Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Claudia Regina Sgobbi de Faria / Banca: José Angelo Barela / Resumo: O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques. / Abstract: Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks. / Mestre

Orientador: Selma Maria Michelin Matheus / Resumo: A ingestão de etanol compromete a estrutura do cérebro, apresentar efeitos bifásicos sobre a atividade motora, agindo como um estimulante ou depressor dependendo da dose ou a duração de utilização. Ele interfere na absorção e metabolismo de vitamina D3, o que se correlaciona com alguns distúrbios neurológicos e neuropsiquiátricos. Há relatos sobre a associação de etanol com alterações ósseas, incluindo baixos níveis de vitamina D3. Com base nisso, o objetivo deste estudo foi avaliar os efeitos em testes de comportamento da administração isolada de vitamina D3 ou a sua administração em associação com etanol, durante alcoolismo crônico. A fim de conseguir isso, foram utilizados dois grupos experimentais: ratos Wistar machos (n = 20) e ratos UChB linhagem machos (n = 20) (bebedores voluntários de etanol). Ambos os grupos foram divididos em dois subgrupos: Vitamina D3 - 12.5μg / kg / dia (500 UI) de colecalciferol (WV, n = 10, e UV, n = 10), e de controle (CC, n = 10, e UC, n = 10), durante um período de 75 dias. O peso corporal análises e testes de comportamento (reflexo de sobressalto acústico e campo aberto) foram realizados em 90 e 165 dias de idade. Além disso, os níveis de plasma de corticosterona foram medidos a 165 dias, sem diferença estatística entre os grupos experimentais. O grupo Wistar apresentou valores mais baixos ASR no momento final (Controle e completada), enquanto as percentagens PPI foram maiores no grupo inicial. No grupo UChB houve nenhuma diferença em perc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Ethanol intake compromises brain structure, presenting biphasic effects over motor activity, acting as a stimulant or depressor depending on the dose or duration of use. It interferes in vitamin D3 absorption and metabolism, what correlates to some neurologic and neuropsychiatric disorders. There are reports on the association of ethanol with bone alterations, including low levels of vitamin D3. Based on that, the objective of this study was to evaluate the effects in behavior tests of isolated administration of vitamin D3 or its administration in association with ethanol, during chronic alcoholism. In order to achieve that, two experimental groups were used: male Wistar rats (n=20), and UChB lineage male rats (n=20) (volunteer ethanol drinkers). Both groups were divided in two subgroups: Vitamin D3 – 12.5µg/kg/day (500 UI) of cholecalciferol (WV, n=10, and UV, n=10), and Control (WC, n=10, and UC, n=10), for a period of 75 days. Body weight analyses and behavior tests (acoustic startle reflex and open field) were conducted at 90 and 165 days of age. In addition to that, corticosterone plasma levels were measured at 165 days, with no statistical difference between the experimental groups. The Wistar group presented lower ASR values in the final moment (Control and supplemented), while the PPI percentages were higher in the initial group. In the UChB group there was no difference in PPI percentages with the pre-stimuli used. When the ASR responses were compared between groups ... (Complete abstract click electronic access below) / Mestre

No description available.

Les chimiothérapies à base de sels de platine exercent leurs effets anti-tumoraux en compromettant l'intégrité de l'ADN. Cette cytotoxicité conduit à une augmentation du stress oxydant qui, à son tour, favorise les processus de mort cellulaire. L'oxaliplatine indiquée dans les cancers métastatiques secondaires du colon et dans les cancers colorectaux, induit une augmentation des espèces réactives de l’oxygène en diminuant le glutathion réduit dans les cellules cancéreuses. Similairement aux autres chimiothérapies à base de sels de platine, elle doit être utilisée avec précaution. En effet, la majorité des patients recevant de l'oxaliplatine développent des neuropathies périphériques. Cette neurodégénérescence est un facteur limitant de cette chimiothérapie puisqu'elle peut nécessiter une réduction du dosage ou même une interruption du traitement si cet effet secondaire atteint une sévérité de grade 3. Les toxicités neurologiques peuvent se manifester dans les heures suivant l'injection sous forme aiguë. La forme chronique résulte d'injections cumulées de doses élevées. La forme aiguë, caractérisée par une paresthésie transitoire et une myotonie, est réversible et se résout généralement en quelques jours tandis que la forme chronique présente une paresthésie et une thermoalgie persistantes résultant de la dégradation axonale distale et de la démyélinisation des fibres nerveuses de gros diamètre. Les voies inflammatoires ont été incriminées dans l'étiologie de cette neurodégénérescence. Le niclosamide, un ténicide modulant les voies Stat3, Wnt, Notch et Beta-caténine, a été étudié in vitro et in vivo. Ayant déjà démontré les propriétés anti-inflammatoires de ce composé dans la sclérodermie systémique, nous avons cherché à déterminer si le niclosamide pourrait également prévenir la neurotoxicité de l'oxaliplatine. Le niclosamide a démontré une neuroprotection à la fois in vitro sur les neurones traités par l'oxaliplatine et in vivo dans les modèles de neuropathies périphériques induites par l'oxaliplatine. Le niclosamide est déjà utilisé en clinique avec des effets secondaires limités. L'association de cette molécule avec l'oxaliplatine pourrait augmenter l'indice thérapeutique de cette chimiothérapie. La benztropine est un inhibiteur des récepteurs muscariniques M1 et M3 possédant un potentiel de remyélinisation démontré dans le système nerveux central en favorisant la différenciation et la prolifération des cellules précurseurs des oligodendrocytes. La répartition différentielle entre les sous-types de récepteurs peut permettre le ciblage spécifique des cellules tumorales, notamment par l'inhibition de la signalisation autocrine de l'acétylcholine. La benztropine est un composé bien toléré qui ne provoque aucune réaction immunologique lors de son administration. Cette molécule présente un effet neuroprotecteur in vitro sur les neurones traités par l'oxaliplatine au cours d’études de viabilité cellulaire ainsi qu’in vivo dans les modèles murins de neuropathies périphériques induites par l'oxaliplatine et le diabète. L'association de cette molécule avec l'oxaliplatine pourrait augmenter l'indice thérapeutique de cette chimiothérapie, en potentialisant ses effets antitumoraux tout en diminuant la neurotoxicité. L’ubiquité des propriétés neuroprotectrices de la benztropine a été démontrée sur des neuropathies périphériques résultants d’autres étiologies. Nous avons ici décrit deux molécules permettant de conserver l’efficacité antitumorale du traitement par oxaliplatine tout en limitant ses effets neurotoxiques. Nous avons décrit les mécanismes par lesquels ces molécules exercent leur neuroprotection. Les résultats prometteurs obtenus au cours de ces travaux permettent d’envisager l’utilisation en clinique de ces molécules afin de prévenir non seulement les neuropathies périphériques induites par l'oxaliplatine, mais aussi les neuropathies périphériques résultant d'autres étiologies. / Platinum-based chemotherapies have been shown to elicit their anti-tumoral effects by compromising DNA integrity. These impairments ultimately lead to a burst in oxidative stress which in turn promotes cell death processes. Oxaliplatin, a platinum-based antineoplastic drug is usually indicated in secondary metastatic colon cancers and colorectal cancers and mediates a rise in reactive oxygen species through the depletion of reduced glutathione in cancerous cells. This chemotherapy is indicated as a frontline and an adjuvant treatment and similarly to other platinum-based chemotherapies, it warrants for particular caution. Most patients receiving oxaliplatin develop peripheral neuropathies. This neurodegeneration is a limiting factor of this chemotherapy since it may require the lowering of dosage or even the interruption of the treatment if this side-effect is assessed as a grade 3 peripheral neuropathy. Neurological toxicities may manifest within hours of injection as an acute form or as a chronic form resulting from cumulated high-dosage injections. The acute form, characterized by transient paresthesia and myotonia, is reversible and usually resolves within days while the chronic form presents persistent paresthesia and thermoalgia resulting from distal axonal degradation and demyelination of large fibers. Inflammatory pathways have also been incriminated in the etiology of this neurodegeneration. Niclosamide, a teniacide known to downregulate Stat3, Wnt, Notch and Beta-catenin pathways was investigated in vitro and in vivo. Having previously demonstrated this compound’s anti-inflammatory properties in systemic sclerosis, we sought to investigate whether niclosamide could also prevent oxaliplatin’s neurotoxicity. Niclosamide demonstrated neuroprotection both in vitro on oxaliplatin-treated neurons and in vivo in models of oxaliplatin-induced peripheral neuropathies. Niclosamide is used in humans with limited side-effects. The association of this molecule with oxaliplatin could increase the therapeutic index of this chemotherapy. Benztropine is an inhibitor of muscarinic M1 and M3 receptors with known remyelinating potential in the central nervous system by promoting oligodendrocytes precursor cells differentiation and proliferation. The differential distribution between subtypes of receptors can allow the specific targeting of tumor cells, namely through the inhibition of autocrine acetylcholine signaling. This compound is well tolerated and does not elicit any immunological reaction upon its administration. These observations of potential for both, preventing neurotoxicity as well as increasing the efficacy profile of neurotoxic chemotherapies, prompted us to investigate this M1 and M3 receptors inhibitor. Benztropine demonstrated neuroprotection in vitro on oxaliplatin-treated neurons as demonstrated by viability assays studies as well as in vivo in models of oxaliplatin-induced as well as diabetic peripheral neuropathies. The association of this molecule with oxaliplatin could increase the therapeutic index of this chemotherapy, potentiate this chemotherapy’s antitumoral effects against certain cancers as well as decrease the occurrence of diabetic neuropathies, a prevalent complication of diabetes. We have herein described two molecules which allow oxaliplatin treatment to exert its cytotoxic effects without eliciting its neurotoxicity. Furthermore, we have described the mechanisms by which these molecules exert their neuroprotection. The neuroprotective abilities of one of these molecules have also been broadened by the study of other types of peripheral neuropathies, namely diabetic neuropathies. The promising results obtained over the course of these works allow for optimism in the prospect of finding therapies to counteract not only oxaliplatin-induced peripheral neuropathies but peripheral neuropathies resulting from other etiologies.

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 5 uppsatser.

Background: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. Methods/design: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. Interventions: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat (TM)). TempStat (TM) is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. Outcomes: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. Discussion: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability.

published_or_final_version / abstract / Anatomy / Doctoral / Doctor of Philosophy

Thesis (M. Phil.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

Peripheral neuropathy associated with agenesis of the corpus callosum (ACCPN or HMSN/ACC) is a severe polyneuropathy affecting both the peripheral nervous system and the central nervous system. It is transmitted as an autosomal recessive trait and is particularly frequent in the French Canadian population of Quebec (Canada). The disease was linked to chromosome 15 in 1996 by Dr. Rouleau's team. / We genotyped polymorphic markers in the ACCPN candidate region on chromosome 15 in over 67 patients and 200 control individuals. Observation of affected haplotypes confirmed the presence of a founder effect in the French Canadian population. Recombination analysis reduced the candidate interval to approximately 2 cM between markers D15S1040 and ACTC on chromosome 15. Linkage disequilibrium analysis suggested the gene resides nearest marker D15S1232. A physical map of the newly refined candidate region was constructed using YAC, BAC and PAC clones. These clones were used to confirm the position of candidate ESTs and genes as being either within or outside the ACCPN candidate region. / The connexin 36 gene, which was confirmed to reside within the region, was excluded as the gene responsible for ACCPN using SSCP analysis. The SLC12A6 gene was also confirmed to reside within the candidate interval and was tested for mutations using SSCP, dHPLC and sequence analyses. We found a total of four disease-specific mutations in SLC12A6, all of which are expected to truncate the KCC3 protein (the protein produced by the SLC12A6 gene). Two of the four mutations were identified in the French Canadian population; 80 French Canadian ACCPN patients are homozygous for the c.2436delG in exon 18 and one French Canadian patient is a compound heterozygote, having the c.2436delG mutation as well as the 1584_1585delCTinsG mutation in exon 11. Two additional mutations were identified in one Turkish and one Italian family in exons 22 and 15 respectively. The effects of the c.2436delG mutation on KCC3 function was studied in X. laevis oocytes and the truncated protein is not functional. Finally, collaborators at Vanderbilt University disrupted the slc12a6 gene in the mouse and found a phenotype similar to the human disease. / Identification of SLC12A6 as the gene mutated in ACCPN will allow for accurate molecular diagnosis as well as carrier testing in the French Canadian population. It is also the first step in understanding the molecular mechanism leading to the disease.

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 116-154). / Electronic reproduction. / Also available by subscription via World Wide Web / xvii, 157 leaves, bound ill. 29 cm