Submitted by DANILO PAZIAN PAULO (danilo.ifsp.bgi@gmail.com) on 2017-07-10T16:09:54Z No. of bitstreams: 1 Versão Final V1.pdf: 6668672 bytes, checksum: d517c07a2f6f08350724000e0f4d4b64 (MD5) / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-07-13T20:30:48Z (GMT) No. of bitstreams: 1 paulo_dp_me_ilha.pdf: 6668672 bytes, checksum: d517c07a2f6f08350724000e0f4d4b64 (MD5) / Made available in DSpace on 2017-07-13T20:30:48Z (GMT). No. of bitstreams: 1 paulo_dp_me_ilha.pdf: 6668672 bytes, checksum: d517c07a2f6f08350724000e0f4d4b64 (MD5) Previous issue date: 2017-05-12 / Dinamômetros biomédicos são equipamentos utilizados para medir forças exercidas pelas mãos. Com o uso deste tipo de equipamento, é possível realizar avaliações biomecânicas das mãos de pacientes que após cirurgias, acidentes ou patologias osteomioarticulares, tiveram redução na sua capacidade de exercer forças com as mãos. O objetivo deste trabalho foi a implementação de um dinamômetro biomédico ergonômico, de fácil utilização, com capacidade de comunicação com diferentes tipos de dispositivos móveis, como smartphones e tablets. O projeto realizado se constitui no aprimoramento de duas versões anteriores de dinamômetros implementadas no Laboratório de Instrumentação Eletrônica e Engenharia Biomédica da UNESP –Campus de Ilha Solteira. Testes em voluntários utilizando o dinamômetro desenvolvido e um dinamômetro comercial da marca SAEHAN, e posterior análise estatística dos dados revelam uma excelente confiabilidade intra-examinador para o dinamômetro desenvolvido, com coeficiente de correlação intraclasse médio de 0,95 entre os diferentes grupos analisados, e de 0,98 para o dinamômetro SAEHAN. A análise estatística revela também uma excelente confiabilidade concorrente para as medidas realizadas pelo dinamômetro desenvolvido em relação às do dinamômetro SAEHAN, sendo de 0,93 para mãos dominantes e 0,92 para mãos não dominantes. Assim, o dinamômetro desenvolvido é confiável, válido e comparável com o dinamômetro SAEHAN quando adotados os mesmos procedimentos de exame de preensão palmar. / Biomedical dynamometers are equipment used to measure forces exerted by the hands. Using this type of equipment, it is possible to perform biomechanical evaluations of the hands of patients that after surgery, accidents or diseases have had a reduction in the ability to exert force with their hands. The objective of this work was the implementation of an ergonomic biomedical dynamometer, easy to use, with ability to communicate with different types of mobile devices such as smartphones and tablets. The project carried out constitutes the improvement of two previous dynamometers versions implemented in the Electronic Instrumentation and Biomedical Engineering Laboratory at UNESP - Ilha Solteira. Volunteer tests using the developed dynamometer and a commercial SAEHAN dynamometer, and subsequent statistical analysis of the data revealed an excellent intra-examiner reliability for the developed dynamometer, a mean of 0,95 among different groups analyzed, and a mean of 0,98 for the SAEHAN dynamometer. The statistical analysis also revealed an excellent concurrent reliability for the measurements performed by the dynamometer developed in relation to those of the SAEHAN dynamometer, being 0,93 for dominant hands and 0,92 for non-dominant hands. Thus, the developed dynamometer is reliable, valid and comparable with the SAEHAN dynamometer when the same grip strength examination procedures were adopted.

Na bacia do Arroio Chuí, localizada na região sul da Planície Costeira do Rio Grande do Sul no município de Santa Vitória do Palmar, geralmente nas margens constituídas de barrancas, são encontrados grande quantidade de fósseis de mamíferos integrantes da megafauna pleistocênica. Os estudos até então realizados tinham escopo basicamente na identificação taxonômica dos fósseis e os aspectos biológicos e ecológicos dessa fauna. No presente trabalho, foi elaborado um banco de dados contendo informações relativas às assembleias fossilíferas do Arroio Chuí, tafonomia e a distribuição espacial no sistema de coordenadas da superfície verdadeira terrestre, em um ambiente de Sistema de Informações Geográficas (SIG). A base de dados foi elaborada a partir do acervo analisado do museu Coronel Tancredo Fernandes de Mello, gerando tabelas de dados contendo informações sobre o material fossilifero, georreferenciando os sítios contendo fósseis e desenvolvendo análises estatísticas. A localização precisa das ocorrências de fósseis permitiu a observação de sua distribuição espacial, o que constituiu uma ferramenta na avaliação paleogeográfica da região e permitiu gerar subsídios que auxiliaram para colaborar na compreensão da evolução geológica da porção sul da planície costeira. / In the Chuí Creek basin, located in the southern Coastal Plain of Rio Grande do Sul state, in the Santa Vitoria do Palmar county, usually in the banks, great number of fossils of mammals of the Pleistocene megafauna is found. The studies developed so far focused on the taxonomic identification and biological and ecological aspects of this fauna. In the present work a database containing informations regarding the fossil assemblages of Chuí Creek, taphonomy and spatial distribution in the true Earth surface coordinate system, was elaborated in a Geograpgic Information System (SIG) environment. The database was elaborated from the collection of Coronel Tancredo Fernandes de Mello museum, producing data tables with informations regarding the fossil material, georeferencing the fossil sites and generating statistical analyses. The precise location of the fossils showed their spatial distribution, which turned out to be a tool for evaluate the regional paleogeography and aided to understand the geological evolution of the southern portion of the coastal plain.

Na bacia do Arroio Chuí, localizada na região sul da Planície Costeira do Rio Grande do Sul no município de Santa Vitória do Palmar, geralmente nas margens constituídas de barrancas, são encontrados grande quantidade de fósseis de mamíferos integrantes da megafauna pleistocênica. Os estudos até então realizados tinham escopo basicamente na identificação taxonômica dos fósseis e os aspectos biológicos e ecológicos dessa fauna. No presente trabalho, foi elaborado um banco de dados contendo informações relativas às assembleias fossilíferas do Arroio Chuí, tafonomia e a distribuição espacial no sistema de coordenadas da superfície verdadeira terrestre, em um ambiente de Sistema de Informações Geográficas (SIG). A base de dados foi elaborada a partir do acervo analisado do museu Coronel Tancredo Fernandes de Mello, gerando tabelas de dados contendo informações sobre o material fossilifero, georreferenciando os sítios contendo fósseis e desenvolvendo análises estatísticas. A localização precisa das ocorrências de fósseis permitiu a observação de sua distribuição espacial, o que constituiu uma ferramenta na avaliação paleogeográfica da região e permitiu gerar subsídios que auxiliaram para colaborar na compreensão da evolução geológica da porção sul da planície costeira. / In the Chuí Creek basin, located in the southern Coastal Plain of Rio Grande do Sul state, in the Santa Vitoria do Palmar county, usually in the banks, great number of fossils of mammals of the Pleistocene megafauna is found. The studies developed so far focused on the taxonomic identification and biological and ecological aspects of this fauna. In the present work a database containing informations regarding the fossil assemblages of Chuí Creek, taphonomy and spatial distribution in the true Earth surface coordinate system, was elaborated in a Geograpgic Information System (SIG) environment. The database was elaborated from the collection of Coronel Tancredo Fernandes de Mello museum, producing data tables with informations regarding the fossil material, georeferencing the fossil sites and generating statistical analyses. The precise location of the fossils showed their spatial distribution, which turned out to be a tool for evaluate the regional paleogeography and aided to understand the geological evolution of the southern portion of the coastal plain.

Na bacia do Arroio Chuí, localizada na região sul da Planície Costeira do Rio Grande do Sul no município de Santa Vitória do Palmar, geralmente nas margens constituídas de barrancas, são encontrados grande quantidade de fósseis de mamíferos integrantes da megafauna pleistocênica. Os estudos até então realizados tinham escopo basicamente na identificação taxonômica dos fósseis e os aspectos biológicos e ecológicos dessa fauna. No presente trabalho, foi elaborado um banco de dados contendo informações relativas às assembleias fossilíferas do Arroio Chuí, tafonomia e a distribuição espacial no sistema de coordenadas da superfície verdadeira terrestre, em um ambiente de Sistema de Informações Geográficas (SIG). A base de dados foi elaborada a partir do acervo analisado do museu Coronel Tancredo Fernandes de Mello, gerando tabelas de dados contendo informações sobre o material fossilifero, georreferenciando os sítios contendo fósseis e desenvolvendo análises estatísticas. A localização precisa das ocorrências de fósseis permitiu a observação de sua distribuição espacial, o que constituiu uma ferramenta na avaliação paleogeográfica da região e permitiu gerar subsídios que auxiliaram para colaborar na compreensão da evolução geológica da porção sul da planície costeira. / In the Chuí Creek basin, located in the southern Coastal Plain of Rio Grande do Sul state, in the Santa Vitoria do Palmar county, usually in the banks, great number of fossils of mammals of the Pleistocene megafauna is found. The studies developed so far focused on the taxonomic identification and biological and ecological aspects of this fauna. In the present work a database containing informations regarding the fossil assemblages of Chuí Creek, taphonomy and spatial distribution in the true Earth surface coordinate system, was elaborated in a Geograpgic Information System (SIG) environment. The database was elaborated from the collection of Coronel Tancredo Fernandes de Mello museum, producing data tables with informations regarding the fossil material, georeferencing the fossil sites and generating statistical analyses. The precise location of the fossils showed their spatial distribution, which turned out to be a tool for evaluate the regional paleogeography and aided to understand the geological evolution of the southern portion of the coastal plain.

(thesis): Palmar-plantar erythrodysesthesia (PPE) frequently accompanies the therapy with a continuous 5-FU infusion or peroral capecitabine (5-FU prodrug). In the most severe cases this adverse effect leads to discontinuation of a needful therapy. Local 10 % uridine ointment is used to prevent and treat the said adverse event. Nevertheless, this method is not generally accepted as an effective one because it has never been proved in a randomized controlled clinical trial. Most probably, a direct effect of a cytostatic compound on the skin of hands and foots causes PPE. The toxicity of 5-FU is mediated primarily by its incorporation into RNA and by thymidylate synthase (TS) inhibition and subsequent DNA synthesis disruption. The importance of particular 5-FU toxicity mechanisms varies in different cell types. For choosing the best PPE local antidote it is necessary to find out which molecular mechanism applies in keratinocytes. We have chosen pyrimidine nucleosides as the most suitable compounds for the local PPE therapy because the uridine ointment is already being used in several oncology centers in the Central Europe. In order to find out the 5-FU toxicity mechanism, we further tested the effect of calciumfolinate (CF) which strengthens the TS inhibition by 5-FU. We studied also uracil and...

INTRODUÇÃO: As distrofias musculares de cinturas (DMC) representam um grupo heterogêneo de desordens hereditárias e degenerativas da musculatura esquelética, com evolução progressiva, caracterizadas pelo acometimento predominante das cinturas escapular e/ou pélvica. São classificadas de acordo com o padrão de herança e o gene envolvido, podendo ser autossômicas dominantes ou autossômicas recessivas. No presente estudo, foi feita a análise de pacientes com diagnóstico de distrofia muscular de cinturas 2B (DMC2B). Trata-se de condição autossômica recessiva, cujo gene envolvido na sua fisiopatologia é o DYSF; sua mutação pode associar-se a alterações na proteína disferlina. OBJETIVOS: Avaliar a distribuição da fraqueza muscular na distrofia muscular de cinturas 2B com ênfase no acometimento dos membros superiores; realizar avaliação objetiva da força muscular para preensão palmar e pinças; correlacionar a força muscular dos diferentes movimentos com a idade de início dos sintomas, idade na ocasião da avaliação, tempo de evolução da doença e capacidade funcional. METODOLOGIA: Estudo prospectivo, observacional, corte transversal, caso-controle. Foi feita avaliação clínica da força muscular de membros superiores e superiores dos pacientes, através de instrumentos clínicos específicos e dinamômetro de pinça e de preensão palmar; adicionalmente, foram aplicadas escalas de capacidade funcional (Escala de Vignos e Escala de Brooke). RESULTADOS: Foram avaliados 12 pacientes com diagnóstico molecular confirmado de DMC2B e recrutados 41 pacientes para o grupo controle. Os grupos não diferiram por gênero nem nas médias etárias. A média da idade de início dos sintomas dos pacientes foi de 26,9 anos (DP 10,05); a idade média na ocasião da avaliação foi de 43,6 anos (DP 9,34). A avaliação clínica da força muscular evidenciou maior acometimento de membros inferiores em relação aos membros superiores. A dinamometria de pinça (bidigital e trigidital) e de preensão palmar evidenciou diferença significativa entre os pacientes e o grupo controle para todos os movimentos citados. Os valores de CK apresentaram média de 2769 U/L (cerca de quinze vezes o limite superior de normalidade). As escalas de avaliação de capacidade funcional evidenciaram uma correlação significativa entre a idade do paciente na ocasião da avaliação e o escore na escala de Brooke. CONCLUSÃO: A análise do padrão de fraqueza dos pacientes com DMC2B evidenciou acometimento de membros inferiores e também de membros superiores. A análise objetiva com dinamometria demonstrou acometimento em todos os movimentos avaliados, evidenciando o envolvimento distal de membros superiores. A análise da capacidade funcional de membros superiores apresentou correlação com idade na avaliação (quanto maior a idade do paciente, maior o grau de incapacidade para membros superiores). Os valores de CK e de força muscular correlacionaram-se com a idade do início dos sintomas e idade na avaliação, ou seja, o início mais precoce da doença correlacionou-se com quadros mais graves (maiores valores de CK e maior envolvimento de força muscular - principalmente distal de membros superiores) / INTRODUCTION: Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of hereditary and degenerative disorders of the skeletal muscle, with progressive evolution, characterized by the predominant involvement of the scapular and / or pelvic girdles. They are classified according to the inheritance pattern and the involved gene, being autosomal dominant or autosomal recessive. In the present study, we evaluated patients with a diagnosis of 2D (LGMD2B). The LGMD2B is an autosomal recessive condition whose gene involved in its pathophysiology is DYSF; its mutation may be associated with changes in protein dysferlin. OBJECTIVES: To assess the distribution of muscle weakness in 2D womb muscular dystrophy with emphasis on upper limb involvement; perform objective evaluation of muscle strength for palmar grip and forceps; to correlate the muscular strength of the different movements with the age of onset of symptoms, age at the time of evaluation, duration of disease and functional capacity. METHODS: Prospective, observational, cross-sectional, case-control study. Clinical evaluation of the muscular strength of the upper and upper limbs of the patients was made through specific clinical instruments and pinch dynamometer and palmar grip; In addition, functional capacity scales were applied (Vignos Scale and Brooke Scale). RESULTS: Twelve patients with confirmed molecular diagnosis of DMC2B were evaluated and 41 patients were recruited for the control group. The groups did not differ by gender nor in the age groups. The mean age of onset of the patients\' symptoms was 26.9 years (SD 10.05); the mean age at the time of the evaluation was 43.6 years (SD 9.34). The clinical evaluation of muscle strength showed a greater involvement of the lower limbs in relation to the upper limbs. Pinch dynamometry (bidigital and trigidital) and handgrip dynamometry showed a significant difference between the patients and the control group for all the mentioned movements. CK values presented a mean of 2769 U / L (about eight times the upper limit of normality); there was a significant negative correlation (p <0.01) between the age of the patient at the time of the evaluation and the maximum value of CK. The functional capacity evaluation scales showed a significant correlation between the age of the patient at the time of the evaluation and the score on the Brooke scale. The correlation values between the muscular strength between the different movements evaluated and the age of onset of symptoms, age at the time of evaluation and time of evaluation of the disease presented values of significance close to 0.05 for the upper limb distal muscles and age of onset and age at the time of evaluation. CONCLUSION: The analysis of the weakness pattern of patients with LGMD2B showed involvement of lower limbs as well as upper limbs. Objective analysis with dynamometry showed involvement in all the movements evaluated, showing the distal involvement in the upper limbs. The analysis of functional capacity of upper limbs showed correlation with age in the evaluation (the higher the patient\'s age, the greater the degree of incapacity for upper limbs). The values of CK and muscle strength correlated with the age of onset of symptoms and age at the assessment, ie the earlier onset of the disease was correlated with more severe conditions (higher CK values and greater involvement of muscle strength - mainly distal upper limbs)

As zonas costeiras estão em constante processo de pressão, tanto pela ação humana, que acaba rompendo o equilíbrio dominante, como pela ação da natureza, que está ligada principalmente a fatores geológicos, fatores climáticos e à dinâmica costeira. Neste trabalho buscou-se analisar a evolução do processo de ocupação urbana na faixa oceânica no município de Santa Vitória do Palmar, nos balneários do Hermenegildo e da Barra do Chuí, devido ao fato de esse local apresentar problemas em seu processo de urbanização, que se configuram pela falta de planejamento e de ordenamento territorial. Para essa análise, utilizou-se produtos de sensoriamento remoto em escala multitemporal, com perspectivas temporais em que se pode trabalhar e entender as rupturas de paradigmas em diferentes momentos históricos. Para isso, foram feitas análises em um levantamento aerofotogramétrico, adquirido pelo Exército Brasileiro, na Escala 1:75.000 do ano de 1964, análises em Imagens de Satélite Landsat TM7, do ano de 1996 e Imagens de Satélite QuickBird do ano de 2010. Portanto, esse trabalho propôs uma análise em escala multitemporal no processo de urbanização dos balneários do Hermenegildo e da Barra do Chuí, para um melhor entendimento do porquê dos problemas com as construções residenciais na faixa frontal ao Oceano Atlântico, que tem levando muitos moradores a perda total de suas residências. Verificou-se que a evolução dos percentuais de ocupação urbana nos balneários do Hermenegildo e da Barra do Chuí foi bastante significativa, sendo o que os dois balneários apresentaram crescimento mais elevado nas três primeiras décadas analisadas e ainda concluiu-se que no último intervalo da análise os índices de crescimento urbano foram menores para os dois balneários, recomendando-se maiores estudos e monitoramento dos vetores de crescimento urbano para ambos os balneários, com maior atenção para o balneário do Hermenegildo, devido ao grave problema de erosão costeira. / Coastal zones are constantly affected by the pressure process, caused by the human action, which ends up breaking the dominant balance, as well as by the action of the nature, which is mainly related to geologic and climatic factors and to the coastal dynamic. This study aims to analyze the urban occupation evolution process along Santa Vitória do Palmar coastline, especially Balneário do Hermenegildo and Balneário da Barra do Chuí, considering the fact that this specific territory presents lots of problems concerning its urbanization process. For this analysis, images captured by remote sensing were used in a multitemporal scale, trough time perspectives that enable this study to develop and understand the paradigmatic ruptures in different historical periods. In order to do so, different types of images were analyzed, such as the aerial photogrammetric survey, taken by the Brazilian Army, in the 1:75.000 scale of 1964, TM7 Landsat Satellite Images, taken in 1996, and QuickBird Satellite Images, taken in 2010. Therefore, this study promoted an analysis in a multitemporal scale of the urbanization process regarding the territory already mentioned, in order to discover the causes of the problems involving residential constructions located on the frontal area of the Atlantic Ocean, which might be the reason why the residents are totally losing their residences. It was found that the development of the urban occupation percentage in Balneário do Hermenegildo and Balneário da Barra do Chuí was very significant, based upon the fact that both beaches present a notorious increase on the first three analyzed decades and, beyond that, it was concluded that during the last interval of the analysis, the urban growth indices were lower for both, suggesting that this field demands more studies and monitoring of the urban growth vectors for both beaches, attaching particular attention to Balneário do Hermenegildo because of its severe coastal erosion problem.

Submitted by Cássio da Cruz Nogueira (cassionogueirakk@gmail.com) on 2017-10-02T19:13:11Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoGrauMelhora.pdf: 1059122 bytes, checksum: 208eebb112c8eea88f0b3a8aacb32061 (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-10-03T12:19:06Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoGrauMelhora.pdf: 1059122 bytes, checksum: 208eebb112c8eea88f0b3a8aacb32061 (MD5) / Made available in DSpace on 2017-10-03T12:19:06Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AvaliacaoGrauMelhora.pdf: 1059122 bytes, checksum: 208eebb112c8eea88f0b3a8aacb32061 (MD5) Previous issue date: 2011-11-08 / A hanseníase é uma doença que provoca grande impacto social pelas sequelas decorrentes do dano neural, gerando um contingente da população com deformidades e incapazes de realizar atividade da vida diária e laboral. Com o objetivo de avaliar o grau de melhora da força de preensão palmar (FPP), por meio do dínamômetro JAMAR®, em pacientes com neuríte hansênica sob uso de corticóide, realizou-se um estudo tipo série de casos, constituído de uma amostra obtida por conveniência de 20 pacientes portadores de neuríte hansênica aguda, atendidos e acompanhados no ambulatório do Núcleo de Medicina Tropical (NMT) da Universidade Federal do Pará, onde a primeira aferição foi realizada no dia do diagnóstico e início do tratamento para neuríte e a segunda aferição trinta dias após a primeira avaliação. A neurite ulnar foi predominante e valores da FPP na mão não dominante apresentaram a média de 20,25 ± 13,16 kgf. e 18,50 ± 11,70 kgf. na primeira e segunda aferição respectivamente. Nos pacientes hansênicos com neuríte, a FPP apresentou-se diminuída em relação aos valores médios da população (no sexo masculino obteve 79,86% e 86% dos valores de referência, na mão dominante e não dominante respectivamente. No sexo feminino os valores 53,49% e 65,05% na mão dominante e não dominante respectivamente). Com relação à reação hansênica, observou-se que a na reação hansênica tipo I obteve-se valores de força de 27,40 ± 9,57 kgf. na mão dominante e 32,40 ± 8,21 kgf. na mão não dominante na primeira aferição. Na segunda aferição registraram-se valores médios de 30,90 ± 12,90 kgf. na mão dominante e 34,00 ± 9,29 kgf. na mão não dominante. A reação hansênica tipo II apresentou-se com valores de força de preensão palmar menores, embora não significativos (p≥0,06). Os pacientes que apresentaram melhora do quadro neurítico, expresso pela regressão da dor apresentaram aumento significativo da força de preensão palmar na mão dominante (p<0,02) Desta forma conclui-se que a FPP pode colaborar no acompanhamento de pacientes com neuríte hansênica sob uso de corticóides, porém novos estudos devem ser realizados para obtenção de informações que auxilie seu uso. / Leprosy is a disease that causes important social consequences for resulting from nerve damage, leading a contingent of people with deformities and unable to perform activities of daily life and work. In order to assess the degree of improvement in hands force (FPP) using the JAMAR ® dynamometer in patients with leprous neuritis in the use of corticosteroids, there was designed a case series study, consisting of a sample obtained for convenience of 20 patients with acute leprous neuritis, treated as outpatients and the Center for Tropical Medicine (NMT), Federal University of Pará, where the first measurement was performed the day of diagnosis and early treatment for neuritis and the second measurement thirty days after the first evaluation. The ulnar neuritis was prevalent and the FPP values in non-dominant hand had an average of 20.25 ± 13.16 kgf. And 18.50 ± 11.70 kgf. in the first and second measurement respectively. In leprosy patients with neuritis, FPP was reduced compared to the average population (in males obtained 79.86% and 86% of the reference values, the dominant and nondominant hands respectively. In females the values 53.49% and 65.05% in the dominant and nondominant hand, respectively). With respect to leprosy reaction, it was observed that the type I leprosy reaction was obtained force values of 27.40 ± 9.57 kgf. in the dominant hand and 32.40 ± 8.21 kgf. in the non-dominant hand in the first measurement. In the second measurement were recorded average values of 30.90 ± 12.90 kgf. in the dominant hand and 34.00 ± 9.29 kgf. in the non-dominant hand. The type II leprosy reaction presented with values lower grip strength, although not significant (p ≥ 0.06). Patients who had an improvement in neuritic expressed by the regression of pain showed a significant increase in grip strength in dominant hand (p <0.02) Thus we conclude that the PPF can collaborate in the monitoring of patients with leprous neuritis in use of corticosteroids, but further studies should be conducted to obtain information to assist its use.

Abstract Distal radius fractures (DRFs) are the most commonly encountered fall-related fracture in clinical practice. Recognised as a typical fragility fractures, the ageing of the population may increase the occurrence of DRFs in the near future. The aims of this thesis were (I) to describe the epidemiology of DRFs in a cohort of adult patients in the city of Oulu during the year 2008 and to study changes in the incidence of DRFs during the last decades in Finland and other northern countries and the relationship between slippery conditions during the winter and the incidence of DRFs, (II) to compare the results of primary nonoperative treatment and early palmar plating of primarily dislocated DRFs in 80 patients &#8805; 50 years old in an randomised controlled study and (III) to investigate the rate and risk factors for plate-related complications after palmar plate fixation of 881 DRFs. The crude incidence rate of DRFs was 258/100 000 person-years in Oulu in 2008, and the age-specific incidence rate in the female population aged &#8805; 70 years was increased compared to previous studies in Finland and in Norway. A clear seasonal variation was observed in fall-related DRFs. The number of DRFs was 2.5 times higher on slippery winter days compared to non-winter days. Early palmar plating of DRFs showed favourable DASH (disabilities of the arm, shoulder and hand) scores at two years compared to primary nonoperative treatment. Delayed surgery in the primary nonoperative treatment group did not provide comparable DASH scores to early plating. The overall complication rate in the cohort of 881 plate-fixated DRFs was 15%. These could be regarded as plate-related in 7% of cases. Operations performed by low-volume surgeons and patient ages &#60; 40 years were independent predictors of plate-related complications. In conclusion, the incidence of DRFs has increased during the last decades in Finland in elderly females, and slippery winter conditions increase the risk of DRFs. Early palmar plating of DRFs produces more consistent results compared to primary nonoperative treatment in patients &#8805; 50 years old. The complication rate after palmar plating of DRFs is significantly influenced by surgeon experience and patient age. / Tiivistelmä Värttinäluun alaosan murtuma (rannemurtuma) on yleisin kaatumistapaturman aiheuttama luunmurtuma, jonka taustalla on monesti ikääntymisestä johtuva luun hauraus. Väestön edelleen ikääntyessä rannemurtumien ilmaantuvuus todennäköisesti lisääntyy. Tämän väitöskirjan tavoitteina oli (1) kuvata rannemurtumien epidemiologiaa ja ilmaantuvuuden muutosta Suomessa ja muissa Pohjoismaissa viimeisten vuosikymmenien aikana, sekä tutkia liukkaiden talvikelien yhteyttä rannemurtumien ilmaantuvuuteen. Lisäksi tavoitteena oli (2) verrata kahden eri hoitokäytännön — varhaisen levykiinnityksen ja ensisijaisen konservatiivisen hoidon — kliinisiä tuloksia ≥ 50-vuotiailla rannemurtumapotilailla. Lopuksi tavoitteena oli (3) selvittää rannemurtuman levytykseen liittyvien komplikaatioiden yleisyys sekä riskitekijät. Rannemurtumien ilmaantuvuus oli oululaisessa aikuisväestössä 258/100 000 henkilövuotta vuonna 2008. Ikä-spesifinen ilmaantuvuus lisääntyi aiempaan suomalaistutkimukseen verrattuna etenkin &#62; 70 vuotiailla naispotilailla ja sama suuntaus todettiin myös aiemmassa norjalaistutkimuksessa. Rannemurtumien ilmaantuvuudessa todettiin selkeä vuodenaikavaihtelu, ja liukkaalla talvikelillä rannemurtuman riski oli 2.5-kertainen verrattuna ei-talvikelin murtumariskiin. Varhaisella rannemurtuman levykiinnityksellä saavutettiin paremmat DASH (Disabilities of the Arm, Shoulder, and Hand) – pisteet kahden vuoden seurannassa verrattuna ensisijaiseen konservatiiviseen hoitoon. Murtuman asennon heikentyessä seurannassa ei myöhäisleikkauksella saavutettu kliinistä hyötyä ensisijaisessa konservatiivisen hoidon ryhmässä. Komplikaatioprosentti 881 levykiinnityksellä hoidetun rannemurtumapotilaan aineistossa oli 15 %. Levytyskomplikaatioita todettiin 7 %:lla potilaista. Itsenäisiä levytyskomplikaatioille altistavia riskitekijöitä olivat kirurgin vähäinen leikkauskokemus ja potilaan matala ikä (&#60; 40 vuotta). Yhteenvetona voidaan todeta, että rannemurtumien ilmaantuvuus on lisääntynyt Suomessa iäkkäillä naispotilailla viimeisten vuosikymmenten aikana ja liukkaudella on selkeä yhteys rannemurtumien ilmaantuvuuteen. Varhaisella leikkaushoidolla saavutetaan yhtenäisemmät hoitotulokset verrattuna ensisijaiseen konservatiiviseen hoitoon ≥ 50-vuotialla rannemurtumapotilailla. Kirurgin leikkauskokemus ja potilaan ikä ovat yhteydessä rannemurtuman levytyskomplikaatioiden riskiin.

Durch die Einführung der MRT-Untersuchung am stehenden sedierten Pferd ist deren Anzahl deutlich angestiegen. Hierbei stellen sich neue Fragen und Herausforderungen bezüglich der Einschätzung der Vielzahl an auftretenden Signalveränderungen. Es ergeben sich aber auch neue Möglichkeiten bezüglich der statistischen Auswertung von Befunden mit aussagekräftigen Fallzahlen. In dieser Studie sollte daher untersucht werden, wie Signalveränderungen statistisch verwendbar beschrieben und eingestuft werden können. Weiterhin sollte die Verteilung der Befunde insgesamt und bei der bilateralen Untersuchung der Vordergliedmaßen bestimmt werden. Mögliche Rückschlüsse auf deren klinische Bedeutung sollten gezogen werden. Hierzu wurden 120 bilaterale Niederfeld-MRT-Untersuchungen der Hufregion (240 Gliedmaßen) am stehenden Pferd durch zwei Tierärzte gesichtet und eine Befundbeschreibung mit einem Einstufungsschema (Grade 1-4) entsprechend dem vorgefundenen Spektrum an Signalveränderungen erstellt. Durch Anwendung und Zusammenfassung 66 wiederholte Diskussion der verschiedenen Kriterien im 1. Bewertungsdurchgang wurden die Beschreibungen und Grade auf Grundlage bestehender Literatur ausgearbeitet. In einem 2. Bewertungsdurchgang wurden die Strukturen eingestuft und die Ergebnisse statistisch ausgewertet. Hierbei wurden die generellen Häufigkeiten der Signalabweichungen erfasst und deren Zusammenhang zum Auftreten von unilateralen oder bilateralen Lahmheiten beachtet. Signalabweichungen am Strahlbein, der Tiefen Beugesehne und dem Hufgelenk standen deutlich im Vordergrund. Hierbei waren Strahlbeinveränderungen signifikant häufiger bei beidseitig lahmen Pferden zu finden, während Sehnenveränderungen deutlich häufiger bei einseitig lahmen Pferden vorgefunden wurden. Hufgelenkveränderungen wurden hingegen nicht signifikant vermehrt bei bilateralen oder unilateralen Lahmheiten festgestellt. Die Fesselbein-Strahlbein-Hufbeinbänder zeigten eine Häufung von Signalabweichungen bei lahmen Gliedmaßen, wobei diese vermehrt in Zusammenhang mit starken Veränderungen des Strahlbeins zu beobachten waren. Bei den übrigen Strukturen ließ sich kein statistisch aussagekräftiger Zusammenhang feststellen, da die Fallzahlen mit dem deutlichsten Befund an diesen Strukturen zu gering für eine Auswertung waren. Die entstandene Befundbeschreibung mit Einstufungsschema ermöglicht Vergleiche der MRT-Veränderungen z.B. mit klinischen Parametern. Signalabweichungen bestimmter Strukturen konnten statistisch eindeutig mit dem Auftreten und der Art der Lahmheit in Verbindung gebracht werden, während dies bei anderen Strukturen nicht möglich war. Hieraus ergeben sich Hinweise für die Einschätzung der Befunde und ihrer klinischen Relevanz. Insbesondere geringgradige Befunde sollten vorsichtig bewertet werden, da diese auch häufig bei nicht lahmen Gliedmaßen auftraten. Weitere statistische Vergleiche mit klinischen Parametern sind möglich und notwendig um das Krankheitsbild des „Equinen palmaren Fußsyndroms“ weiter zu untersuchen. / As a result of adopting MRI examinations for standing sedated horses their number has increased significantly. In this respect there are new questions and challenges being faced regarding estimating the huge number of occurring signal changes. New possibilities also arise regarding the statistical analysis of findings with convincing number of examined cases. In this study therefore it should be investigated how signal changes can be suitably described and classified statistically. Furthermore, the distribution of the findings as a whole and in the bilateral investigations of the forelimbs should be ascertained. Possible conclusions should be drawn regarding their clinical significance. Concerning this, 120 bilateral low-field-MRI examinations of the foot (240 limbs) on a standing horse were looked at by two veterinarians and a description of the analysis with a classification scheme (grades 1-4) corresponding to the existing spectrum of signal changes was compiled. By applying and repeatedly discussing the various Summary 68 criteria in the first evaluation round the descriptions and grades were worked out on the basis of existing literature. In a second evaluation round the structures were classified and the results statistically evaluated. In this regard the general frequency of signal deviations was recorded and its connection to the occurrence of unilateral or bilateral lameness was observed. Signal deviations at the navicular bone, deep digital flexor tendon and the coffin joint noticeably prevailed. In this respect changes to the navicular bone were found significantly more frequently in bilaterally lame horses while changes in tendons were found significantly more often in unilaterally lame horses. In contrast, changes in the coffin joint were not significantly more in bilateral or unilateral lameness. The collateral sesamoidean ligaments showed an accumulation of signal deviations at lame limbs, whereby this was observed more frequently in connection with pronounced changes of the navicular bone. In the remaining structures no statistically significant connection was found as the number of examined cases with the most significant results at these structures was too low for an evaluation. The related description of the findings with a classification scheme enables comparisons of MRI changes e.g. with clinical parameters. Signal deviations of certain structures were found to be clearly statistically associated with the occurrence and type of lameness, while this was not possible at other structures. This provides useful information for evaluating findings and their clinical relevance. Low-grade findings should be interpreted with caution since these also occurred frequently at non-lame limbs Further statistical comparisons with clinical parameters are possible and necessary in order to further examine the clinical picture of the equine palmar foot syndrome.