INTRODUÇÃO: A instabilidade multiligamentar do joelho, normalmente, é provocada por um trauma que determina sua luxação, um evento pouco frequente, mas, que pode trazer sequelas devastadoras. Mesmo com o tratamento cirúrgico preconizado é alto o índice de complicações. A mobilização precoce no pósoperatório provoca afrouxamento dos ligamentos reconstruídos, o que leva à instabilidade residual. A imobilização melhora a estabilidade, mas provoca dor e rigidez. Este trabalho tem o objetivo de avaliar se o uso do fixador externo articulado proporciona melhora na mobilidade, estabilidade e na função subjetiva de pacientes submetidos à reconstrução ligamentar. MÉTODOS: Neste ensaio clínico randomizado com grupos paralelos, 33 pacientes do ambulatório do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo com mais que 3 semanas de lesão dos ligamentos cruzados anterior e posterior associado à lesão de ligamento colateral fibular e/ ou ligamento colateral tibial foram submetidos à cirurgia de reconstrução multiligamentar, após alocação cega aleatória ao grupo 0 - controle (18 pacientes), com órtese rígida ou ao grupo 1 - fixador externo articulado por 6 semanas (15 pacientes), no período entre novembro de 2010 e novembro de 2013. Após seguimento mínimo de um ano de pós-operatório, a estabilidade dos ligamentos reconstruídos foi avaliada ao exame físico, foram mensurados os déficits de extensão e de flexão residual em relação ao joelho contralateral não acometido e foi aplicado o questionário específico para sintomas do joelho de Lysholm. RESULTADOS: Não houve diferença na avaliação da estabilidade articular nem na extensão entre os grupos. No grupo 1, o déficit de flexão passiva foi menor (4,8º +- 5,4º contra 18,2 +- 14,8º, p < 0,05) com mais pacientes, obtendo déficit de flexão considerado normal, de até 5º (64% contra 18%, p < 0,05) e com classificação excelente ou boa no questionário de Lysholm (73% contra 35%, p < 0,05). CONCLUSÕES: Comparado ao protocolo de reabilitação com órtese rígida removível, o uso do fixador externo articulado no tratamento cirúrgico das lesões multiligamentares do joelho proporciona os mesmos resultados de estabilidade ligamentar, aumenta a amplitude de movimento final, com manutenção da extensão e redução do déficit de flexão e proporciona melhores resultados funcionais / INTRODUCTION: Multiligament knee instability is normally caused by a trauma which results in its dislocation, an infrequent event, but one which can have devastating aftereffects. Even with the recommended surgical treatment the rate of complications is high. Early post-operative mobilization provokes loosening of the reconstructed ligaments, which leads to residual instability. Immobilization improves the stability, but causes pain and stiffness. This study aims to assess whether the use of an articulated external fixator provides improvements in the mobility, stability and the subjective function of the patients submitted to ligament reconstruction. METHODS: In this randomized clinical trial with parallel groups, 33 patients of the outpatient clinic of the Institute of Orthopaedics and Traumatology of the Hospital das Clínicas of the University of Sao Paulo with more than 3 weeks of injury to the anterior cruciate ligaments and the posterior cruciate ligaments associated with injury to the fibular collateral ligament and/or medial collateral ligament, were submitted to multiligament reconstruction surgery, after blind random allocation to either: Group 0 - control (18 patients), with rigid bracing, or to Group 1 - articulated external fixator for 6 weeks (15 patients), in the period from November, 2010 to November 2013. The stability of the reconstructed ligaments were assessed after 1 year postoperatively by physical examination, the deficit of residual extension and flexion was measured in relation to the unaffected contralateral knee and the Lysholm knee scoring scale questionnaire was applied. RESULTS: There was no difference in the assessment of joint stability or of the extension between the groups. In group 1 the passive flexion deficit was less (4.8º +- 5.4º versus 18.2 +- 14.8º, p<0.05) with more patients obtaining a flexion deficit considered normal, or up to 5º (64% versus 18%, p<0.05) and with excellent or good classification in the Lysholm knee scoring scale questionnaire (73% versus 35%, p<0.05). CONCLUSIONS: Compared to the rehabilitation protocol with removable rigid bracing, the use of an articulated external fixator in the treatment of multiligament knee injuries provides equal results for ligament stability, increases the amplitude of the Range of Motion, maintains the extension and reduces the flexion deficit, and provides better functional result

Orientador: Darcy Flavio Nouer / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T00:08:27Z (GMT). No. of bitstreams: 1 Viotti_AdrianadeOliveira_M.pdf: 2563925 bytes, checksum: 4df9549d622411867272692474ab8ed9 (MD5) Previous issue date: 2004 / Resumo: As variações morfológicas e o tamanho mandibular contribuem para a maioria dos desvios oclusais, maloclusões, e displasias dos maxilares. O tratamento ortodôntico é um procedimento de gerenciamento de espaços, e o estudo do processo de crescimento da região retromolar é essencial ao diagnóstico e planejamento do tratamento ortodôntico, com a finalidade de ajustar os dentes às dimensões ósseas de suporte. A avaliação do espaço disponível para se obter as posições dentárias corretas e conseguir a oclusão desejada é um dos passos do diagnóstico diferencial. Este trabalho apresenta uma metodologia para avaliar o ¿espaço útil ortodôntico¿ por meio do aumento dos incrementos de crescimento da região retromolar baseado somente em estruturas ósseas: área anterior, representada pela cortical vestibular do mento e na área posterior, a borda anterior do ramo ascendente mandibular. No presente estudo transversal foram mensuradas 240 lerradiografias da cabeça em norma lateral, distribuídas igualmente para os gêneros femininos e masculinos nas faixas etárias dos 7 aos 18 anos de idade. As análises dos dados estatísticos mostraram que o espaço retromolar teve um aumento de 0,9mm/ano no gênero feminino e 0,8mm/ano no gênero masculinono período estudado. Especificamente na avaliação das faixas etárias estudadas, os seguintes crescimentos foram observados: no gênero feminino de 7 a 10 anos: 5,2 mm, de 11 a 14 anos: 3,6mm e de 15 a 18 anos: 2,4mm. Já no gênero masculino, observou-se, de 7 a 10 anos: 3,6mm, de 11 a 14 anos: 2,8mm e dos 15 aos 18 anos: 3,2mm. Na correlação da medida equivalente à base mandibular (B ¿ X) e parte da altura do ramo (Y ¿ Z) constatou-se uma equivalência no crescimento dos segmentos. No tocante a metodologia proposta e a preconizada por Merrifield observou-se na correlação de Pearson um índice de 0,726 / Abstract: The morphologic variations and the mandible size contribute for most deviations occlusions, malocclusion and diseases of the maxillaries. The orthodontic treatment is a spaces management procedure, and the growth process study of the region retromolar is essential to the diagnosis and planning of the orthodontic treatment, with the purpose of adjusting the teeth to the bony dimensions of support. The evaluations of the available space to if obtain the dental positions and to get the wished occlusion is one of the diagnosis differential. This study show us a methodology of the evaluated the ¿utile orthodontic area ¿based in the growing increments of the retromolar region based only in bone structure: anterior area, the vestibular sinfisys cortical, and in the posterior area the anterior board of the mandible branch. In this study was measured 240 cephalometrics radiographies divided for the female and male sex in the age zones from 7 to 18 years. The results show us that the retromolar space had an increase of 0,9 mm/year in the female sex and 0,8 mm/year in male sex in the study period. Specifically in the evaluation of age zones was study, we observed the following growing increments in female sex 7 to 10 years: 5,2 mm/year, 11 to 14 year: 3,6 mm/year, 15 to 18 year: 2,4 mm/year. In the male sex observed in 7 to 10 year: 3,6 mm/year, 11 to 14 year: 2,8 mm/year and 15 to 18 year: 3,2 mm/year. In the correlation equivalent of mandible base (B ¿ X) and part of the mandible branch¿s high (Y ¿ Z), observed a growing synchrony of the segments. In the propose methodology and in Merrifield¿s propose observed the Pearson correlation an indices of 0,726 / Mestrado / Ortodontia / Mestre em Ortodontia

Two corneal dystrophies, posterior polymorphous corneal dystrophy (PPCD) and keratoconus, have been associated with missense mutations found in the transcription factor-encoding gene Visual System Homeobox 1 (VSX1). Despite this association, the pathogenic link between VSX1 and these diseases remains controversial. To address this issue, I utilized a variety of in vitro approaches to study how seven VSX1 missense mutations found in disease populations that span two highly conserved domains, the homeodomain (HD) and CVC domain affect VSX1 transcriptional activity, protein expression levels and subcellular localization. I also carried out an in vivo investigation by generating a mouse line carrying a mutation in Vsx1: P254R. Corneal morphology was examined through histology and ex vivo whole eye confocal imaging which was used to assess corneal thickness. Quantification of immunocytochemistry was used to characterize terminal marker expression in the inner retina compared to previously described phenotypes in Vsx1-null mice. My in vitro results showed that mutations found in both the HD and CVC domain alter the normal transcriptional repression activity in Vsx1. These changes were not due to changes to protein expression or subcellular localization. Characterization of corneal and retinal phenotypes in vivo revealed no significant differences in Vsx1 P254R mice when compared to wild-type and Vsx1-null controls. In conclusion, my work shows that Vsx1 P254R is not pathogenic for corneal dystrophies in a mouse model. However, my in vitro studies show that Vsx1 mutations have the ability to alter transcriptional activity and therefore still have the potential to be pathogenic in humans. Further investigation is needed to determine whether VSX1 mutations found in disease populations are, in fact, causative for corneal dystrophies. / Graduate / 2019-04-25

Inledning: Yrsel är ett av de symtom som uppstår vid stroke i cerebellum och hjärnstammen på grund av cirkulatorisk insufficiens i den posteriora cirkulationen. Vestibulär rehabilitering (VR) är den rehabiliteringsform som idag används på patienter med yrsel, oberoende av orsak till yrseln. VR fokuserar på att utsätta patienten för de moment som skapar yrsel för att starta en habituering i hjärnan. Vi upplever en klinisk kunskapslucka vid fysioterapeutiska interventioner för strokepatienter med yrsel vilket skapar svårighet att ge denna patientgrupp evidensbaserad rehabilitering. Syfte: Syftet med studien var att överblicka nuvarande fysioterapeutiska interventioner för behandling av yrsel orsakad av stroke i cerebellum och hjärnstammen. Metod: En systematisk litteraturstudie genomfördes i databaserna PubMed, Amed, Cinahl, Scopus, SweMed+ och PEDro. I studien inkluderades artiklar av randomize controlled trial (RCT) och artiklar av icke RCT design. Granskningsverktyget PEDro användes för att bedöma inkluderade artiklarnas kvalitet. Resultat: Totalt granskades fyra artiklar vilket resulterade i tre olika kategorier av interventioner och signifikanta resultat vid delar av de inkluderade utfallsmåtten. Konklusion: Artiklarna som inkluderades i studien visar på att VR ger minskade symtom av yrsel och förbättrad balans hos patienter med stroke i cerebellum och hjärnstammen.

La mosca minadora Liriomyza huidobrensis es una plaga agrícola de importancia mundial, ampliamente distribuida y representa la plaga más dañina en el cultivo de papa en el Perú. El control biológico, que incluye el uso de parasitoides, representa la mejor estrategia para el control de esta plaga. La utilización exitosa de los parasitoides dependerá de nuestro conocimiento de dichos factores, incluyendo las interacciones tritróficas entre plantas hospederas, insectos y parasitoides. Nuestro estudio se realizó sobre el parasitoide Chrysocharis flacilla con el objetivo de evaluar el efecto de las interacciones tróficas en determinados parámetros biológicos como longevidad, supervivencia, producción de progenie, proporción sexual y longitud de la tibia posterior. Se desarrollaron tres sistemas de procedencia del parasitoide: Papa - L. huidobrensis, Haba - L. huidobrensis y Maíz -L. graminivora, cuyos adultos interactuaron con tres asociaciones de prueba idénticas a los sistemas de procedencia mencionados. Todas las evaluaciones se realizaron mediante pruebas Elección y No Elección. C. flacilla presentó una variación intraespecifica en todos los parámetros evaluados. Se encontraron diferencias significativas en su longevidad, supervivencia, proporción sexual y longitud de la tibia posterior luego de interactuar con las distintas asociaciones planta – minador de prueba; asimismo, en su producción de progenie entre las tres procedencias estudiadas. Se menciona la implicancia que puede tener la planta hospedera, así como, el minador hospedero sobre dicha variación en C. flacilla. Finalmente, el parasitoide no presenta preferencia por alguno de sus sistemas de procedencia y las asociaciones tróficas Haba - L. huidobrensis y Maíz -L. graminivora pueden funcionar adecuadamente como hospederos alternos del parasitoide. / ---The leaf miner Liriomyza huidobrensis is an agricultural pest of global importance, widely distributed, representing the most damaging pest in Peru for potato crop. Biological control, including the use of parasitoids, represents the best strategy for controlling this pest. The successful uses of parasitoids will depend on our knowledge of many factors, including tritrophic interactions between host plants, insects and parasitoids. Our study was performed on parasitoid Chrysocharis flacilla in order to assess the effect of trophic interactions in biological parameters such as longevity, survival, production of progeny, sex ratio and posterior tibia length. Three parasitoid origin systems were developed: Potato - L. huidobrensis, Faba bean - L. huidobrensis and Maize -L. graminivora, whose adults interacted with three associations identical to origin systems mentioned. Assessments were made in both No Choice and Choice Tests. We found that C. flacilla has an intraspecific variation in all biological parameters assessed. We found significant differences on longevity, survival, sex ratio and posterior tibia length after interactions with the three different crop – leaf miner associations assessed; moreover, offspring production showed significant differences among the three origin systems studied. We discuss host plant and host leaf miner implications on such intraspecific variation in parasitoid. Finally, C. flacilla does not have any preference for its origin systems; and the trophic associations Faba bean - L. huidobrensis and Maize -L. graminivora can function adequately as alternate hosts of the parasitoid. Keywords: longevity, survival, sex ratio, posterior tibia length, offspring, No choice test, Choice test, plant-leafminer-parasitoid association. / Tesis

Ultrastructural observations reveal that the spermatozoids of the hornworts Notothylas and Phaeoceros contain two mitochondria and not one as described previously. Mitochondrial ontogeny and nuclear metamorphosis during spermiogenesis in these plants differ from all other archegoniates. The discovery that the posterior region of the coiled nucleus (when viewed from the anterior aspect) lies to the left of the anterior, in striking contrast to the dextral coiling of the nucleus of spermatozoids of other embryophytes, underlines the isolated nature of the hornworts among land plants. As the blepharoplast develops, the numerous ovoid mitochondria initially present in the nascent spermatid fuse to form a single elongated organelle which is positioned subjacent to the MLS and extends down between the nucleus and plastid. At the onset of nuclear metamorphosis, the solitary mitochondrion has separated into a larger anterior mitochondrion (AM) associated with the MLS and a much smaller posterior mitochondrion (PM) adjacent to the plastid. The PM retains its association with the plastid and both organelles migrate around the periphery of the cell as the spline MTs elongate. By contrast, in moss spermatids, where mitochondria undergo similar fusion and division, the AM is approximately the same size as the PM and the latter is never associated with the spline. As in other archegoniates, except mosses, spline elongation precedes nuclear metamorphosis in hornworts. Irregular strands of condensed chromatin compact basipetally to produce an elongated cylindrical nucleus which is narrower in its mid-region. During this process excess nucleoplasm moves rearward. It eventually overarches the inner surface of the plastid and entirely covers the PM.

Posterior reversible encephalopathy syndrome (PRES) is associated with seizures, visual disturbances, headache, and altered mental status. Given its presentation, the diagnosis can be mistaken for other severe conditions. Palliative medicine consultants should be aware of PRES and be prepared to counsel families on the treatment and prognosis of this syndrome.

Ankle foot orthosis (AFO) stiffness affects ankle range of motion but can also provide energy storage and return to improve mobility. To perform multiple activities during the day, a person may want to change their AFO stiffness to meet their activity’s demand. Carrying multiple AFO and changing the AFO is inconvenient and could discourage users from engaging in multiple activities. This thesis developed a new quick-release mechanism (QRM) that allows users to easily change posterior strut elements to change AFO stiffness. The QRM attaches to the AFO and requires no tools to operate. The new QRM includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. A prototype was modelled with SolidWorks and simulated with SolidWorks Simulation. The QRM was designed to have no mechanical failure during intense activities such as downhill walking and running. Unlike a solid screw connection, the QRM needed an additional part to eliminate unsecured motion related to clearance between the quick release key and receptacle anchor. Mechanical test results and measurement data demonstrated no deformation on each part after mechanical testing. User testing revealed that, although the quick release mechanism can be locked or unlocked rapidly, the person’s posture when operating can facilitate strut swapping. A learning effect occurred by repeated practice. The Quick Release AFO (QRAFO) prototype verified the manufacturing feasibility of the QRAFO design. Overall, the novel quick release AFO improved strut swapping time without sacrificing device strength.

Vitreomacular traction (VMT) is a condition characterized by an incomplete posterior vitreous detachment resulting in traction on the macula and decreased visual acuity. The process of vitreomacular traction can lead to a number of maculopathies including cystoid macular edema, epiretinal membranes, and macular holes. VMT is more common in patients over 40 years of age; however no population-based studies documenting the prevalence of VMT in this age group has been published. Purpose: The current study was undertaken to evaluate the prevalence of vitreomacular traction syndrome in the population aged above 40. Clinical examination does not adequately illustrate the extent of vitreomacular adhesion; therefore, Optical Coherence Tomography (OCT) was used to determine the presence of VMT. High-definition OCT has provided new insight into vitreomacular traction syndrome by allowing for better visualization of the tractional forces at the vitreoretinal interface. This investigation will analyze the vitreomacular interface with regard to VMT in correlation to age through use of the Spectral Domain OCT. Methods: One hundred and thirty-one eyes of 67 patients (36 females/31 males) were examined by optical coherence tomography (OCT). OCT was performed to obtain high-resolution cross-sectional images of the vitreoretinal interface in the posterior fundus. Results: The status of the posterior vitreoretinal interface was evaluated as follows; (1) Intact Vitreous- No posterior vitreous abnormality is depicted on OCT. (2) Vitreomacular adhesion/incomplete PVD- the posterior vitreous is partially attached and can be seen in contact with the macula on OCT. (3) Vitreomacular traction- the posterior vitreous is partially adhered to the inner retina resulting in distortion of the retinal architecture. (4) Complete posterior vitreous detachment, indicating no contact between the vitreous and retina. Conclusion: OCT results found no vitreous abnormality in 39.7% of all eyes; PVD in 6.87% of eyes, VMA in 51.1% of eyes, and VMT in 2.29% of eyes. Age was a significant risk factor to the development of VMT, while gender was not. As age increases, the probability of having VMT increases by 1.2%. Due to the association between vitreomacular traction and a variety of maculopathies, recognition and diagnosis of this entity is crucial. High definition OCT has allowed for outstanding visualization of the vitreomacular interface, which has allowed for a better understanding of this entity.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12888号 / 論医博第2088号 / 新制||医||1007(附属図書館) / 31642 / (主査)教授 小泉 昭夫, 教授 平家 俊男, 教授 福山 秀直 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM