Durch eine optimierte Anwendungsbeobachtung (AWB) sollte die Dokumentation der therapeutischen Anwendung eines Phytopharmakons vervollständigt werden. Ausgewählt wurde ein wässriger Extrakt aus der südafrikanischen Teufelskralle im Anwendungsgebiet der Therapie degenerativer Erkrankungen des Bewegungsapparates (Gon- und Coxarthrose). Wie eine Darstellung der Klinik zeigte, lag bis dahin keine Studie für diese Anwendung des Extraktes vor. Die Therapie erfolgte über 12 Wochen, die Wirksamkeit wurde bewertet primär mit dem Western-Ontario-McMaster-Universities-Osteoarthritis-Index (WOMAC) und der VAS-Schmerzskala. Die Ergebnisse dieser AWB belegen erstmalig die Wirksamkeit bei degenerativen rheumatischen Erkrankungen. Mit einer Verbesserung des WOMAC-Scores um 22,9 % im gesamten Kollektiv und um 24,1 % bei Patienten mit stärkeren Beschwerden dürfen die Ergebnisse als klinisch relevant erachtet werden. Besonders stark war die Wirkung im Subscore zur Steifigkeit (Verbesserung um mehr als 30 % im stärker betroffenen Kollektiv und in der Gesamtgruppe um 22,2 %). Durch den verwendeten Erfassungsparameter Arhuser Rückenschmerzindex war ein Vergleich mit den Ergebnissen früherer Studien mit dem gleichen Extrakt möglich. Die Verbesserung in annähernd vergleichbarer Größenordnung zeigte, dass die Ergebnisse der AWB valide sind. Für den WOMAC-Gesamtscore wurden in Studien mit nicht-steroidalen Antirheumatika Verbesserungen um 25 - 40 % berichtet; der Subscore zur Steifigkeit verbesserte sich um 20 - 50 % in den Verum- und bis zu 20 % in den Placebo-Gruppen. Die Wirkstärke der Teufelskralle ist im Vergleich zu den Wirkstärken synthetischer Arzneistoffe daher beachtlich. Die Teufelskralle kann als alleinige medikamentöse Maßnahme eingesetzt werden. Mittels einer verbesserten Qualität in Planung, Durchführung und Auswertung sowie Berichterstattung von Anwendungsbeobachtung kann ein wichtiger Beitrag für den therapeutischen Stellenwert von Phytopharmaka geleistet werden.

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This thesis examined the sensitivity of the EQ-5D-5L instrument in measuring health-related quality of life (HRQoL) among patients with persistent symptoms following COVID-19, including fatigue, memory and concentration problems, and dyspnea. Additionally, it was analyzed whether adding these symptoms to the EQ-5D-5L improved the explained variance for HRQoL. Patients from Uppsala University Hospital, Sweden, answered a survey that included questions on five dimensions of health represented by the EQ-5D-5L and an additional question on general health score called EQ-VAS. Multiple linear regression, Spearman’s rank correlation coefficient, and Least Absolute Shrinkage and Selection Operator (LASSO) were used to examine the sensitivity of the EQ-5D-5L. For the explanatory analysis, the Adjusted 𝑅2 was used to evaluate explanatory power with and without the presence of the symptoms. The results showed that the EQ-5D-5L dimensions explained a moderate proportion of the variance for fatigue and memory/concentration problems and a weak proportion for dyspnea. The explanatory analysis provided findings that fatigue significantly improved the explained variance of EQ-VAS by 5.5%, adding memory/concentration problems only improved it marginally, and adding dyspnea was non-significant. Additionally, strong to moderate correlations between fatigue and memory/concentration problems were found with multiple dimensions of the EQ-5D-5L. These findings suggest that the EQ-5D-5L instrument may be a valuable tool in assessing HRQoL in patients with persistent COVID-19 symptoms and that adding fatigue to the EQ-5D-5L could be beneficial for improving explanatory power to HRQoL in patients suffering from infectious disease. / COMBAT post-covid

Master of Science / Department of Anatomy and Physiology / Bruce D. Schultz / Epithelial cells lining the vas deferens modify the luminal contents to which sperm are exposed in response to neuroendocrine, autocrine and lumicrine transmitters. The role and identity of vas deferens epithelial potassium channels that provide the correct luminal environment for sperm maturation and delivery have not yet been determined. Cultures of vas deferens epithelial cells isolated from adult pigs were employed to investigate contributions of selected ion channels to net flux. A two-pore potassium channel, TASK-2, was identified on the apical membrane of cultured primary porcine vas deferens epithelial cells (1°PVD). Bupivacaine, a known TASK-2 inhibitor, when added to the apical bathing solution, inhibited forskolin- stimulated short circuit current, Isc, in a concentration dependent manner with a maximum inhibition of 72 ± 6% and an IC50 of 7.4 ± 2.2 µM. Apical exposure of 1°PVD cells to quinidine, lidocaine, and clofilium (other known TASK-2 blockers) inhibited forskolin-stimulated Isc in a concentration dependent manner. Fitting a modified Michalis-Menten function to the data revealed IC50 values of 274 µM, 531 µM, and 925 µM, respectively. Riluzole, a two-pore potassium channel activator, stimulated bupivacaine-sensitive Isc, further confirming the contribution of TASK-2 to net ion flux. Western blotting demonstrated the presence of TASK-2 immunoreactivity in 1°PVD cell lysates, while immunocytochemistry demonstrated apical localization of the targeted epitope in virtually all cells lining native porcine vas deferens. These results suggest that TASK-2 likely plays a role in vas deferens epithelial ion transport that may account for the reportedly high concentration of potassium in the male reproductive duct lumen. TASK-2 likely contributes to male fertility as an integral member of the regulated transport processes that account for the luminal environment to which sperm are exposed.

Name: The Effect of Facilitating Kinesio Taping of lower scapula fixators on pain threshold of trigger points in the m. trapezius pars descendens Objectives: This study is a pilot study. The goal of this study is to determine effects of Facilitating Kinesio Taping of lower scapula fixators on painfulness of trigger points in the m. trapezius pars descendens. Methods: The study took place in a private medical office with thirteen patients. All of these patients were physically examined using standard tests of physiotherapy. Patients were measured using a pressure algometer to assess trigger points as painful. They reported the intensity of pain on VAS. The places of measurement were trigger points one and two in the muscle according Travell and Simons. Data were analyzed using the statistical program SPSS 15.0 and Microsoft Office Excel. Results: This study had three hypotheses. In the case of the first hypothesis, I concluded that KT has an effect on the pain threshold and its application will reduce the pain threshold in m.trapezius pars descendens. Statistical significance was the value of p = 0.03 and p = 0.011, the value of material significance (101.31 kPa and 106.7 kPa) confirmed my theory that after KT will increase the pressure of 100 kPa in the TrP1 and TrP2. In the second hypothesis, it...

Le Syndrome d’Apnée Obstructive du Sommeil affecte 4 à 6 % de la population en France soit près de 3 millions de personnes. Toutefois, les techniques de diagnostic usuelles ne permettent pas de déterminer de façon précise les sites d’occlusion ni de décrire les interactions fluide-paroi qui jouent un rôle important dans les processus de fermeture des voies aériennes supérieures. Au cours de ce travail, un ensemble d’outil a été mis en œuvre pour explorer les mécanismes sous-jacents conduisant à une apnée obstructive. La détermination géométrique et la caractérisation mécanique des voies aériennes supérieures, d’une part, la mesure des écoulements dans ces dernières, d’autre part, ont été réalisées par imagerie par résonance magnétique de l’hydrogène, pour les tissus, de l’hélium-3 et du fluor-19 pour les gaz. Les données obtenues ont été exploitées tout d’abord dans un modèle numérique statique pour estimer les lois d’état locales et caractériser la compliance des voies aériennes supérieures, puis, dans un modèle monodimensionnel, prenant en compte l’interaction fluide-structure et la limitation de débit au cours de l’inspiration, pour localiser les sites potentiellement responsables d’un éventuel collapsus. Par ailleurs, les écoulements de gaz d’hélium-3 et d’hexafluorure de soufre ont été simulés afin de déterminer le potentiel de ces deux modalités d’imagerie de gaz pour l’étude des obstructions des voies aériennes. La faisabilité d’une imagerie statique et dynamique par résonance magnétique du fluor a été démontrée. Avec une densité du gaz traceur bien plus importante, cette dernière technique présente une plus grande sensibilité à l’obstruction. Cette thèse ouvre ainsi une nouvelle voie de diagnostic et de guide thérapeutique personnalisé pour ce syndrome. / Obstructive Sleep Apnea (OSA) is a common disorder occurring in almost 3 million French people. However, current diagnosis methods are not sufficient to precisely define obstructing sites and doesn't take into account the fluid structure coupling which plays an important role during upper airway closing. During this thesis, we developed a series of tools exploring upper airway closing process. On the one hand, a screening tool of the structure and the mechanical properties of the upper airway, and on the other hand, a screening tool exploring with dynamic images of inert gases flow into the upper airway, were obtained using conventional hydrogen MRI coupled to magnetic resonance elastography (MRE) and helium-3 or fluor-19 gases MRI, respectively. Geometric and biomechanical data obtained using MRI/MRE are injected into a numerical model given the compliance and the state law of upper airway. Contributions of anatomical restriction on airway collapse are also investigated using a multi-compartmental two-dimensional fluid structure interaction model during a breath inspiration to predicted airway mechanical changes and collapse pressures. Furthermore, helium 3 and sulfur hexafluoride flow was modeled at steady state using commercial finite volume software to evaluate potential feasibility to image upper airway collapsibility during OSA. First dynamic MR imaging using sulfur hexafluoride (SF6) was obtained showing the feasibility of this technique. Using SF6, 6 times denser than air, shows a higher sensibility to upper airway obstruction. This thesis opens a new imaging modality to probe and to diagnose upper airway obstruction.

Os incentivos fiscais são instrumentos utilizados pelas esferas governamentais com o intuito de desenvolver determinada região. Essa concessão é baseada na premissa que, os benefícios trazidos com a presença de indústrias superam os custos decorrentes da renúncia fiscal. Entretanto, essa relação Custo-Benefício vem sendo questionada, considerando-se que os custos de manter a empresa na região superam os benefícios gerados. Com o intuito de investigar essa situação, duas indústrias do ramo de fiação e tecelagem no Estado do Ceará foram pesquisadas. Elas foram beneficiadas pelos incentivos fiscais, e denominadas de empresa “A" e “B". Foi calculado o Índice Custo-Benefício (ICB) de cada uma, sendo considerados os montantes dos benefícios e custos passíveis de mensuração. Na metodologia de cálculo dos benefícios foi utilizada a Demonstração do Valor Adicionado – DVA. Para os custos, foi considerado o total de tributos dispensados de recolhimento. Os resultados apontaram que os benefícios foram superiores aos custos (ICB > 1) em ambas as empresas. Entretanto, o índice foi decrescente na empresa “A", podendo evidenciar uma dependência perigosa dos incentivos fiscais, a ponto de comprometer a continuidade da empresa caso fossem removidos. A empresa “B" apresentou o índice constante, mas, o montante dos custos da renúncia fiscal teve um razoável acréscimo em 2000, podendo indicar a mesma dependência já mencionada. Pela análise da DVA das empresas pesquisadas, pode ser inferido que o modelo de concessão de incentivos fiscais favoreceu à má distribuição de renda no Estado do Ceará. O ICB é um indicador útil para a análise dos incentivos fiscais, devendo ser examinado juntamente com outros itens que contemplem os aspectos não mensuráveis. O objetivo é avaliar a possibilidade de reduzir, ou extinguir, os incentivos fiscais das empresas, ou até mesmo, cessar a política de renúncia fiscal da região. Ressaltando, por fim, as conclusões com base nos dois casos estudados não podem ser estendidos para as demais empresas incentivadas, carecendo de mais pesquisas nesse sentido para evidenciar o comportamento desse grupo. / The fiscal incentives are instruments used by the governments with the intention of developing a special area. This concession is based on the premise that, the benefits brought with the presence of industries overcome the costs of the fiscal renouncement. However, that relationship Cost-Benefit has been questioned, being considered the costs to maintain the company in the area overcome the generated benefits. With the intention of investigating that situation, two industries of the spinning branch and weaving in the State of Ceará were researched. They were benefited by the fiscal incentives, and denominated of company "A" and "B". The Cost-Benefit Index (CBI) was made calculations of each one, being considered the amounts of the benefits and costs susceptible to measure. In the methodology of calculation of the benefits was used the Added Value Statement – AVS. To the costs, the total of released tributes of withdrawal was considered. The results indicated the benefits were superior at the costs (CBI > 1) in both companies. However, the index was decreasing in the company "A", could evidence a dangerous dependence of the fiscal incentives, to the point of committing the continuity of the company if were removed. The company "B" presented the constant index, but, the amount of the costs of the fiscal renouncement had a reasonable increment in 2000, that could indicate the same dependence already mentioned. For the analysis of AVS of the researched companies, it can be inferred that the model of concession of fiscal incentives, favored to the bad distribution of income in the State of Ceará.

Made available in DSpace on 2016-04-25T18:40:05Z (GMT). No. of bitstreams: 1 Eduardo Arraes.pdf: 34103877 bytes, checksum: 0057ec3b516f3a18a40616c6d82b8627 (MD5) Previous issue date: 2014-12-12 / ln this work we analyze the consolidated, from the year 2012, Value Statement (VAS) of 132 business entities listed on Stock, Commodities and Futures Exchange- BMF & BOVESPA, part a specific segment named Novo Mercado BOVESP/ (NMB), who voluntarily brings together companies compromised with to apply the principles of corporate Governance, this segment was chosen for the accuracy of the regulation regarding transparency in corporate information. Were analyzed the Added Value generated by each segment and subsidiary group of companies separated by economic sector, the information found were confronted with the Brazilian Accounting Standard CPC 09. The results have reconciled to the methodology for ca1culatingand were compared with 2012 National GDP, were established a parallel between t1:1etwo calculation methodologies and ratio of the segment relevance on the national scenery. The VAS for its accounting approach, proved to be effidel1tand potentially important serve as a basis for decision-making of various social segments, including the government, which could use is as a data source for public policy of fomentation incentives. / Neste trabalho são analisadas e consolidadas as Demonstrações do Valor Adicionado (DVA) do ano de 2012 132 entidades empresariais listadas na Bolsa de valores ,Mercadorias e Futuros -- BM&FBOVESPA, em um segmento especifico denominado Novo, Mercado que reúne voluntariamente empresas que se comprometem a aplicar os principias de Governança Corporativa, esse segmento foi escolhido pelo rigor do regulamento em relação transparência das informações corporativas. Foi analisado Valor Adicionado gerado pelo segmento e subsidiariamente o valor de cada grupo de empresas Neste trabalho separadas por setor econômico, as informações encontradas forrol1 confrontadas com a norma contábil, CPC 09. Os resultados encontrados foram reconciliados à meto( .01c:giade cálculo do Instituto Brasileiro de Geografia e Estatística (IEGE) e comparados com o PIE Nacional 2012, estabeleceu-se um paralelo entre as duas metodologias de cálculo e a relação de relevância do no cenário nacional. A DVA, pôr sua abordagem contábil, mostrou-se potencialmente eficiente e importante para servir de base para tomada de decisões vários segmentos da sociedade, entre eles o governo, que poderia utilizá-la como fonte de dados para decisões de políticas públicas de fomento

Os incentivos fiscais são instrumentos utilizados pelas esferas governamentais com o intuito de desenvolver determinada região. Essa concessão é baseada na premissa que, os benefícios trazidos com a presença de indústrias superam os custos decorrentes da renúncia fiscal. Entretanto, essa relação Custo-Benefício vem sendo questionada, considerando-se que os custos de manter a empresa na região superam os benefícios gerados. Com o intuito de investigar essa situação, duas indústrias do ramo de fiação e tecelagem no Estado do Ceará foram pesquisadas. Elas foram beneficiadas pelos incentivos fiscais, e denominadas de empresa “A” e “B”. Foi calculado o Índice Custo-Benefício (ICB) de cada uma, sendo considerados os montantes dos benefícios e custos passíveis de mensuração. Na metodologia de cálculo dos benefícios foi utilizada a Demonstração do Valor Adicionado – DVA. Para os custos, foi considerado o total de tributos dispensados de recolhimento. Os resultados apontaram que os benefícios foram superiores aos custos (ICB > 1) em ambas as empresas. Entretanto, o índice foi decrescente na empresa “A”, podendo evidenciar uma dependência perigosa dos incentivos fiscais, a ponto de comprometer a continuidade da empresa caso fossem removidos. A empresa “B” apresentou o índice constante, mas, o montante dos custos da renúncia fiscal teve um razoável acréscimo em 2000, podendo indicar a mesma dependência já mencionada. Pela análise da DVA das empresas pesquisadas, pode ser inferido que o modelo de concessão de incentivos fiscais favoreceu à má distribuição de renda no Estado do Ceará. O ICB é um indicador útil para a análise dos incentivos fiscais, devendo ser examinado juntamente com outros itens que contemplem os aspectos não mensuráveis. O objetivo é avaliar a possibilidade de reduzir, ou extinguir, os incentivos fiscais das empresas, ou até mesmo, cessar a política de renúncia fiscal da região. Ressaltando, por fim, as conclusões com base nos dois casos estudados não podem ser estendidos para as demais empresas incentivadas, carecendo de mais pesquisas nesse sentido para evidenciar o comportamento desse grupo. / The fiscal incentives are instruments used by the governments with the intention of developing a special area. This concession is based on the premise that, the benefits brought with the presence of industries overcome the costs of the fiscal renouncement. However, that relationship Cost-Benefit has been questioned, being considered the costs to maintain the company in the area overcome the generated benefits. With the intention of investigating that situation, two industries of the spinning branch and weaving in the State of Ceará were researched. They were benefited by the fiscal incentives, and denominated of company "A" and "B". The Cost-Benefit Index (CBI) was made calculations of each one, being considered the amounts of the benefits and costs susceptible to measure. In the methodology of calculation of the benefits was used the Added Value Statement – AVS. To the costs, the total of released tributes of withdrawal was considered. The results indicated the benefits were superior at the costs (CBI > 1) in both companies. However, the index was decreasing in the company "A", could evidence a dangerous dependence of the fiscal incentives, to the point of committing the continuity of the company if were removed. The company "B" presented the constant index, but, the amount of the costs of the fiscal renouncement had a reasonable increment in 2000, that could indicate the same dependence already mentioned. For the analysis of AVS of the researched companies, it can be inferred that the model of concession of fiscal incentives, favored to the bad distribution of income in the State of Ceará.

Introdução: A Dor Pélvica Crônica (DPC) é um problema social, com alta prevalência, acometendo mulheres na idade reprodutiva. Cada vez mais salientamos a importância de investigar instrumentos apropriados para avaliação da dor, facilitando na prática clínica a escolha do melhor método que torne mais completa a avaliação de aspectos da intensidade na mensuração da dor crônica. Portanto, o objetivo deste estudo é correlacionar diferentes instrumentos de avaliação da intensidade dolorosa, a escala numérica (EN), escala visual analógica (EVA) e a algometria de pressão, nas mulheres com DPC, a fim de identificar o instrumento que melhor expressa o quadro doloroso. Métodos: foram avaliadas pelo ginecologista oitenta mulheres encaminhadas ao ambulatório do serviço de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA), trinta e três mulheres apresentaram algum aspecto dos nossos critérios de não inclusão. Selecionamos para participar do estudo quarenta e sete pacientes com DPC, sendo que vinte pacientes apresentavam endometriose diagnosticada por videolaparoscopia e vinte e sete pacientes apresentavam outras causas ginecológicas. Utilizamos no estudo um roteiro para anamnese cujos dados relacionados com a DPC foram coletados, tais como diagnóstico, tratamento, sintomatologia e locais da dor. Escores de dor foram classificados de acordo com a intensidade, através das escalas de dor (EN e EVA), instrumentos baseados no autorrelato do indivíduo e algometria de pressão, para verificar o limiar de dor à pressão das pacientes. Na análise dos dados, a concordância entre as escalas foi avaliada pelo coeficiente de correlação intraclasse (ICC) e a associação entre as escalas com o algômetro foi avaliada pelo coeficiente de correlação de Spearman, o nível de significância adotado foi de 5% (P<0,05). Resultados: As participantes do estudo tinham idade média de 38,3 ± 7,6 anos. Utilizamos o ICC para análise da correlação entre os instrumentos de relato da percepção dolorosa, ou seja, entre as EN e EVA, em relação à dor (0,992), na dismenorreia (1,00) e na dispareunia (0,996), e encontramos excelente concordância entre as escalas, com P<0,01. As associações da algometria com as escalas foram moderadas e inversas, apresentando diferenças estatisticamente significativas, quanto maior a pontuação nas escalas EN e EVA em relação à dispareunia, menores os valores no algômetro, exceto nos pontos LA1 e LA2 em ambos os lados. Também houve associação inversa das escalas EN e EVA na dismenorréia, no ponto LAB2 lado direito e associação inversa no ponto PS lado direito com a escala EVA de dor, com diferenças estatisticamente significativas. Conclusão: As escalas são instrumentos eficientes para avaliação da dor, podendo ser utilizada tanto a EN quanto a EVA na avaliação da intensidade dolorosa. Na avaliação das mulheres com DPC devemos utilizar a algometria de pressão associada à EN ou EVA, instrumentos inversamente proporcionais, confiáveis e sensíveis, tornando menos subjetiva a avaliação da dor para melhor expressar o quadro doloroso. / Introduction: The Chronic Pelvic Pain (CPP) is a social problem, with high prevalence, affecting women in reproductive age. Increasingly, has been emphasised the importance of investigating appropriate instruments for evaluation of pain in clinical practice, by facilitating the choice of the best method to make more complete the evaluation in measuring intensity aspects of chronic pain. Therefore, the objective of this study is to correlate different painful intensity assessment tools, the numeric scale (NS), visual analogue scale (VAS) and algometry pressure, in women with CPP, in order to identify the instrument that best expresses the pain. Methods: were evaluated by the gynecologist eighty women referred to the Gynecology and Obstetrics service, Clinical Hospital of Porto Alegre (HCPA), thirty three women had some aspect of our criteria for not inclusion. The study included forty seven patients, twenty patients had endometriosis diagnosed by laparoscopy and twenty seven patients had other gynecological causes. For the analyses in this study we used a road map for anamnesis whose data related to the CPP was collected, such as diagnosis, treatment, symptoms and pain locations. In addition, pain scores were classified according to intensity, through the pain scales (NS and VAS), based on self-report instruments of individual and algometry, to verify the pressure pain threshold of the patients. Statistically, the agreement between scales was assessed by intraclass correlation coefficient (ICC) and the association between the scales with the algometer were evaluated by Spearman's rank correlation coefficient, the level of significance adopted was 5% (P<0,05). Results: Study participants had an average age of 38.3 ± 7.6 years old. In the statistical analysis, we used ICC reporting instruments of perception painful I mean, between NS and VAS regarding pain (0,992), in dysmenorrhoea (1.00) and Dyspareunia (0.996), and we found excellent correlation between scales, with P<0,01. The associations of algometria with the scales were moderate and inverses, showing differences statistically significant, the higher the score NS and VAS in relation to Dyspareunia smaller values in algometer, except in points LA1 and LA2 on both sides. Indeed, there were also inverse association of scales NS and VAS on dysmenorrhea, in point LAB2 in the right side and inverse association in point PS in the right side with scale VAS of pain, with statistically significant differences. Conclusion: the scales are effective instruments for evaluation of pain, and may be used both in NS and VAS at painful intensity evaluation. In the evaluation of women with CPP should be used the algometry pressure associated with NS or VAS, instruments inversely proportional, reliable and sensitive, making less subjective pain assessment to better express the pain.