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Lesões na cartilagem articular do joelho são patologias frequentes e geralmente causadas por traumas. Apesar de algumas serem assintomáticas, essas alterações osteocondrais podem evoluir para degeneração da cartilagem articular e osteoartrose. Uma da degeneração progressiva da cartilagem articular leva a osteoartrite (OA), comumente sendo a articulação femorotibiopatelar a mais afetada. Como os tratamentos convencionais para OA não são curativos, apenas paliativos, a terapia celular com células-tronco (CT) desponta como alternativa. Neste trabalho utilizamos células-tronco de dente decíduo esfoliado (Stem cells from Human Exfoliated Deciduous teeth - SHED), cultivadas em associação com um biomaterial, para tratar lesões osteocondrais provocadas em joelhos de ovinos. Quatro defeitos osteocondrais foram cirurgicamente produzidos para testar quatro condições: 1) SHED associada ao biomaterial, 2) somente biomaterial, 3) somente SHED e 4) nenhum tratamento (controle). Os ovinos foram acompanhados clinicamente e através de exames radiográfico, US e artroscopia, por 120, 190, 365 e 730 dias até a eutanásia. Os resultados revelaram que o tratamento com biomaterial em associação com SHED, produziu reparo similar à estrutura cartilagínea a partir de 190 dias, apresentando características de cartilagem adjacente. Entretanto, apesar dos resultados positivos em relação ao reparo da lesão osteocondral, não foi possível afirmar se a melhora deveu-se a diferenciação direta das SHED para células presentes na cartilagem ou se foi um efeito parácrino das mesmas. Em tempo, não foi observada rejeição e nenhuma reação adversa ao implante celular xenogênico durante o período experimental. / Articular cartilage injuries on the knee are frequent pathologies and usually caused by trauma. Although some are asymptomatic, these changes may evolve into osteochondral articular cartilage degeneration and osteoarthritis. A progressive degeneration of articular cartilage leads to osteoarthritis (OA), being femorotibiopatelar joint the most affected one. As conventional treatments for OA are not curative, but palliative, cell therapy with stem cells (SC) stands out as an alternative. In this work we used stem cells from human exfoliated deciduous teeth (SHED), grown in association with a biomaterial, to treat osteochondral lesions on sheep\'s knees. Four osteochondral defects were surgically produced to test four conditions: 1) SHED associated with the biomaterial, 2) only the biomaterial, 3) only SHED and 4) no treatment (control). The sheep were followed clinically and through radiographic exams, US and arthroscopy, for 120, 190, 365 and 730 days until euthanasia. The results showed that treatment with biomaterial in combination with SHED produced repair similar to the cartilage structure from 190 days, showing cartilage adjacent features. However, despite the positive results in relation to the repair of osteochondral lesion it was not possible to say whether the improvement was due to direct differentiation of SHED for cells present in cartilage or was a paracrine effect. In time, there was no rejection and no adverse reaction to the xenogenic cell implant during the trial period.

Lesões na cartilagem articular do joelho são patologias frequentes e geralmente causadas por traumas. Apesar de algumas serem assintomáticas, essas alterações osteocondrais podem evoluir para degeneração da cartilagem articular e osteoartrose. Uma da degeneração progressiva da cartilagem articular leva a osteoartrite (OA), comumente sendo a articulação femorotibiopatelar a mais afetada. Como os tratamentos convencionais para OA não são curativos, apenas paliativos, a terapia celular com células-tronco (CT) desponta como alternativa. Neste trabalho utilizamos células-tronco de dente decíduo esfoliado (Stem cells from Human Exfoliated Deciduous teeth - SHED), cultivadas em associação com um biomaterial, para tratar lesões osteocondrais provocadas em joelhos de ovinos. Quatro defeitos osteocondrais foram cirurgicamente produzidos para testar quatro condições: 1) SHED associada ao biomaterial, 2) somente biomaterial, 3) somente SHED e 4) nenhum tratamento (controle). Os ovinos foram acompanhados clinicamente e através de exames radiográfico, US e artroscopia, por 120, 190, 365 e 730 dias até a eutanásia. Os resultados revelaram que o tratamento com biomaterial em associação com SHED, produziu reparo similar à estrutura cartilagínea a partir de 190 dias, apresentando características de cartilagem adjacente. Entretanto, apesar dos resultados positivos em relação ao reparo da lesão osteocondral, não foi possível afirmar se a melhora deveu-se a diferenciação direta das SHED para células presentes na cartilagem ou se foi um efeito parácrino das mesmas. Em tempo, não foi observada rejeição e nenhuma reação adversa ao implante celular xenogênico durante o período experimental. / Articular cartilage injuries on the knee are frequent pathologies and usually caused by trauma. Although some are asymptomatic, these changes may evolve into osteochondral articular cartilage degeneration and osteoarthritis. A progressive degeneration of articular cartilage leads to osteoarthritis (OA), being femorotibiopatelar joint the most affected one. As conventional treatments for OA are not curative, but palliative, cell therapy with stem cells (SC) stands out as an alternative. In this work we used stem cells from human exfoliated deciduous teeth (SHED), grown in association with a biomaterial, to treat osteochondral lesions on sheep\'s knees. Four osteochondral defects were surgically produced to test four conditions: 1) SHED associated with the biomaterial, 2) only the biomaterial, 3) only SHED and 4) no treatment (control). The sheep were followed clinically and through radiographic exams, US and arthroscopy, for 120, 190, 365 and 730 days until euthanasia. The results showed that treatment with biomaterial in combination with SHED produced repair similar to the cartilage structure from 190 days, showing cartilage adjacent features. However, despite the positive results in relation to the repair of osteochondral lesion it was not possible to say whether the improvement was due to direct differentiation of SHED for cells present in cartilage or was a paracrine effect. In time, there was no rejection and no adverse reaction to the xenogenic cell implant during the trial period.

Made available in DSpace on 2014-12-17T14:13:58Z (GMT). No. of bitstreams: 1 CiroAMG_DISSERT.pdf: 558997 bytes, checksum: 88cebb7de07042495962e2b8c45d2da0 (MD5) Previous issue date: 2012-02-10 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Physical Education professionals are usually exposed to excessive physical workloads that evolve into painful symptomatology and muscle and bone disorders that originate from the work-related exercises. Purposo: The goal of this study was to investigate the prevalence and factors associated with pain painful symptomatology in teachers in gymnastics academies. An analytical transversal cut study was performed involving 163 gymnastics teachers working in the main gyms in the city of Salvador-BA. For evaluation of pain, validated versions in Portuguese of the McGill Protocol and the Wisconsin Pain Inventory were used. For obtain results of descriptive statistical analysis of the collected data was performed, followed by TStudent, and Pearson and Spearman correlation tests to verify possible correlations between the presence of pain and other variables which were considered independent. Finally, for the identification of potential risk factors associated with pain, a binary logistic regression analysis was performed. For all statistical analysis, we cnsidered p< 0.05. Results: The painful symptoms was reported by 88.3% of the subjects surveyed. High pain levels were observed in 63.8% of the interviewed professionals, where the intensity varied from moderate to severe. Pain in the lumbar region was present in 55.2% of subjects. Positive correlations were found between the level of pain intensity and the variables related with the workload activity and daily life of the teachers in almost all body joints analyzed. Some factors had been verified associates to the painful sintomatologia as the age of the professionals, the daily hours load of labor work, and the lack of interval of rest between the lessons. Conclusions: We found a high prevalence in gym teachers working in the city of Salvador-BA, which interfered in various daily activities of their home and professional lives. The most affected region was the lumbar region, followed by the knees, neck, shoulders, ankles, hands, hips, feet, elbows and forearms. The factors associated with development of painful symptomatology were the age of the professionals, daily hours of work and the lack of rest intervals between lessons. The high prevalence of pain in Physical Education teachers can be regarded as a serious occupational health problem, which would demand the urgent deployment of preventive intervention programs to minimize the impact of pain among these professionals / Os profissionais de Educa??o F?sica geralmente s?o expostos a excessivas cargas de trabalhos f?sicos que evoluem para o acometimento de sintomatologia dolorosa e dist?rbios musculoesquel?ticos oriundos do exerc?cio laboral. Objetivo: Investigar a preval?ncia da sintomatologia dolorosa e fatores associados em professores de academia de gin?stica. M?todos: Foi realizado um estudo anal?tico de corte transversal em 163 professores de gin?stica atuantes nas principais academias da cidade de Salvador-Ba. Para avalia??o da sintomatologia dolorosa foram usadas vers?es validadas para o portugu?s do protocolo McGill e do Invent?rio para dor de Wisconsin. Para obten??o dos resultados atrav?s da an?lise estat?stica dos dados coletados foi realizado uma an?lise descritiva, seguida dos testes TStudent e correla??o de Pearson e Spearman para analisar as poss?veis correla??es existentes entre a presen?a de dor e as demais vari?veis consideradas independentes. Para a identifica??o dos potenciais fatores de risco associados ? sintomatologia dolorosa uma an?lise de regress?o log?stica bin?ria. O valor de p < 0,05 foi considerado para toda an?lise estat?stica. Resultados: A sintomatologia dolorosa foi relatada por 88,3 % dos sujeitos pesquisados. Observaram-se n?veis elevados de dor em 63,8% dos entrevistados, onde a intensidade variou de moderada ? severa. A dor na regi?o lombar esteve presente em 55,2% dos sujeitos. Foram verificadas correla??es positivas entre o grau de intensidade da dor e as vari?veis relacionadas com a carga da atividade laboral e da vida cotidiana dos professores em quase todas as articula??es do corpo analisadas. Verificaram-se v?rios fatores associados ? sintomatologia dolorosa como a idade dos profissionais, a carga hor?ria di?ria de trabalho laboral, e a falta de intervalo de repouso entre as aulas. Conclus?es: Constatou-se uma elevada preval?ncia de dor nos professores de academias de gin?sticas atuantes na cidade de Salvador-Ba interferindo em v?rias atividades da vida cotidiana e laboral. A regi?o mais acometida foi a lombar, seguida dos joelhos, pesco?o, ombros, tornozelos, m?os, quadris, p?s, cotovelos e antebra?os. Os fatores associados ? sintomatologia dolorosa foram, a idade dos profissionais, a carga hor?ria di?ria de trabalho laboral, e a falta de intervalo de repouso entre as aulas. A elevada preval?ncia de dor nos professores de educa??o f?sica pode ser considerada como um grave problema de sa?de ocupacional, o que demandaria a necessidade urgente de implanta??o de programas de interven??o preventiva voltados para minimizar o impacto da sintomatologia dolorosa entre estes profissionais

La vancomycine est un antibiotique fréquemment utilisé dans le contexte hospitalier pour les infections cutanées et nosocomiales. Son utilisation nécessite un suivi thérapeutique pharmacocinétique (TDM) de la part du clinicien, étant donné l’index thérapeutique étroit et la variabilité de son profil pharmacocinétique entre les individus. Alors que le risque de néphrotoxicité associée à la vancomycine s’accroît avec sa durée de traitement, sa clairance et son volume de distribution deviennent difficiles à prédire dans le contexte des traitements prolongés, ce qui est souvent requis chez les patients avec infections ostéoarticulaires. Avec l’approche de modélisation pharmacocinétique de population (popPK), ce projet de maîtrise a cherché à évaluer les changements longitudinaux des paramètres pharmacocinétique de la vancomycine dans une population de patients atteints d’infections ostéoarticulaires. Dans un premier temps, nous avons décrit la pratique de TDM chez les patients qui recevaient de la vancomycine intraveineuse (IV) pour les infections ostéoarticulaires à l’Hôpital Général de Montréal entre décembre 2020 et décembre 2022. Dans un deuxième temps, nous avons identifié deux modèles popPK longitudinaux dans la littérature et évalué leur performance prédictive dans cette population. Bien que ces modèles proposent des approches intéressantes pour décrire les changements longitudinaux de la vancomycine, ils se sont avérés inadéquats pour décrire les paramètres pharmacocinétiques de cet antibiotique dans notre population. D’autres travaux seront nécessaires pour développer et valider des modèles longitudinaux de la vancomycine qui devront tenir compte des variables qui décrivent l’état inflammatoire du patient et des méthodes alternatives pour intégrer une structure longitudinale dans le modèle popPK. / Vancomycin is commonly used in the hospital setting to treat skin and soft tissues infections as well as nosocomial infections. As vancomycin has a small therapeutic window and its pharmacokinetic properties vary significantly across individuals, clinicians must ensure close therapeutic drug monitoring (TDM). As the risk of vancomycin induced nephrotoxicity increases with duration of therapy, clearance and distribution of vancomycin become difficult to predict in the context of long term treatment which is often required for osteoarticular infections. With the use of population pharmacokinetic (popPK) modeling, we aimed to examine the longitudinal changes in the pharmacokinetic properties of vancomycin in patients with osteoarticular infections. In the first part of this master’s project, we described the local practices of TDM in patients receiving intravenous (IV) vancomycin for osteoarticular infections at the Montreal General Hospital between December 2020 et December 2022. In the second part, we identified two longitudinal popPK models in the literature and assessed their predictive performance in this population. Although these models offer an interesting approach to integrate a longitudinal component in their structure, they were ultimately not applicable to our population. Further efforts to address the time related changes of vancomycin’s pharmacokinetics should take into account clinical factors such as the degree of systemic inflammation and consider alternative methods to integrate the duration of treatment and longitudinal components in the model structure.