Publicación a texto completo no autorizada por el autor / Determina la relación que existe entre el nivel de riesgo de posturas disergonómicas y el dolor musculoesquelético de la columna vertebral en los fisioterapeutas del Servicio de Terapia Física y Rehabilitación en la Clínica San Juan de Dios-Arequipa, 2017. Corresponde un tipo de estudio cuantitativo y correlacional y un diseño de investigación observacional, prospectivo y transversal. Utiliza una muestra de 17 fisioterapeutas del Servicio de Terapia Física y Rehabilitación en la Clínica San Juan de Dios-Arequipa. Evalúa el nivel de riesgo de posturas disergonómicas nediante el método REBA y a través del cuestionario nórdico de kuorinka evalúa el dolor musculoesquelético de la columna vertebral. Establece una relación entre ambas variables, nivel de riesgo de posturas disergonómicas y el dolor musculoesquelético de la columna vertebral. Encuentra que el 78.6% de la muestra que presenta nivel de riesgo medio con dolor musculoesquelético fuerte en la columna vertebral. Mientras que el 66.7% de fisioterapeutas con nivel de riesgo alto tiene dolor musculoesquelético fuerte en la columna vertebral. Concluye que existe relación significativa moderada (p=0.028 y rho=0.531) entre el nivel de riesgo de posturas disergonómicas y el dolor musculoesquelético en columna vertebral en los fisioterapeutas del Servicio de Terapia Física y Rehabilitación de la Clínica San Juan de Dios-Arequipa, 2017. / Tesis

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19558号 / 医博第4065号 / 新制||医||1013(附属図書館) / 32594 / 京都大学大学院医学研究科医学専攻 / (主査)教授 平岡 眞寛, 教授 福原 俊一, 教授 一山 智 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

椎間板変性を引き起こす要因として、骨性終板内の栄養管狭小および軟骨終板の石灰化による椎間板への栄養供給の低下が推察されているが、椎体終板内栄養管の3次元微細構造は未だ明確にされていない。本論文は高解像度マイクロCTを用いて家兎腰椎骨性終板内栄養管の3次元微細構造を明らかにする事を目的とし、各栄養管の長さ,直径,配向及び表面からの深さを定量的に解析することでその多層構造を定量的に評価することができた。 / Insufficient nutrient supply through vertebral canal structures to the intervertebral disc (IVD) has been considered as an important contributor for disc degeneration. In spite of this, three-dimensional (3D) topology inside the vertebral endplate remains poorly understood. This study aims to characterize the 3D canal structure in the rabbit lumbar vertebral endplate using micro computed tomography (µCT), and revealed a distinct depth-dependent structure of the canal in the rabbit vertebral endplate characterized by length, diameter and orientation of the individual canals. / 博士(工学) / Doctor of Philosophy in Engineering / 同志社大学 / Doshisha University

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As dissecções da artéria vertebral causam acidentes vasculares cerebrais isquêmicos e hemorrágicos. A dissecção arterial é a ruptura da sua parede com formação de hematoma intramural. Podem ser espontâneas, acometendo a artéria vertebral extra ou intracraniana. O tratamento em geral é clínico, porém em alguns casos está indicada intervenção. A via endovascular é uma importante alternativa, permitindo o tratamento específico da lesão em alguns casos, mas na maioria sacrificando a artéria vertebral, após teste de tolerância à oclusão. Com o objetivo de analisar os aspectos clínicos e técnicos do tratamento endovascular, estudamos de forma prospectiva 15 pacientes. Três apresentavam dissecções traumáticas (todas extracranianas) e 12 espontâneas, dos quais dois tiveram traumatismos menores como desencadeantes. Cinco pacientes apresentaram dissecções extracranianas, oito, intracranianas e dois, combinadas. No grupo das extracranianas, a principal indicação de tratamento foi a presença de fístula arteriovenosa, em três dos cinco pacientes. No grupo da intracranianas, foi a presença de hemorragia meníngea. Nos quatro pacientes com acidente vascular isquêmico, a indicação de tratamento deveu-se à presença de pseudoaneurismas que não involuíram com tratamento clínico. Nesse grupo, dois pacientes tinham dissecção extracraniana, um, intra e um, combinada. Um paciente apresentou intolerância à oclusão e foi encaminhado para tratamento conservador. Dos 14 pacientes tratados, um teve como estratégia a oclusão seletiva da lesão, 11 a oclusão da artéria vertebral proximal à lesão e dois oclusão acima e abaixo da lesão. Os materiais utilizados foram balões destacáveis em sete pacientes, molas de destaque livre em 6 e molas eletricamente destacáveis associadas a molas de destaque livre em 1 paciente. Dois pacientes apresentaram complicações do tratamento, e um paciente, recidiva de fístula arteriovenosa, todos resolvidos sem seqüelas. A angiografia controle revelou oclusão total do segmento dissecado ou do pseudoaneurisma em 9 pacientes, reversão do fluxo em quatro e preservação da artéria vertebral com oclusão da lesão em um. Num período de seguimento de 8,6 meses não se registraram recorrências. O tratamento foi eficiente na prevenção de ressangramentos e na trombose dos pseudoaneurismas e apresenta segurança em relação a complicações. / Vertebral artery dissections can cause brain ischemia and hemorrhage. Arterial dissection consist of mural tears with subsequent intramural hematoma formation. They may occur either spontaneously or as a consequence of traumatism, in the extracranial or intracranial vertebral artery. The treatment is usually clinical, but in some instances intervention is indicated. The endovascular approach is an important tool, allowing specific treatment of the lesion in some cases, but sacrificing the vertebral artery in most cases. With the aim of analyze the clinical and technical aspects of the endovascular treatment, we studied prospectively 15 patients treated by endovascular approach. Three presented traumatic dissections (all extracranial) and 12 spontaneous dissections, two of which after minor traumatic events. Five patients had extracranial dissections, eight, intracranial and two, combined. In the extracranial dissection group, the main indication for treatment was the presence of an arteriovenous fistula (three of five patients). In the intracranial group, it was subarachnoid hemorrhage. Four patients presenting with brain isquemia were treated because of pseudoaneurysms that did not resolve in clinical treatment. In this group 2 patients had extracranial dissections, one had intracranial and one had both. One patient did not tolerate occlusion and was treated clinically. Fourteen patients were treated by endovascular means, one with selective lesion occlusion, 12 with proximal vertebral artery occlusion and two with proximal and distal vertebral artery occlusion. The embolic material were detachable balloons in 7 patients, platinum microcoils in 6 patients and electrically detachable platinum microcoils and platinum microcoils in one patient. Two patients presented complications, and one presented recurrence of an arteriovenous fistula, all resolved without sequelae. Angiographic controls disclosed total occlusion of the segment with dissection or of the pseudoaneurysm in 9 patients, retrograde flow in 4 and vertebral artery preservation with selective lesion occlusion in 1. During a mean follow-up period of 8,6 months no recurrence was observed. The treatment was efficient in preventing recurrent hemorrhage and promoting pseudoaneurysms thrombosis, besides it was a safe treatment option.

As dissecções da artéria vertebral causam acidentes vasculares cerebrais isquêmicos e hemorrágicos. A dissecção arterial é a ruptura da sua parede com formação de hematoma intramural. Podem ser espontâneas, acometendo a artéria vertebral extra ou intracraniana. O tratamento em geral é clínico, porém em alguns casos está indicada intervenção. A via endovascular é uma importante alternativa, permitindo o tratamento específico da lesão em alguns casos, mas na maioria sacrificando a artéria vertebral, após teste de tolerância à oclusão. Com o objetivo de analisar os aspectos clínicos e técnicos do tratamento endovascular, estudamos de forma prospectiva 15 pacientes. Três apresentavam dissecções traumáticas (todas extracranianas) e 12 espontâneas, dos quais dois tiveram traumatismos menores como desencadeantes. Cinco pacientes apresentaram dissecções extracranianas, oito, intracranianas e dois, combinadas. No grupo das extracranianas, a principal indicação de tratamento foi a presença de fístula arteriovenosa, em três dos cinco pacientes. No grupo da intracranianas, foi a presença de hemorragia meníngea. Nos quatro pacientes com acidente vascular isquêmico, a indicação de tratamento deveu-se à presença de pseudoaneurismas que não involuíram com tratamento clínico. Nesse grupo, dois pacientes tinham dissecção extracraniana, um, intra e um, combinada. Um paciente apresentou intolerância à oclusão e foi encaminhado para tratamento conservador. Dos 14 pacientes tratados, um teve como estratégia a oclusão seletiva da lesão, 11 a oclusão da artéria vertebral proximal à lesão e dois oclusão acima e abaixo da lesão. Os materiais utilizados foram balões destacáveis em sete pacientes, molas de destaque livre em 6 e molas eletricamente destacáveis associadas a molas de destaque livre em 1 paciente. Dois pacientes apresentaram complicações do tratamento, e um paciente, recidiva de fístula arteriovenosa, todos resolvidos sem seqüelas. A angiografia controle revelou oclusão total do segmento dissecado ou do pseudoaneurisma em 9 pacientes, reversão do fluxo em quatro e preservação da artéria vertebral com oclusão da lesão em um. Num período de seguimento de 8,6 meses não se registraram recorrências. O tratamento foi eficiente na prevenção de ressangramentos e na trombose dos pseudoaneurismas e apresenta segurança em relação a complicações. / Vertebral artery dissections can cause brain ischemia and hemorrhage. Arterial dissection consist of mural tears with subsequent intramural hematoma formation. They may occur either spontaneously or as a consequence of traumatism, in the extracranial or intracranial vertebral artery. The treatment is usually clinical, but in some instances intervention is indicated. The endovascular approach is an important tool, allowing specific treatment of the lesion in some cases, but sacrificing the vertebral artery in most cases. With the aim of analyze the clinical and technical aspects of the endovascular treatment, we studied prospectively 15 patients treated by endovascular approach. Three presented traumatic dissections (all extracranial) and 12 spontaneous dissections, two of which after minor traumatic events. Five patients had extracranial dissections, eight, intracranial and two, combined. In the extracranial dissection group, the main indication for treatment was the presence of an arteriovenous fistula (three of five patients). In the intracranial group, it was subarachnoid hemorrhage. Four patients presenting with brain isquemia were treated because of pseudoaneurysms that did not resolve in clinical treatment. In this group 2 patients had extracranial dissections, one had intracranial and one had both. One patient did not tolerate occlusion and was treated clinically. Fourteen patients were treated by endovascular means, one with selective lesion occlusion, 12 with proximal vertebral artery occlusion and two with proximal and distal vertebral artery occlusion. The embolic material were detachable balloons in 7 patients, platinum microcoils in 6 patients and electrically detachable platinum microcoils and platinum microcoils in one patient. Two patients presented complications, and one presented recurrence of an arteriovenous fistula, all resolved without sequelae. Angiographic controls disclosed total occlusion of the segment with dissection or of the pseudoaneurysm in 9 patients, retrograde flow in 4 and vertebral artery preservation with selective lesion occlusion in 1. During a mean follow-up period of 8,6 months no recurrence was observed. The treatment was efficient in preventing recurrent hemorrhage and promoting pseudoaneurysms thrombosis, besides it was a safe treatment option.

Chondrichthyans are cartilaginous fishes that include the extant chimaeras, sharks, and batoids, and their extinct relatives. In this dissertation, I examined the growth, development, and relationships of extinct and extant chondrichthyans. I reexamined the skeleton of fossil and fetal specimens of the angel sharks (Squatiniformes) and reanalyzed the current morphologically based hypothesis of chondrichthyan evolution, which conflicts with the current molecular based hypothesis. I did this by including extinct taxa and new characters based on dentition, and the ethmoid, occipital, pectoral, and vertebral skeleton. My results supported the pre-existing morphological hypothesis that angel sharks, saw sharks, and batoids form a clade. However, some of my new characters, particularly those based on the vertebral morphology, indicate that fetal and juvenile angel sharks do not share as many apomorphies with batoids as previously hypothesized from the examination of adults. I also examine the relationships of major groups within batoids, beginning with the construction of a hypothesis of the evolutionary history of electric rays (Torpediniformes). My results are consistent with previous rank-based classifications. However, they deviate from previous classifications depending on the criteria used to generate the hypothesis and on which taxon, or combination of taxa, were used to root the ingroup phylogeny. Because pectoral and vertebral morphology are so critical to morphological hypotheses, I also examined the growth and development of the synarcual cartilage in batoid fishes, with particular emphasis on the synarcual of skates (Rajiformes). My results demonstrate that calcification and chondrification do not proceed in the same order, temporally and spatially. Finally, I redescribe the extinct batoid †Cyclobatis, known only from the Cretaceous, and evaluate its phylogenetic position. My results indicate that †Cyclobatis, the oldest known rajid, is also the sister taxon to a clade of all known extant members of Rajidae. Furthermore, the inclusion of new characters, mainly derived from the synarcual, help to resolve the interrelationships of Rajidae. / text