Dissertations / Theses on the topic 'Musculo skeletal disorders'

Musculo – skeletal stress in nursing staff and its association with health disorders Aim of the study was to investigate health complaints and work pressure among nursing staff, and to evaluate the associations of musculo - skeletal stress with their health disorders. Methods. During October - December, 2003, 300 employees of one Kaunas hospital were interviewed. In this case - control study, 100 respondents were included into the case group, and 200 were controls. The main criterion for the selection of controls was no engagement in activities characteristic of a nurse and an assisting nurse. The questionnaire was anonymous. Statistical analysis of the obtained findings was performed using SPSS 12 statistical software package. Results. Nurses whose work was not related to lifting weights (the control group) more frequently complained of pains in the neck (87,5 %), the shoulder girdle (91,7 %), and the back (93,2 %), whereas those whose work was related to lifting weights, more frequently complained of pains around the waist (73,0 %) and in the legs (94,9 %). The study showed that the pain syndrome in the arms by two times more frequently occurred in the control group (12,1 % compared to 6,0 % in the case group), which is characteristic of the sedentary job, especially computer work. Pain syndrome in the legs by four times more frequently occurred in the case group, compared to controls, which is typical of work related to weight lifting. The evaluation of the activities... [to full text]

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The objective of this study is to analyze the influence of risk factors on exposure to WMSD workers in repetitive activities in the footwear sector. Therefore, we analyzed the data for 71 workplaces in the productive area of a shoe company which are characterized by having a defined task cycle, and had the index of exposure to WMSD upper limbs calculated through the OCRA method. Data analysis was accomplished using the exploratory data analysis of WMSD and construction of a Generalized Linear Model (GLM). This model identified the factors that influence the rate of exposure the most and made it possible to quantify the possible chance of raising this index when risk factors are present in the workplaces. The factor indicated as the most influential one was the "sudden movements" factor, the presence of this factor increases the chance of raising the level of exposure in 2.12 times more than when this factor is not present.
O objetivo deste trabalho foi analisar os fatores de risco e o índice de exposição a LER/DORT dos trabalhadores em atividades repetitivas no setor calçadista.Para tanto foram analisados dados referentes a 71 postos de trabalho da área produtiva de uma empresa calçadista que se caracterizam por possuir um ciclo de tarefa definido, e que tiveram calculados o índice de exposição a LER/DORT nos membros superiores através do método OCRA. O tratamento dos dados foi realizado através da análise exploratória dos dados de LER/DORT e da construção de um Modelo Linear Generalizado (MLG).Este modeloidentificou os fatores que mais influenciam o índice de exposição e possibilitouquantificar a chance de elevação deste índice quando os fatores de risco estão presentes nos postos de trabalho. O fator indicado como o mais influente foi o fator movimentos bruscos , a presença deste fator aumenta a chance de se elevar o índice de exposição em 2,12 vezes a mais do que quando este fator não está presente.

In skeletal muscle, loss of neuronal nitric oxide synthase (nNOS) from the sarcolemma has been observed in a few muscular dystrophies and myopathies. However, the extent of this phenomenon, its mechanism, and its physiological impact are not well understood. Using immunofluorescent staining for nNOS, a survey of 161 patient biopsies found absent or reduced sarcolemmal nNOS in 43% of patients. Patient mobility and muscle functional status correlated with nNOS mislocalization from the sarcolemma. Mouse models of inherited and acquired myopathies showed similar loss of sarcolemmal nNOS and impaired mobility and muscle function. A proteomic approach, using mass spectrometry and differentially labeled control and steroid-induced myopathy (SIM) mouse samples, found novel nNOS binding proteins including alpha-actinin-3 (ACTN3), which exhibited decreased interaction with nNOS after steroid treatment. It revealed a potential explanation for impaired muscle function in SIM as nNOS interactions were lost at the sarcomere and gained at the sarcoplasmic reticulum impairing contractility. Treating nNOS-deficient mice with steroids demonstrated that loss of sarcolemmal nNOS reduces muscle contractility and strength in SIM through increased nitric oxide (NO) signaling. In SIM mice treated with a nitric oxide donor and steroids, nitric oxide partially protects the muscle from atrophy and improves muscle fatigability and recovery suggesting nNOS mislocalization also decreases NO availability. These findings show that loss of sarcolemmal nNOS is a common phenomenon that negatively impacts muscle function. Therapeutic strategies targeting nNOS or NO signaling need to allow for the complexity of local nitric oxide content and cellular context.

Obesity and type 2 diabetes mellitus (T2DM) are both complex diseases with multifactorial etiologies. Together they affect over 640 million people worldwide and have a significant impact on the global healthcare system incurring costs of over 800 billion dollars. The overall goal of my doctoral research has been to elucidate metabolic predictors and underlying mechanisms in obesity and T2DM. Specifically, I have examined mechanisms contributing to disordered oxidative metabolism in skeletal muscle. My research included participants who were recruited from the Ottawa Hospital Weight Management Clinic in which they completed a clinically supervised meal-replacement and lifestyle intervention program. More so, my doctoral studies evaluated characteristics of muscle mitochondrial function in obesity and T2DM and revealed impaired mitochondrial respiration and electron transport chain supercomplex assembly in muscle from patients with T2DM. The first aim was to study the impact of T2DM on weight loss ability in a large population of obese patients participating in a standardized meal replacement and lifestyle modification program. As there is considerable variability in weight loss propensity, it was found that T2DM significantly deters weight loss although the effect is not large. Since skeletal muscle energetics are central in the development and progression of obesity and T2DM, the second and third aims were to study mitochondrial function in this tissue with the idea of uncovering molecular etiologies. The second aim found deficiencies in mitochondrial respiration in individuals with obesity and T2DM compared to individuals with obesity alone. Reductions in mitochondrial respiration were correlated with increasing levels of HbA1C and attributed to paucity in supercomplex formation in the mitochondrial inner membrane (MIM) of the electron transport chain (ETC). The third aim was to delineate differential fuel oxidation mechanisms and circulating protein biomarkers in obese diet-sensitive (ODS) and obese diet-resistant (ODR) participants following a high fat meal (HFM) challenge. Whole-body analyses were conducted in addition to measures in blood, adipose tissue, skeletal muscle and primary cells. Remarkable increases in oxidative capacity were measured post-HFM. In addition, impaired mitochondrial function was found in the ODR group despite lack of differences in mitochondrial content or the assembly of supercomplexes. Differences were also found in circulating acylcarnitines as well as expression of several proteins including Heat shock 70 kDa protein 1A/1B, Tyrosine-protein kinase Fgr, and Peptidyl-prolyl cis-trans isomerase D. Ultimately, a better understanding of mechanisms involved could lead to significant improvements in personalized medical approaches in obesity and T2DM.

Although the effects of diabetes on bone mineral content has been studied, little is known about the structural alterations in collagen, maturation of apatite crystals and carbonate content in diabetic bone. The first part of this study aimed to investigate the mineral and organic properties of cortical, trabecular and growth plate regions of rat femur tissues in type I diabetes using FTIR microspectroscopy and Vickers microhardness test. A decrease in mineral content (degree of mineralization), decrease in microhardness, increase in carbonate content, increase in size and maturation of hydroxyapetite crystals, which are the implications of increased osteoporosis, were observed in diabetic bone. In addition, a decreased carbonate substitution into bone apatite and an increase in labile type carbonate was observed in diabetic bone. There was a decrease in the level of crosslinking of collagen in cortical and trabecular regions of diabetic femurs, implying a decrease in bone collagen quality that may contribute to bone fragility. Recent evidence implies that intramyocellular lipid accumulation is directly correlated with insulin resistance, a key parameter in the generation of obesity. The second part of this study is mainly focused on the determination of the structural and compositional characterization of macromolecules of longissimus dorsi and quadriceps muscles of Berlin fat mouse inbred (BFMI) lines using ATR-FTIR spectroscopy and FTIR microspectroscopic imaging, together with the quantification of fiber specific distribution of lipids in these muscles by the use of confocal microscopy. The study groups included 10 weeks old standard breeding diet fed (juvenile) and 20 weeks old high fat diet fed control and BFMI lines. The results revealed the loss of unsaturation in lipids, increased triglyceride content, increased amount of lipids having shorter chain length, increased lipid peroxidation and fiber specific accumulation of lipids in type IIa and intermediate fibers in skeletal muscles of both 10 weeks old and 20 weeks old BFMI lines, emphasizing their obese phenotype. However, the alterations were more prominent in skeletal muscles of 20 weeks old high fat diet fed BFMI lines, displaying a more severe obesity phenotype. The results of the characterization revealed that BFMI860 and BFMI861 lines are convenient models for the study of spontaneous obesity and studies to enlighten the genetic basis of obesity.

Este estudo objetivou a adaptação transcultural do questionário Cultural Study of Musculo-Skeletal and Other Symptoms and Associated Disability - CUPID Questionnaire, para a língua portuguesa falada no Brasil e a validação do seu conteúdo. O estudo é do tipo metodológico e foi realizado obedecendo aos procedimentos internacionais recomendados e aos procedimentos específicos indicados pelo autor do Questionário, uma vez que será aplicado em estudo multicêntrico por ele coordenado. A adaptação transcultural foi realizada seguindo as etapas de tradução, retrotradução, avaliação destas versões por um comitê de juízes e pré-teste da versão pré-final. O pré-teste foi realizado no Departamento de Enfermagem do Hospital Universitário da Universidade de São Paulo com 40 trabalhadores de enfermagem. Ajustes foram feitos após a análise das traduções pelo comitê de juízes quando o Índice de Validade de Conteúdo foi inferior a 80%. A versão resultante do questionário foi então pré-testada para verificar a capacidade compreensão e preenchimento pelos sujeitos e a possibilidade de ajustes, considerando o indicativo de ajustes quando 15% destes apresentassem dificuldades em relação ao preenchimento. Os resultados do pré-teste apontam um número significativo de trabalhadores de enfermagem com dores em região lombar, ombro, cotovelo, punho e/ou mão e joelho, associados a sintomas psicossociais e demais incapacidades. A análise das respostas dos sujeitos aos itens do Questionário não evidenciou dificuldades de compreensão e entendimento na totalidade dos itens, indicando a validade de seu conteúdo para a língua portuguesa falada no Brasil. Conclui-se que a versão Brasileira do CUPID Questionnaire é um instrumento adequado para identificar os sintomas musculoesqueléticos, indicados pelos trabalhadores de enfermagem, relacionados às atividades ocupacionais, aspectos psicossociais e outras incapacidades associadas
The objective of this study was to adapt the Transcultural Questionnaire Cultural Study of Muscular-Skeletal and Other Symptoms and Associated Disability CUPID Questionnaire, to the Portuguese language spoken in Brazil and to validate its contents. This methodological study was performed in accordance with internationally recommended procedures and the specific procedures indicated by the Questionnaires author since it will be applied in a multicenter study coordinated by the author. The transcultural adaptation was performed following the steps of translation, back-translation, evaluation of these versions by a committee of judges and pre-test version of the pre-final. The pre-test was performed in the Nursing Department of University Hospital at the University of Sao Paulo with 40 nursing workers. Adjustments were made after an analysis of the translations by a committee of judges when an index of content validation was less than 80%. The resulting version of the questionnaire was then pre-tested to verify the capacity of comprehension and form completion by the subjects and the possibility of adjustments considering an adjustment indicator when 15% of them presented difficulty related to form completion. The results of this pre-test showed that a significant number of Nursing workers complained of pain in the regions of lumbar, shoulder, elbow, wrist and or hand and knee, symptoms associated with psychosocial and other disabilities. Analysis of the subjects responses to items of the questionnaire revealed no difficulty in the comprehension and total understanding of the items indicating a validity of its contents for the Portuguese language spoken in Brazil. It can be concluded that the Brazilian Version of the CUPID Questionnaire is an adequate instrument for the identification of musculoskeletal symptoms indicated by nursing workers related to occupational activities, psychosocial aspects and other associated incapacities

Current quantitative nuclear magnetic resonance (NMR) technics offer biomarkers that allow performing non-invasive longitudinal studies for the follow up of therapeutic trials in neuromuscular disorders (NMD). In contrast to fat degeneration, the mechanisms of inflammation/oedema/necrosis and fibrosis are characteristic signs of disease activity, which makes their quantification a promising source of crucial biomarkers for longitudinal studies. This thesis work consisted on the implementation of more precise quantitative NMR methods adapted to the clinical study of skeletal muscle (SKM) for : (i) detection and quantification of sites of disease activity by T2-mapping of muscle water ; (ii) investigation of the different pathophysiological mechanisms underlying T2 alterations ; and (iii) Detection and quantification of muscle fibrosis. We implemented two methods for T2 mapping of muscle water. The first one is based on a multi-spin-echo sequence du type CPMG. In this method the 1H-NMR signals from water and lipids are acquired simultaneously. The acquired data are fitted to a tri-exponential model, in which water and fat signals are separated by exploring the T2 difference between water and fat. This method allows extraction of muscle water T2-value in the presence of fat infiltration. The second method is based on a " partially spoiled steady state free precession " (pSSFP) sequence. In contrast to the first method, which demands a sophisticated post-treatment of images acquired at 17 different echo-times, with the pSSFP a T2-mapping is extracted from two 3D data sets. 3D acquisition is compatible with spectrally selective water excitation, which eliminates signal contribution from lipids. Both methods were validated experimentally on patients and healthy subjects. The results demonstrated their capacity to detect and quantify disease activity sites. This 2 works have been published in two international journals : Azzabou, de Sousa, Araujo, & Carlier, 2014. Journal of Magnetic Resonance Imaging. DOI 10.1002/jmri.24613 (in press); et de Sousa, Vignaud, Araujo, & Carlier . 2012. Magnetic Resonance in Medicine. 67:1379-1390. Although it was shown to reveal disease activity, mono-exponential T2 of muscle water is non-specific to what concerns the mechanisms underlying its alterations. It has been long known that T2 relaxation in SKM tissue is multi-exponential. This is currently accepted to reveal anatomical compartmentation of myowater. We implemented a method for localized spectroscopic CPMG acquisition. CPMG data respect echo-time sampling and signal to noise ration limits for allowing robust multiexponential analysis. This work allowed us to establish a compartmentation model that perfectly explains the multi-exponential T2 relaxation observed in SKM tissue. This work was published in the " Biophysical Journal " (Araujo, Fromes & Carlier 2014. New Insights on skeletal muscle tissue compartments revealed by T2 NMR relaxometry. (In press)). Pilot studies performed in patients show promising results and suggest potential application of the method in clinical studies. Fibrosis starts with an excessive accumulation of intramuscular connective tissue (IMCT). We have explored the " Ultrashort time to echo " (UTE) method with the aim to detect and characterize the signal from IMCT. In a first study we characterized in vivo a short T2 component (~500 µs) in SKM, and we collected evidences suggesting that this component might reflect IMCT. Then we implemented a methodology that allowed imaging this short component in SKM tissue for the first time.

Actuellement, des méthodes quantitatives de résonance magnétique nucléaire (RMN) offrent des biomarqueurs qui permettent la réalisation d’études longitudinales pour le suivi de l’évolution des maladies neuromusculaires et des essais thérapeutiques de manière non-invasive. A la différence de la dégénérescence graisseuse, les processus d’inflammation/œdème/nécrose et fibrose sont des signes d’activité des maladies et leurs quantifications constitueraient ainsi de biomarqueurs parfaitement adaptés pour le suivi thérapeutique. Ce travail de thèse a consisté à mettre en place des méthodologies quantitatives plus précises et adaptées à l’étude clinique du muscle pour : (i) détecter et quantifier des sites d’activité de maladies par la cartographie T2 de l’eau ; (ii) identifier les différents processus pathophysiologiques qui sont à l’origine des altérations du T2 ; et (iii) détecter et quantifier la fibrose musculaire. Nous avons implémenté deux méthodes pour la quantification du T2 de l’eau dans le muscle. La première est basée sur une séquence d’écho de spin du type CPMG, où les signaux provenant des protons des lipides et de l’eau sont acquis simultanément et séparés à postériori par un traitement tri-exponentiel qui exploite la différence entre les T2 qui caractérisent les signaux de l’eau et de la graisse. La deuxième technique est basée sur une séquence de « partially spoiled steady state free precession (pSSFP) ». Différemment de la première technique qui nécessite un traitement assez élaboré sur des images acquises à 17 temps d’écho différents, dans la pSSFP la cartographie T2 est extraite à partir de deux séries de données 3D. L’acquisition 3D est compatible avec des techniques de sélection spectrale de l’eau, ce qui évite la contamination par les signaux des lipides. Les deux méthodes ont été validées expérimentalement chez des malades et des sujets sains et ont démontré leur capacité à détecter et quantifier des sites d’activité de maladies. Ces deux travaux font l’objet de deux publications dans des journaux scientifiques internationaux : Azzabou, de Sousa, Araujo, & Carlier, 2014. Journal of Magnetic Resonance Imaging. DOI 10.1002/jmri.24613 (in press); et de Sousa, Vignaud, Araujo, & Carlier . 2012. Magnetic Resonance in Medicine. 67:1379-1390. Malgré le fait de permettre la détection des sites d’activité de maladies, la mesure mono-exponentielle du T2 de l’eau par imagerie reste non-spécifique vis-à-vis des processus physiologiques à l’origine de l’augmentation du T2. Il est connu que la relaxation T2 du muscle squelettique n’est pas mono-exponentielle. Cela est interprété comme une conséquence de la compartimentation anatomique de l’eau tissulaire. Nous avons mis au point une méthode pour l’acquisition localisée de données CPMG. Cette technique permet l’acquisition des données dans des conditions nécessaires pour la réalisation de traitements multi-exponentiels précis. Ce travail nous a permis d’établir un modèle de compartimentation qui explique parfaitement la relaxation T2 dans le muscle. Il a fait l’objet d’un article publié dans le « Biophysical Journal » (Araujo, Fromes & Carlier 2014. New Insights on skeletal muscle tissue compartments revealed by T2 NMR relaxometry. (In press)). Les essais réalisés chez des sujets malades suggèrent un grand potentiel pour l’application de la méthode dans des études cliniques. La formation de la fibrose commence avec une accumulation excessive de tissu conjonctif intramusculaire (TCIM). Nous avons exploité la technique « Ultrashort Time-to-Echo » (UTE) pour essayer de détecter et caractériser le signal du TCIM. Dans une première étude, nous avons caractérisé in vivo une composante à T2 court (~500 µs) dans le muscle, et nous avons trouvé des indices qui suggèrent qu’elle représente le TCIM. Dans une deuxième étude, nous avons mis au point une méthodologie qui a permis d’imager cette composante à T2 court dans le muscle pour la première fois
Current quantitative nuclear magnetic resonance (NMR) technics offer biomarkers that allow performing non-invasive longitudinal studies for the follow up of therapeutic trials in neuromuscular disorders (NMD). In contrast to fat degeneration, the mechanisms of inflammation/oedema/necrosis and fibrosis are characteristic signs of disease activity, which makes their quantification a promising source of crucial biomarkers for longitudinal studies. This thesis work consisted on the implementation of more precise quantitative NMR methods adapted to the clinical study of skeletal muscle (SKM) for : (i) detection and quantification of sites of disease activity by T2-mapping of muscle water ; (ii) investigation of the different pathophysiological mechanisms underlying T2 alterations ; and (iii) Detection and quantification of muscle fibrosis. We implemented two methods for T2 mapping of muscle water. The first one is based on a multi-spin-echo sequence du type CPMG. In this method the 1H-NMR signals from water and lipids are acquired simultaneously. The acquired data are fitted to a tri-exponential model, in which water and fat signals are separated by exploring the T2 difference between water and fat. This method allows extraction of muscle water T2-value in the presence of fat infiltration. The second method is based on a « partially spoiled steady state free precession » (pSSFP) sequence. In contrast to the first method, which demands a sophisticated post-treatment of images acquired at 17 different echo-times, with the pSSFP a T2-mapping is extracted from two 3D data sets. 3D acquisition is compatible with spectrally selective water excitation, which eliminates signal contribution from lipids. Both methods were validated experimentally on patients and healthy subjects. The results demonstrated their capacity to detect and quantify disease activity sites. This 2 works have been published in two international journals : Azzabou, de Sousa, Araujo, & Carlier, 2014. Journal of Magnetic Resonance Imaging. DOI 10.1002/jmri.24613 (in press); et de Sousa, Vignaud, Araujo, & Carlier . 2012. Magnetic Resonance in Medicine. 67:1379-1390. Although it was shown to reveal disease activity, mono-exponential T2 of muscle water is non-specific to what concerns the mechanisms underlying its alterations. It has been long known that T2 relaxation in SKM tissue is multi-exponential. This is currently accepted to reveal anatomical compartmentation of myowater. We implemented a method for localized spectroscopic CPMG acquisition. CPMG data respect echo-time sampling and signal to noise ration limits for allowing robust multiexponential analysis. This work allowed us to establish a compartmentation model that perfectly explains the multi-exponential T2 relaxation observed in SKM tissue. This work was published in the « Biophysical Journal » (Araujo, Fromes & Carlier 2014. New Insights on skeletal muscle tissue compartments revealed by T2 NMR relaxometry. (In press)). Pilot studies performed in patients show promising results and suggest potential application of the method in clinical studies. Fibrosis starts with an excessive accumulation of intramuscular connective tissue (IMCT). We have explored the « Ultrashort time to echo » (UTE) method with the aim to detect and characterize the signal from IMCT. In a first study we characterized in vivo a short T2 component (~500 µs) in SKM, and we collected evidences suggesting that this component might reflect IMCT. Then we implemented a methodology that allowed imaging this short component in SKM tissue for the first time

Orientador: Jose Inacio de Oliveira
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: A pesquisa teve como objetivo propor um protocolo de investigação de alterações dos tecidos moles, perceptíveis à palpação em pacientes com LER/DORT. A metodologia proposta verificou, por meio de um estudo preliminar, a região a ser avaliada, a demarcação anatômica e o equipamento com especificação a ser utilizado na realização das medidas. Os sujeitos da pesquisa foram selecionados obedecendo a critérios que permitiam a verificação das alterações nos tecidos moles. A população avaliada constituiu-se de 20 homens com média de idade de 41,4 anos, massa corporal média de 76 kg, altura média de 1,71 m e índice de massa corporal (IMC) médio de 26,02 kg/m2; e de 20 mulheres com idade média de 37,9 anos, massa corporal média de 62,7 kg, altura média de 1,64 m e índice de massa corporal (IMC) médio de 23,6 kg/m2. Por meio de técnica palpatória, foi examinada a região do antebraço do membro superior dominante de dez homens e dez mulheres adoecidos com LER/DOR, e dez homens e dez mulheres sem adoecimento no membro superior, porém acometidos de lesão em outra área Os resultados foram submetidos ao cálculo da significância (p < 0,05) e determinou-se a variabilidade das amostras, testando hipóteses. Estes se apresentaram estatisticamente significantes no grupo de mulheres com adoecimento (63 cm) em comparação com as mulheres sem adoecimento (75 cm), mostrando diminuição no deslocamento tecidual na região muscular (terço proximal) do antebraço do membro superior dominante em mulheres com lesão. O fato de se obter resultados significativos no grupo de mulheres suscitou a discussão sobre o adoecimento e suas conseqüências na população trabalhadora feminina. Estudos específicos sobre gênero mostram que os riscos são maiores em mulheres, porém a distribuição da morbidade não está vinculada ao gênero. O experimento visou à elaboração de um protocolo de investigação quantitativa das aderências em tecidos moles e, ainda à comprovação metodológica da coleta desses dados. Porém verificou-se, nos resultados obtidos, possibilidades de se estabelecer parâmetros que possam, de maneira simplificada, mostrar possíveis alterações nos tecidos moles A importância prática desta investigação está na utilidade do dado quantificado para complementar e reafirmar avaliações osteomusculares para fins de diagnósticos de incapacidade em pacientes com LER/DORT. A quantificação pode auxiliar no discernimento subjetivo que envolve a avaliação desses pacientes
Abstract: The research aimed at proposing an investigation protocol for palpable soft tissues in RSI patients Through a preliminary study, the proposed methodology checked the area to be evaluated, the anatomical delimitation of this area as well as the equipment to be used for measurement and specifications. Research subjects were selected pursuant to criteria that allow for the checking of soft tissue abnormalities. The subject population consisted of 20 males averaging 41.4 years of age, 76 kg. body mass average, 1.71 m. average height and average Body Mass Index (BMI) equal to 26.02 kgm2, and 20 females averaging 37.9 years of age, 62.7 kg body mass average, 1.64 m. average height and average Body Mass Index (BMI) equal to 23 6 kgm2 Through palpation technique, the forearm area of the dominant superior limb was examined. The subjects were 10 men and 10 women diagnosed of RSI in the area under scrutiny, and 10 men and 10 women without RSI diagnosis in such area, although injured in other areas. The results were submitted to significance calculation (p < 0.05) and the variability of the samples was determined through hypothesis test These showed to be statistically significant in the positive RSI diagnosis women's group (63 cm) as compared to the healthy women sample (75 cm), the first subjects presenting tissues displacement decrease at the muscle area (proximal third) of the upper limb forearm in positive RSI diagnosis women's group. The issue of significant results having been found in the women's group raised the point of RSI in the female working population. Specific studies on gender show that risks are higher in women, however, the morbidity distribution is not linked to gender. The experiment aimed at preparing a protocol for quantitative investigation of soft tissue adherence and providing methodologic proof of the collection of those data. However, in the obtained results we saw possibilities of establishing parameters that could, in a simplified way, show possible changes in soft tissues. This investigation importance to everyday use is that this quantified datum complements and reasserts osteo-muscular evaluations for disability diagnoses of RSI patients. This quantification may aid to the subjective discernment required to the evaluation of RSI patients
Doutorado
Saude Coletiva
Doutor em Saude Coletiva

Résumé: Le muscle squelettique possède une excellente capacité à se regénérer notamment grâce à ses cellules progénitrices stromales (mrSC) et myogéniques (CPM). À la suite de certains traumas et pour des raisons encore méconnues, la qualité de sa régénération est compromise ce qui mène à l’apparition de structures aberrantes tel l’os mature, aussi appelée ossification hétérotopique (OH) post-traumatique. Notre laboratoire a montré dans un modèle murin que les mrSC sont pleinement impliquées dans cette pathologie. De plus, un facteur fortement ostéoinducteur, BMP9, ne cause l’OH que si, et seulement si, le muscle est endommagé. Ce modèle d’étude est unique puisqu’il présente les particularités physiopathologiques de l’OH post-traumatique, un dommage du muscle étant essentiel à la formation d’os. De plus, ce modèle a permis de mettre en évidence le rôle prédominant du microenvironnement des cellules progénitrices dans le développement de cette pathologie. Nous avons donc émis l’HYPOTHÈSE selon laquelle le microenvironnement du muscle endommagé contient des facteurs qui peuvent influencer le phénotype de ses cellules progénitrices stromales et myogéniques favorisant ainsi le développement de l’OH. Nos résultats montrent que l’état hypoxique d’un muscle sévèrement endommagé augmente la prolifération et la différenciation ostéogénique des mrSC. De plus, l’hypoxie induit spécifiquement l’expression de BMP9 par les mrSC. L’impact de BMP9 a également été évalué sur la différenciation des CPM. Les résultats montrent qu’à des concentrations physiologiques, BMP9 inhibe le potentiel myogénique des CPM en faveur d’une différenciation ostéogénique, et cela tant dans la lignée myoblastique murine C2C12 que chez les CPM primaires humaines. En résumé, le muscle endommagé développant l’OH possède un microenvironement spécifique responsable du débalancement de la capacité régénérative de ses progéniteurs. Nos travaux montrent que ce microenvironnement cause un retard de la myogenèse et une ostéogenèse où participeront non seulement les mrSC mais également les CPM. L’identification et la compréhension des mécanismes régulant ces facteurs s’avèrent clé pour offrir aux cliniciens des outils de diagnostic mais également des alternatives ou des approches complémentaires aux traitements prophylaxiques actuels.
Abstract: Skeletal muscle has an extraordinary ability to regenerate due to its resident stromal cells (mrSCs) and myogenic progenitor cells (MPCs). Following certain traumas, the quality of the regeneration of skeletal muscle can be compromised for unknown reasons, leading to the appearance of aberrant structures such as mature bone, a process called posttraumatic heterotopic ossification (HO). Our laboratory developed a mouse model to show that mrSCs are fully involved in this pathology. We also showed that BMP9, a highly osteoinductive factor, causes HO if and only if the muscle is damaged. This model is unique in that it recapitulates the pathophysiological features of post-traumatic HO in which muscle damage is essential for bone formation. The model was also used to show that the progenitor cell microenvironment plays a predominant role in the development of this pathology. Based on these results, we HYPOTHESIZED that the microenvironment of the damaged muscle contains factors that can influence the phenotype of its progenitor cell populations, thus promoting the development of HO. Our results showed that the hypoxic state of a severely damaged muscle increases the proliferation and osteogenic differentiation of mrSCs and also specifically induces the expression of BMP9 by mrSCs. The impact of BMP9 on the differentiation of MPCs was also evaluated. At physiological concentrations, BMP9 inhibited the myogenic differentiation potential of murine myoblast C2C12 cells and primary human MPCs, and triggered their differentiation into an osteogenic lineage. In summary, we showed that damaged muscle that develops HO has a specific microenvironment that is responsible for the loss of the regenerative capacity of progenitor cells, leading to a delay in myogenesis, and that mrSCs and MPCs are both involved in osteogenesis. The identification and understanding of the mechanisms regulating these key factors could provide clinicians with valuable diagnostic tools as well as alternative and/or complementary approaches to current prophylactic treatments.

Malignant hyperthermia (MH) is a dominant skeletal muscle disorder caused by mutations in the ryanodine receptor skeletal muscle calcium release channel (RyR1). Allele-specific differences in RyR1 expression levels might provide insight into the observed incomplete penetrance and variations in MH phenotypes between individuals. Firstly, an H4833Y allele-specific PCR (AS-PCR) assay was designed that allowed for the relative quantification of the two RYR1 mRNA alleles in heterozygous samples. In four MHS skeletal muscle samples and two lymphoblastoid cell lines (LCLs), the wild type allele was found to be expressed at higher levels than the mutant RyR1 allele. These differences were not caused by variations in RYR1 mRNA stabilities. Secondly, high-throughput amplicon sequencing was employed for the quantification of both the T4826I and H4833Y causative MH mutations in heterozygous MHS samples. With the exception of one, all detected H4833Y and T4826I mutation frequencies were about 50%. This included a control, which was constructed and proven to have a 3:1 ratio of the wild type (H4833) versus the mutant (Y4833) RYR1 allele. This suggested that that the high-throughput amplicon sequencing approach as used here, was not suitable for accurate quantification of the two RyR1 alleles in heterozygous H4833Y MHS samples. To detect possible variations in RyR1 alleles at the protein level, the RyR1 was to be isolated from microsomes prepared from a H4833Y MHS frozen skeletal muscle tissue. Microsomes isolated from MHS skeletal muscle tissues lacked the immunoreactive band that was believed to be the full length RyR1. Poor muscle quality, due to long term storage was believed to be the main cause of RyR1 depletion. Faster and less expensive screening methodologies are required for the identification of genetic variants in MH research. Thus, in an additional project inexpensive and high-throughput high-resolution melting (HRM) assays were developed to allow screening of the RYR1 gene, for mutations associated with MH and/or central core disease (CCD).

Poor health and injury represent major obstacles to the future economic security of Australia. The national economic cost of work-related injury is estimated at $57.5 billion p/a. Since exposure to high physical demands is a major risk factor for musculoskeletal injury, monitoring and managing such physical activity levels in workers is a potentially important injury prevention strategy. Current injury monitoring practices are inadequate for the provision of clinically valuable information about the tissue specific responses to physical exertion. Injury of various soft tissue structures can manifest over time through accumulation of micro-trauma. Such micro-trauma has a propensity to increase the risk of acute injuries to soft-tissue structures such as muscle or tendon. As such, the capacity to monitor biomarkers that result from the disruption of these tissues offers a means of assisting the pre-emptive management of subclinical injury prior to acute failure or for evaluation of recovery processes. Here we have adopted an in-vivo exercise induced muscle damage model allowing the application of laboratory controlled conditions to assist in uncovering biochemical indicators associated with soft-tissue trauma and recovery. Importantly, urine was utilised as the diagnostic medium since it is non-invasive to collect, more acceptable to workers and less costly to employers. Moreover, it is our hypothesis that exercise induced tissue degradation products enter the circulation and are subsequently filtered by the kidney and pass through to the urine. To test this hypothesis a range of metabolomic and proteomic discovery-phase techniques were used, along with targeted approaches. Several small molecules relating to tissue damage were identified along with a series of skeletal muscle-specific protein fragments resulting from exercise induced soft-tissue damage. Each of the potential biomolecular markers appeared to be temporally present within urine. Moreover, the regulation of abundance seemed to be associated with functional recovery following the injury. This discovery may have important clinical applications for monitoring of a variety of inflammatory myopathies as well as novel applications in monitoring of the musculoskeletal health status of workers, professional athletes and/or military personnel to reduce the onset of potentially debilitating musculoskeletal injuries within these professions.

L'hypoxie intermittente (HI), induite par les apnées du sommeil, conduit à des altérations de la sensibilité à l'insuline et de l'homéostasie glucidique mais les mécanismes impliqués restent mal connus. L'objectif de ce travail était d'étudier les effets et les mécanismes sous jacents d'une exposition chronique à l'HI sur l'homéostasie glucidique. L'HI induit une résistance à l'insuline à la fois systémique et tissulaire, ainsi qu'une amélioration de la tolérance au glucose associée à une activation de l'AMPK musculaire. L'HI cause également des altérations du foie et du tissu adipeux associées à un changement du pattern d'expression des gènes dans ces tissus et à un risque accru de développement de pathologies vasculaires comme l'athérosclérose. Enfin, la délétion de PHD1, une des protéines régulatrices de HIF-1, entraîne une résistance à l'insuline associée une stéatose hépatique, faisant de HIF-1 une cible potentielle impliquée dans les altérations metaboliques induites par l'HI
Intermittent hypoxia (IH), induced by sleep apnea, leads to alterations in insulin sensitivity and glucose homeostasis but the mechanisms involved remains poorly understood. The objective of this work was to study the effects and the underlying mechanisms of chronic exposure to IH on glucose homeostasis. IH induces both systemic and tissue-specific insulin resistance , as well as improved glucose tolerance associated with an activation of muscle AMPK. IH also causes a change in the pattern of gene expression in liver and adipose tissue and an increased risk of vascular pathologies such as atherosclerosis development. Finally, the deletion of PHD1, a regulatory protein of HIF-1, leads to insulin resistance associated with hepatic steatosis, making HIF-1 a possible target involved in the metabolic changes induced by IH

NTRODUCTION Musculoskeletal disorders (MSD) are common in industries worldwide and are a major cause of sick leave, disability and reduced productivity while at work. Many mining-related tasks in South African mines may be associated with MSDs and therefore work-related musculoskeletal disorders are likely to occur in the mining industry. Musculoskeletal disease had hitherto not been researched in the South Africa mining industry and the importance especially as an occupational disease of relevance to the mining industry needed to be considered. Discussion was held within the research tripartite structures; and based on the evidence that musculoskeletal diseases are common in labour-intensive industries worldwide and the South African miners are an ageing population, the need for determining the incidence and associated risk factors was recognized. The Mine Health and Safety Council commissioned this study because there were no studies on musculoskeletal disorders in the South African mining industry. OBJECTIVES The objectives of the study were:  To determine the incidence of musculoskeletal disorders at a South African coal, gold, and platinum mine.  To describe the anatomical sites of MSDs disorders reported by the mineworkers, the occupations and physical activities of these mineworkers and the sick leave and disability associated with the MSD at a South African coal, gold and platinum mine.  To examine associations between MSDs reported by the mineworkers and mental disorders – as measured by the Self Reporting Questionnaire-20 (SRQ-20)-, significant life events (health, assault, fright and financial problems) and social functioning (personal and work relationships and ability to relax).  To examine the association between MSDs reported by mineworkers and their home language.  To examine the association between MSDs reported by the mineworkers and usual and recent physical activities at work. METHOD The study had a mixed design i.e. an incidence study to identify mineworkers presenting to the mines’ primary care clinic with a musculoskeletal disorder and a nested case-control study involving consenting cases to investigate associations between musculoskeletal disorders and risk factors. At three South African mines (a coal mine, a gold mine and a platinum mine), mineworkers presenting to a mine clinic with a musculoskeletal disorder were recorded over a six month period. Complaints arising from acute traumatic injury (e.g. crush injuries, fractures, bruises, dislocations or amputations) were excluded. Mineworkers presenting with a medical condition not related to a musculoskeletal disorder or symptom were selected as controls. A standardized Nordic questionnaire was used to analyse musculoskeletal symptoms. The Southampton Examination Schedule was used to examine mineworkers presenting with neck and upper limb pain. The Self-Reporting Questionnaire was used to establish a possible mental disorder. Questions adapted from the Life Events and Difficulties Schedule and a rating scale for Social Functioning were used to determine psychosocial factors. Home language spoken by mineworkers was also recorded. Trained research nurses administered questionnaires to participating subjects in their preferred language. RESULTS Six hundred and ninety one cases identified at the three primary care clinics at the coal (70 cases), gold (329 cases) and platinum mine (292 cases) were included in this study. Seven hundred and one controls were identified: 81 at the coal mine, 345 at the gold mine and 275 at the platinum mine. The percentages of mineworkers employed on the mine presenting to the mine clinic with a musculoskeletal disorder over the six months of the study were 7.0% at the coal mine, 5.4% at the gold mine and 8.1% at the platinum mine. A more conservative estimate was obtained using only mineworkers who presented during office hours and who had the musculoskeletal disorder confirmed by a research nurse (termed MSD cases). The percentage of MSD cases over the six months of the study was 6.5% at the coal mine, 1.9% at the gold mine and 4.1% at the platinum mine and these data suggest an annual incidence of 130/1000, 38/1000 and 82/1000 for the coal, gold and platinum mines respectively. Lower limb pain was the most common musculoskeletal presentation at the platinum mine and at the coal and gold mine it was lower back pain. At the platinum mine, almost all the cases (96.2%) had disabling symptoms; at the gold mine and coal mine it was 65.3% and 47.1% respectively. Experience of an extremely frightening event increased the odds ratio for a musculoskeletal disorder of the upper limb, lower back and lower limb in the univariate, multivariate analyses and final models at the gold and platinum mine. A possible mental disorder (i.e. high Self-Reporting Questionnaire score) was consistently found to be negatively associated with upper limb pain, lower back pain and lower limb pain. No consistent associations were found between home language (a surrogate for ethnicity) and musculoskeletal disorders except for the upper limb. Kneeling was the only physical activity significantly associated with lower limb pain. Upper limb A recent medical diagnosis (OR = 2.6; 95% 1.2-5.7), speaking Southern Sotho (OR = 2.5; 95% CI 1.1-5.7) or Other Language (OR = 2.0; 95% CI 1.6-2.4) – i.e. Swazi, Afrikaans, Ndebele, Tswana, Portuguese, English, Tsonga or Mpondo - and working on the surface (OR =2.6; 95% CI 1.1-6.0) were associated with upper limb pain. The work activity that involved barring (OR = 0.6; 95% CI 0.4-0.9), working both on the surface and underground (OR = 0.7; 95% CI 0.5-0.8) and having a possible mental disorder (OR = 0.4; 95% CI 0.2-0.5) were negatively associated with musculoskeletal disorders of the upper limb. Lower back pain The risk factors identified were increased age and working on the surface (OR = 2.3; 95% CI 1.9-2.7). Having a possible mental disorder (OR = 0.4; 95% CI 0.4-0.5) and work activity that involved pushing (OR = 0.7; 95% CI 0.5-0.9) were negatively associated. Lower limb pain The risk factors identified were: working at a platinum mine (OR = 2.5; 95% CI 2.1-2.9), increasing age i.e. 45 years and older (OR = 3.5; 95% CI 1.0-12.4), working on the surface (OR = 2.4; 95% CI 1.02-5.6) and the physical activity of kneeling (OR = 2.9; 95% CI 1.6-5.1). Having a possible mental disorder was the only factor that was negatively associated with lower limb pain. A percentage of controls selected had had a diagnosis of musculoskeletal disorders in the past year or longer and this may have diluted associations found (i.e. 29.3% of controls had a history upper limb pain, 49.7% of controls had a history of back pain and 22% of controls had a history of lower limb pain). Therefore, the final model for each anatomical region was adjusted by including an adjustment factor (i.e. history of musculoskeletal disorder) to determine the effect a past MSD would have on the ORs. When the additional models were compared with the final model with all the controls, there were small non-significant differences for a few of the ORs while most ORs were very similar to the model including all controls without the adjustment. DISCUSSION This is the first study to determine the incidence of musculoskeletal disorders in mining in South Africa, and one of few globally in the industry. The research considered risk factors for presenting with a musculoskeletal disorder in three body regions (upper limb, lower back and lower limb). Its strengths included the large range of explanatory variables considered, which included work-related and individual characteristics. Uniquely, report of a frightening event was strongly associated with musculoskeletal disorders (at the gold and platinum mine) and a possible mental disorder was not. The estimated incidence of musculoskeletal disorders was considered high at all three mines with 6.2% of employed mineworkers presenting with a new episode of musculoskeletal pain during the study period. The United States’ Mine Health and Safety Administration database found that the incidence before technological advancements (1983-1984) was 5% and after technological advancements were implemented (2003-2004) had decreased to 4%. The highest percentage of musculoskeletal disorders at the coal and gold mine was from lower back pain. However, at the platinum mine, lower limb pain was the most common musculoskeletal disorder presentation. Surprisingly, no physical activity was found to increase the odds of presenting with upper limb or lower back pain. The reasons for this could be the large percentage of controls who had previously had upper limb or lower back pain; cases and controls preforming similar tasks; or causative exposures had been modified or workers were transferred to ‘light duty’ due to a previous MSD. However, kneeling increased the mineworkers’ odds of presenting with a lower limb disorder. This finding has been reported previously where restrictive work areas due to low ceiling height (in stope panels, for example) cause workers to perform tasks in the kneeling position, resulting in excessive pressure on the knees from body weight. Nearly 10% of cases had a possible mental disorder compared to 15.3% of controls (according to the Self-Reporting Questionnaire). Having a possible mental disorder was found to be consistently negatively associated with upper limb, lower back and lower limb pain. The reasons for this finding are unclear, further research is needed. The controls’ clinical conditions may have been associated with a possible mental disorder (for example HIV and other chronic medical conditions) or the Self-Reporting Questionnaire may not be reliable or sensitive enough for the study population. Experiencing an extremely frightening event and a recent diagnosis of a mental condition were two life events from the Life Events and Difficulties Schedule that were found to increase the odds of presenting with musculoskeletal disorders in this study. The reason or source of the fright could not be determined nor whether the fright was recurrent, prolonged or a single extreme episode which is a limitation of this finding. Working underground can be potentially frightening. Frequent earth tremors, the real threat of rock falls and consistently looking for fault lines, and activities required to secure the roof above the mineworker are part of the job, especially at the gold and platinum mine. Language is likely to be a weak surrogate for ethnicity and in this study was used in an exploratory sense. Industrialisation, urbanization, migration, and electronic media and social affiliations throughout South Africa are in a state of rapid transformation, internalising one another’s values and beliefs which make defining an ethnic group difficult. IMPLICATION FOR POLICY AND PRACTICE There is a growing understanding that mechanical overload may not be the leading cause of regional musculoskeletal pain. Therefore, both work and non-work related factors need to be considered in order to develop multifaceted interventions and programmes. The aim would be to reduce the incidence and disability of musculoskeletal disorders. Important considerations for future research in the mining industry are also discussed. Limitations of and gaps identified in this study are addressed in future research to further our understanding of a very important and potentially manageable condition.

碩士
國立臺北護理健康大學
長期照護研究所
104
In this study, the descriptive cross-sectional design is adopted with the Indonesian and Vietnamese careworkers in the long-term care facilities in the northern Taiwan taken as the subjects and a structured questionnaire is used for data collection. Researchers refusing to participate and foreign careworkers who have been on the job for less than 3 years or under the age of 20 were ruled out. The content of the questionnaire is divided into three parts: basic personal profile, the work content and frequency in the care facility (parts, symptoms and medical treatment) questionnaire. A total of 180 copies of the fully completed questionnaire was recovered. The study results show that the prevalence rate of musculoskeletal discomfort among foreign careworkers was as high as 86.1%. In particular the top three prevalence rates of discomfort parts were 72.8% for lower back, 42.2% for shoulders and 40% for upper back. Each careworker on average had 3.13 parts with musculoskeletal discomfort. Additionally according to the research findings, the 4 executions tasks by institutions foreign careworkers, including moving the patient from bedside to the wheelchair, shifting from bedside to wheelchair, shifting from wheelchair to the bathroom, lifting the patient from flat-lying position to sitting up, and adjusting the position on the wheelchair, are content of high risk susceptible to shoulder, upper back, wrist, and knee MSDs. Furthermore with regards to the forecast model of MSDs, the research findings show that the primary forecast factors include the number of days of work for foreign careworkers in Taiwan , length of care working time in Taiwan, relevant training received prior to coming to Taiwan, prior musculoskeletal discomfort symptoms before coming to Taiwan and work execution frequency For the top three MSDs parts, research findings show that the =the risk factor of lower back or lumbar discomfort are related to the execution frequency of the care work; the risk factor of shoulder discomfort is related to the level of education and the weekly working days. Additionally, the risk factor of upper back discomfort is related to the age of careworker, level of education and prior MSDs before caring for elderly in Taiwan. The study findings suggest the long-term care institutions to routinely provide proper protective devices and instruct on the care activity motions susceptible to causing MSDs during the on-the-job training and new employee training. Moreover, the institutions are suggested to analyze the parts and muscle groups affected to develop the Ergonomics Engineering Musculoskeletal Checklist suitable for future long-term care institutions, in addition to introducing the work content standards process for future long-term care institutions, designing proper assisting tools and strengthening the muscle group classes to lower the MSDs in long-term care institutions.

De acordo com a International Association for the Study of Pain, dor define-se como “uma experiência sensorial e emocionalmente desagradável, associada ou semelhante a uma lesão real ou potencial ao tecido”(Raja et al., 2020). A dor associada ao músculo esquelético e à sua fáscia define-se como dor miofascial, sendo a sua manifestação clínica de grau variável, de acordo com a sua intensidade e experiência de dor vivida pelos indivíduos. A dor miofascial é profunda, difusa e difícil de localizar. Com este estudo pretendeu-se avaliar o domínio da classe Médico-veterinária Portuguesa relativamente ao reconhecimento da dor miofascial em cães e gatos bem como, a sua inclusão como diagnóstico diferencial. O estudo consistiu na realização de um questionário de 34 questões partindo de questões mais generalistas como a avaliação do conceito de dor a outras mais específicas como tratamento implementado em quadros de dor miofascial. Foram recolhidas 150 respostas que permitiram aferir o grau de conhecimento da classe sobre esta temática. Após este estudo, observa-se a falta de consistência no conhecimento adquirido acerca da dor por parte dos clínicos inquiridos. Quando as questões se referem a dor miofascial, o nível de desconhecimento aumenta significativamente sendo que, esta diminuição de conhecimento pode ser associada à falta de estudos clínicos em medicina veterinária, principalmente na área de felinos. Espera-se que este estudo seja um importante ponto de partida para o desenho de estratégias e soluções com vista a aumentar esse conhecimento, quer na identificação deste tipo de dor, quer na sua compreensão e tratamento, em cães e em gatos.
According to the International Association for the Study of Pain, pain is defined as " an unpleasant sensory and emotional experience associated with, or resembling that associated with actual or potential tissue damage". Pain that is associated with skeletal muscle and its fascia is defined as myofascial pain. Its clinical manifestation varies according to the intensity and previous experience of pain of the individuals. Myofascial pain is deep, diffuse and hard to locate. The aim of this study was to assess the knowledge and expertise of the Portuguese veterinarian class regarding the recognition of myofascial pain in dogs and cats, as well as its inclusion as a differential diagnosis. The study consisted in a short questionnaire of 34 questions, starting from more general questions, like the evaluation of the pain concept and other more specific like the implemented treatment in cases of Myofascial pain. 150 answers were collected which allowed to assess the knowledge degree of the class about this theme. The answers were collected and statistically analyzed allowing to evaluate the class's level of knowledge on this topic. After this study, we can conclude that there is a lack of consistency in the knowledge acquired on the subject of pain by inquired clinicians. When the questions refer to myofascial pain, the level of unfamiliarity increases significantly, and this decrease in terms of knowledge may be associated with the lack of clinical studies in veterinary medicine, mainly in the feline area associated with this matter. This study is expected to be an important starting point for the design of strategies and solutions in order to increase this knowledge, both in the identification of this type of pain and in its understanding and treatment in dogs and cats.

O síndrome do túnel do carpo é a neuropatia mais frequente representando 90% das neuropatias e cujos sintomas surgem como resultado da compressão do nervo mediano. A prevalência de desenvolvimento de patologias associadas à prática clínica de medicina dentária, em especial o síndrome do túnel do carpo, apresenta valores elevados. Este tipo de doença afeta principalmente profissionais que desempenham tarefas que envolvem movimentos repetitivos e precisos. Tendo em conta as características desta patologia, o impacto causado não se cinge unicamente a um problema físico e psicológico do profissional afetado, apresentando também uma vertente económico-social implícita. A presente revisão bibliográfica tem assim como objetivo determinar o grau de vinculação entre a prática clinica e o desenvolvimento da patologia assim como o conhecimento relativo à doença e a medidas preventivas dos médicos dentistas. O trajeto metodológico foi pautado numa pesquisa teórica descritiva, através da análise documental, trabalhos de conclusão de curso de graduação e pós-graduação e dissertações com limite temporal entre 1992 e 2017 com as seguintes palavras-chave: Síndrome do túnel do carpo, Desordens músculo esqueléticas, Distúrbios músculo-esqueléticos relacionados com o trabalho, Prevalência síndrome do túnel do carpo em dentistas.
Carpal tunnel syndrome is the most frequent neuropathy representing 90% of neuropathies and the symptoms of which arise as a result of median nerve compression. The prevalence of development of pathologies associated with the clinical practice of dental medicine, especially carpal tunnel syndrome, is high. This type of illness mainly affects pro-fessionals who perform tasks involving repetitive and precise movements. Taking into account the characteristics of this pathology, the impact is not limited to a physi-cal and psychological problem of the affected professional, also presenting an implicit eco-nomic-social aspect. The purpose of this review is to determine the degree of link between clinical practice and the development of pathology as well as knowledge regarding the disease and preventive measures of dentists. The methodological course was based on a descriptive theoretical research, through documen-tary analysis, graduation and postgraduate studies, and dissertations with a time limit between 1992 and 2017 with the following keywords: Carpal Tunnel Syndrome, Muscle Disorders Skeletal disorders, Work-related musculoskeletal disorders, Prevalence carpal tunnel syn-drome among dentists.

Polycystic Ovary Syndrome (PCOS) is a common and complex endocrinopathy. The proposed pathophysiology of PCOS is a synergistic relationship between perturbed gonadotropin pulsatility, hyperandrogenism, insulin resistance and inflammation. However, the nuances of these relationships are yet to be fully elucidated. The biological origins of PCOS are driven by heritability and a polygenic predisposition that is exacerbated by environmental factors (e.g. obesity). Therefore, the aetiology of PCOS is considered multifactorial. While familial clustering of PCOS symptoms is well documented, providing evidence for a genetic contribution to the condition, lifestyle factors also mediate the influence of the underlying mechanism of PCOS. These mechanisms likely involve epigenetics, which are the molecular interactions between genetics and lifestyle. Epigenetic modifications, like DNA methylation alter chromatin structure and gene expression. These DNA modifications are associated with the pathogenesis of obesity-related chronic diseases, yet there is limited evidence in PCOS. Therefore, the overall aim of this thesis was to assess different molecular mechanisms that are postulated to contribute to the aetiology of the syndrome by i) conducting an overview of systematic reviews to synthesise the current evidence and quality of evidence for the relationship between candidate gene polymorphisms and PCOS, ii) investigate the differences in global DNA methylation in specific immune cell populations in women with and without PCOS, iii) identify differences in genome-wide DNA methylation patterns and gene expression in immune cells of women with and without PCOS, iv) to further explore molecular mechanisms of PCOS-specific insulin resistance. My research concluded that there is very little evidence in the literature to ascribe specific genetic variations in PCOS, clearly highlighting a need for standardisation in the design and analysis of genetic association studies in PCOS. I also report that immune cells in women with PCOS display hypo-methylation in T helper cells, T cytotoxic cells, B cells and monocytes. Furthermore, immune cells displayed genome-wide differential gene expression and DNA methylation patterns in T helper cells in women with PCOS. Finally, I show that PCOS-specific insulin resistance may be regulated distal to Akt via interactions with the TGFβ signalling network. In summary, this thesis advances the fundamental understanding of the molecular basis of the aetiology of PCOS and offers a novel hypothesis to drive future research to better understand the syndrome and PCOS-specific insulin resistance.