para o manejo intestinal, com a finalidade de reduzir os fatores que impedem ou dificultam a pessoa com LMT a retornar para suas atividades sociais e laborais, acarretando prejuízos na vida pessoal e para a economia do país já que a maioria dessas pessoas era economicamente ativa e agora dependem da previdência social e dos serviços de saúde com mais frequência. Os achados deste estudo podem subsidiar a prática clínica nos serviços de reabilitação, considerando que um programa de reabilitação precocemente iniciado e individualmente planejado pode auxiliar a pessoa com LMT a ter um funcionamento intestinal adequado e consequentemente uma melhor QV, satisfação e estilo de vida / Quantitative, exploratory, descriptive and transversal study, with the aim to assess the management of the neurogenic intestine and its relationship with the quality of life (QOL), satisfaction and lifestyle on people with traumatic spinal cord injury (TSCI). In accordance with the ethical requirements, the sample was composed by 81 adults with TSCI, from two rehabilitation centers from the states of Sao Paulo and Santa Catarina. The data was collected from five previously validated instruments (socio-demographic questionnaires and of characterization of TSCI, Index of Bladder and Intestine Treatment (BBTI) and two data sets of intestinal function and QOL developed by the International Spinal Cord Society (ISCoS)). Descriptive and correlational analyses were carried out. Most of the participants were male, young, with an average age of 36 years at the time of the injury, low schooling, and social security beneficiaries with low family income (up to three minimum wages) and with the TSCI at thoracic level. The main causes of the TSCI were traffic accidents and falls, the average time TSCI was of 4.7 years. Participants used mainly conservative measures (abdominal massage, Valsalva maneuver and digital anal stimulus) as a method for bowel emptying. Around 90% needed up to 30 minutes for the intestinal management, and had defecation frequency above twice a week. Approximately half of the participants reported fecal incontinence. Intestinal care independence was not associated with the level of the TSCI, however it was associated with satisfaction with bowel care routine and to the time of TSCI, so the longer the time of injury, the greater the independence for the bowel management was. Approximately 40% and 35% reported altering their daily routines due to fecal incontinence and constipation, respectively. The impact on the QV due to intestinal problems was reported by 77, 8% of the sample. There was no significant statistical difference between general QOL with psychological health and physical health (p>0,05). General QOL was associated with the time of TSCI and was lower among the people who had to alter their routines due to fecal losses and among those who needed to use diapers. The people satisfied with their routines of intestinal care presented higher general QOL and higher satisfaction with their psychological health. There is still progress to be made in the intestinal rehabilitation of people with TSCI, developing training strategies for the intestinal management, with the purpose to reduce the factors that prevent people with TSCI to return to their social and labor activities, causing losses in personal life and for the country\'s economy since most of these people were economically active and now depend on social welfare and health services more frequently. The findings of thid study can provide clinical practice in rehabilitation services, considering that a rehabilitation program prematurely launched and individually planned can assist the person with TSCI to have proper bowel function and consequently a better QOL, satisfaction and lifestyle

A lesão medular gera uma condição crônica de saúde ao indivíduo que sofre a injúria e pode acarretar complicações, como o intestino neurogênico. A depender do nível neurológico da lesão, há expectativas de resultados para o funcionamento intestinal e medidas educativas devem ser implementadas ainda na fase aguda da lesão, visando a reabilitação. Estudo de delineamento metodológico que objetivou produzir vídeo educativo com as manobras de esvaziamento intestinal a ser utilizado no preparo de indivíduos com intestino neurogênico. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em quatro etapas: etapa 1: Produção do roteiro e storyboard elaborados a partir das diretrizes do Guia traduzido: \"Intestino Neurogênico: Guia para Pessoas com Lesão Medular\"; etapa 2: Produção dos instrumentos; etapa 3: Coleta de dados; e por fim etapa 4: Produção do vídeo educativo. Foram utilizados dois instrumentos para a validação do roteiro e storyboard. O instrumento para validação de conteúdo continha 15 questões, divididas em quatro sessões e o de validação técnica possuía 11 questões, divididas em três sessões. Em cada sessão dos instrumentos tinha um campo para sugestões. A validade de conteúdo do roteiro e storyboard foi realizada por um comitê de dez juízes de conteúdo e três juízes técnicos. Os resultados demonstraram que todos os juízes de conteúdo eram do sexo feminino, com idade entre 30 a 58 anos. Quanto à atuação profissional atual e maior titulação acadêmica, a maioria trabalhava na área de reabilitação e tinha mestrado. As alternativas \"discordo fortemente\" e \"não sei\", não foram sinalizadas e a porcentagem de respostas total à opção \"concordo fortemente\" foi de 57,3% e \"concordo\" foi de 36,7%. A maioria das sugestões foi relacionada à mudança na linguagem, visando adequação ao público- alvo e para incrementar o uso de fotografias, figuras e animações. Quanto aos juízes técnicos, a maioria era do sexo masculino, com idade entre 37 a 45 anos. Atuavam como analista em mídias digitais e tecnologias educacionais, produção multimídia e em sistemas de informação, com predomínio do título de especialização. A porcentagem total de respostas \"concordo fortemente\" foi de 78,8% e \"concordo\" de 21,2%. Ressaltaram nas sugestões, o cuidado na edição e escolha dos recursos audiovisuais, de maneira a favorecer o interesse e a atenção do usuário. Cada item do instrumento de validação do roteiro e storyboard do vídeo obteve mais de 70% do conceito \"concordo fortemente\" e/ou \"concordo\" pelos juízes. Posteriormente o roteiro e storyboard foram adequados e as sugestões analisadas e acatadas conforme pertinência. A gravação do vídeo ocorreu no Centro de Simulação e no Centro de Informática de Ribeirão Preto da Universidade de São Paulo. A produção do vídeo favoreceu a utilização da prática baseada em evidência e contribuirá para o aprimoramento da assistência de enfermagem, com enfoque na educação de indivíduos com intestino neurogênico e seus cuidadores, além de se constituir em ferramenta tecnológica que poderá ser utilizada em ambiente de aprendizagem virtual e presencial / Spinal cord injury generates a chronic health condition to the individual suffering the injury and can lead to complications such as neurogenic bowel. Depending on the neurological level of injury, there are expectations of results for bowel function and educational measures should be implemented, even in the injury acute phase for the rehabilitation. Methodological design study aimed to produce an educational video with intestinal emptying maneuvers to be used in the preparation of patients with neurogenic bowel. The research, which was approved by the Ethics Committee, was performed in four steps: Step 1: Production and script storyboard drawn from the Guide guidelines translated: \"Neurogenic Bowel: A Guide for People with Spinal Cord Injury\"; Step 2: Production of instruments; Step 3: Data collection; and Step 4: Production of educational video. Two instruments for the validation script and storyboard were used. The instrument for content validation contained 15 questions divided into four sessions and the technical validation possessed 11 questions, divided into these three sessions. In each session of the instruments had a field for suggestions. The validity of the script and storyboard content was performed by an expert panel of 10 content and 3 technical judges. The results showed that all the contents of judges were female, aged 30-58 years. As for the current and highest academic degree professional practice, most working in rehabilitation and has mastered. Alternative \"strongly disagree\" and \"do not know\", were not marked and the percentage of total responses \"strongly agree\" was 57.3% and \"agree\" was 36.7%. Most of the suggestions was related to the change in language, aimed at adaptation to the target audience and to increase the use of photographs, pictures and animations. As for the technical judges, most were male, aged 37-45 years. Worked as an analyst in digital media and educational technologies, multimedia production and information systems, predominantly they had the title of master as expertise. The total percentage of responses \"strongly agree\" was 78.8% and \"agree\" 21.2%. They stressed the suggestions, care in editing and choice of audiovisual resources, in order to favor the interest and the user\'s attention. Each item script validation tool and Video storyboard obtained more than 70% of concept \"strongly agree\" and/or \"agree\" by the judges. Later the script and storyboard were adequate and suggestions analyzed and obeyed as relevance. Video recording took place in the Simulation Center and Ribeirao Preto Computer Centre at the University of São Paulo. The production of the video encouraged the use of evidence-based practice and contribute to the improvement of nursing care, focusing on education of individuals with neurogenic bowel and their caregivers, in addition to being in technological tool that can be used in educational settings virtual and face

A lesão medular gera uma condição crônica de saúde ao indivíduo que sofre a injúria e pode acarretar complicações, como o intestino neurogênico. A depender do nível neurológico da lesão, há expectativas de resultados para o funcionamento intestinal e medidas educativas devem ser implementadas ainda na fase aguda da lesão, visando a reabilitação. Estudo de delineamento metodológico que objetivou produzir vídeo educativo com as manobras de esvaziamento intestinal a ser utilizado no preparo de indivíduos com intestino neurogênico. A pesquisa, aprovada pelo Comitê de Ética, foi realizada em quatro etapas: etapa 1: Produção do roteiro e storyboard elaborados a partir das diretrizes do Guia traduzido: \"Intestino Neurogênico: Guia para Pessoas com Lesão Medular\"; etapa 2: Produção dos instrumentos; etapa 3: Coleta de dados; e por fim etapa 4: Produção do vídeo educativo. Foram utilizados dois instrumentos para a validação do roteiro e storyboard. O instrumento para validação de conteúdo continha 15 questões, divididas em quatro sessões e o de validação técnica possuía 11 questões, divididas em três sessões. Em cada sessão dos instrumentos tinha um campo para sugestões. A validade de conteúdo do roteiro e storyboard foi realizada por um comitê de dez juízes de conteúdo e três juízes técnicos. Os resultados demonstraram que todos os juízes de conteúdo eram do sexo feminino, com idade entre 30 a 58 anos. Quanto à atuação profissional atual e maior titulação acadêmica, a maioria trabalhava na área de reabilitação e tinha mestrado. As alternativas \"discordo fortemente\" e \"não sei\", não foram sinalizadas e a porcentagem de respostas total à opção \"concordo fortemente\" foi de 57,3% e \"concordo\" foi de 36,7%. A maioria das sugestões foi relacionada à mudança na linguagem, visando adequação ao público- alvo e para incrementar o uso de fotografias, figuras e animações. Quanto aos juízes técnicos, a maioria era do sexo masculino, com idade entre 37 a 45 anos. Atuavam como analista em mídias digitais e tecnologias educacionais, produção multimídia e em sistemas de informação, com predomínio do título de especialização. A porcentagem total de respostas \"concordo fortemente\" foi de 78,8% e \"concordo\" de 21,2%. Ressaltaram nas sugestões, o cuidado na edição e escolha dos recursos audiovisuais, de maneira a favorecer o interesse e a atenção do usuário. Cada item do instrumento de validação do roteiro e storyboard do vídeo obteve mais de 70% do conceito \"concordo fortemente\" e/ou \"concordo\" pelos juízes. Posteriormente o roteiro e storyboard foram adequados e as sugestões analisadas e acatadas conforme pertinência. A gravação do vídeo ocorreu no Centro de Simulação e no Centro de Informática de Ribeirão Preto da Universidade de São Paulo. A produção do vídeo favoreceu a utilização da prática baseada em evidência e contribuirá para o aprimoramento da assistência de enfermagem, com enfoque na educação de indivíduos com intestino neurogênico e seus cuidadores, além de se constituir em ferramenta tecnológica que poderá ser utilizada em ambiente de aprendizagem virtual e presencial / Spinal cord injury generates a chronic health condition to the individual suffering the injury and can lead to complications such as neurogenic bowel. Depending on the neurological level of injury, there are expectations of results for bowel function and educational measures should be implemented, even in the injury acute phase for the rehabilitation. Methodological design study aimed to produce an educational video with intestinal emptying maneuvers to be used in the preparation of patients with neurogenic bowel. The research, which was approved by the Ethics Committee, was performed in four steps: Step 1: Production and script storyboard drawn from the Guide guidelines translated: \"Neurogenic Bowel: A Guide for People with Spinal Cord Injury\"; Step 2: Production of instruments; Step 3: Data collection; and Step 4: Production of educational video. Two instruments for the validation script and storyboard were used. The instrument for content validation contained 15 questions divided into four sessions and the technical validation possessed 11 questions, divided into these three sessions. In each session of the instruments had a field for suggestions. The validity of the script and storyboard content was performed by an expert panel of 10 content and 3 technical judges. The results showed that all the contents of judges were female, aged 30-58 years. As for the current and highest academic degree professional practice, most working in rehabilitation and has mastered. Alternative \"strongly disagree\" and \"do not know\", were not marked and the percentage of total responses \"strongly agree\" was 57.3% and \"agree\" was 36.7%. Most of the suggestions was related to the change in language, aimed at adaptation to the target audience and to increase the use of photographs, pictures and animations. As for the technical judges, most were male, aged 37-45 years. Worked as an analyst in digital media and educational technologies, multimedia production and information systems, predominantly they had the title of master as expertise. The total percentage of responses \"strongly agree\" was 78.8% and \"agree\" 21.2%. They stressed the suggestions, care in editing and choice of audiovisual resources, in order to favor the interest and the user\'s attention. Each item script validation tool and Video storyboard obtained more than 70% of concept \"strongly agree\" and/or \"agree\" by the judges. Later the script and storyboard were adequate and suggestions analyzed and obeyed as relevance. Video recording took place in the Simulation Center and Ribeirao Preto Computer Centre at the University of São Paulo. The production of the video encouraged the use of evidence-based practice and contribute to the improvement of nursing care, focusing on education of individuals with neurogenic bowel and their caregivers, in addition to being in technological tool that can be used in educational settings virtual and face

L’exagération de l’activité contractile spontanée (ACS) et les tumeurs de vessie (TV) sont des modifications morphologiques vésicales observées à moyen et long terme chez les patients ayant une hyperactivité détrusorienne neurogène. Cependant la carcinogénèse vésicale chez les patients neurologiques n’a jamais été étudiée à ce jour et la signification de l’ACS est non élucidée. Nos buts étaient d’étudier la carcinogénèse des vessies neurologiques (en particulier le rôle de l’inflammation chronique) et d’étudier les mécanismes de l’ACS.Nous rapportons que l’expression immunohistochimique de Foxp3 est caractéristique des patients neurologiques ayant une TV agressive de différenciation épidermoïde. Ainsi Foxp3 pourrait être une cible pour le développement d’immunothérapies anti-tumorales. Par une étude en bains d’organes sur des fragments de vessies fraîches issus de patients ayant une hyperactivité détrusorienne neurogène réfractaire, nous observons que l’ACS vésicale in vitro est corrélée à l'âge et la présence de muqueuse vésicale. La modulation pharmacologique de la communication intercellulaire médiée par les connexines 40, 43 et 45 n’inhibe pas l’ACS. La traduction clinique de ces résultats préliminaires est encore difficile. Cependant la compréhension de la signification de l’ACS pourrait identifier de nouvelles voies thérapeutiques pour l’hyperactivité détrusorienne neurogène. Nos résultats ne peuvent pas être argumentés par la littérature encore pauvre à ce sujet. Ce programme de recherche innovant sur les modifications morphologiques à moyen et long terme des vessies neurologiques est poursuivi grâce à une collaboration nationale et à la transversalité des domaines d’expertises des chercheurs impliqués. / Increased spontaneous contractile activity (SCA) and bladder cancer are medium and long-term morphological changes of the bladder observed in patients with neurogenic detrusor overactivity. However, urothelial carcinogenesis in neurological patients has never been studied and the signification of ACS remains unknown. Our objectives were to study the bladder carcinogenesis in neurological patients (in particular the role of chronic inflammation), and the mechanisms of SCA in neurogenic bladders. We report that Foxp3 expression appears to be a characteristic of neurological patients presenting with aggressive bladder cancer and squamous cell differentiation. Thus, targeting Foxp3 may represent an interesting strategy to improve anti-tumor immunotherapy for bladder cancer. By conducting organ bath studies on bladder strips from patients with refractory neurogenic detrusor overactivity, we observe that the in vitro SCA may be modulated by age and the presence of mucosa. The pharmacological modulation of intercellular communication, targeting connexins 40, 43 and 45, cannot inhibit the SCA of neurogenic bladder strips. These results are still difficult to translate into clinical practice. However, understanding the origin of bladder SCA could help identify new therapeutic strategies for detrusor overactivity. Our results are still preliminary and cannot be supported by the literature due to paucity of data. This research program on medium and long-term morphological changes of human neurogenic bladders is pursued through a national collaboration and cross-disciplinary areas of expertise of the researchers involved.