Standardisation of the description of patellofemoral motion and comparison between different techniques.

Accepted versio

Health for all, or not?

UNIFESP-EPMLondon University Royal London HospitalUNIFESP, EPMSciEL

Oral presentations at scientific meetings: some hints and tips

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MorfologiaUNIFESP, EPM, Depto. de MorfologiaSciEL

Publish or perish: a provocation

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

From thesis to publication of a paper: some ideas and suggestions

Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Understanding Clinical and Patient Reported Response of Children and Young People with Cerebral Palsy to Botulinum Toxin A: A Longitudinal Observational Study (The Toxin Study)

Background Botulinum Toxin A (BoNT-A) is an established treatment for focal spasticity in children and young people with spastic cerebral palsy (CYPwCP). A systematic review of the available literature within this thesis highlighted that the published evidence for BoNT-A effectiveness is mostly related to short term outcomes focused on impairment level, relating to restriction of body functions and structures, rather than more meaningful measures of activity and participation. Aims To determine the effect of lower limb BoNT-A on ambulant CYPwCP by evaluating outcome across the WHO’s International Classification of Functioning and Disability (ICF) domains of body structure and function, activity and participation and change in movement quality over a 12-month period and investigate whether clinical outcomes reflect children and families’ experience of BoNT-A treatment. Method A prospective observational mixed methods longitudinal study used a one group repeated measures design conducted in two phases. In Phase I the Quality Function Measure and the Canadian Occupational Performance Measure were used to evaluate change in movement quality and evaluate goal attainment following lower limb BoNT-A treatment. Change was also evaluated throughout the ICF domains of body structure and function, activity and participation, using a number of secondary outcome measures (64 CYPwCP). In Phase II semi-structured interviews with a subgroup of families from Phase I explored CYPwCP and parents experience of BoNT-A treatment (Phase II: 18 CYPwCP). Results There was a significant improvement in movement quality and goal attainment across the 12 months following BoNT-A. Spasticity was significantly reduced at 6 weeks with mixed results at 6 and 12 months, dependent on the muscles injected. Functional balance and gait improvements, although improved at 6 weeks, only reached clinical significance at 6 and 12 months, respectively. However, clinically significant improvement in motor function and participation outcomes were seen at 6 weeks post BoNT-A and these were maintained across 12 months. CYPwCP and their families described improvements in movement quality and short term reduced stiffness following injections which were associated with increased activity, improved participation opportunities and increased confidence and self esteem

Protocol for The Toxin Study: Understanding clinical and patient reported response of children and young people with cerebral palsy to intramuscular lower limb Botulinum neurotoxin-A injections, exploring all domains of the ICF. A pragmatic longitudinal observational study using a prospective one-group repeated measures design

INTRODUCTION: Botulinum neurotoxin-A (BoNT-A) is an accepted treatment modality for the management of hypertonia in children and young people with cerebral palsy (CYPwCP). Nevertheless, there are concerns about the long-term effects of BoNT-A, with a lack of consensus regarding the most meaningful outcome measures to guide its use. Most evidence to date is based on short-term outcomes, related to changes at impairment level (restrictions of body functions and structures), rather than changes in adaptive skills (enabling both activity and participation). The proposed study aims to evaluate clinical and patient reported outcomes in ambulant CYPwCP receiving lower limb BoNT-A injections over a 12-month period within all domains of the WHO's International Classification of Functioning, Disability and Health and health-related quality of life (HRQoL). METHODS AND ANALYSIS: This pragmatic prospective longitudinal observational study will use a one-group repeated measures design. Sixty CYPwCP, classified as Gross Motor Function Classification System (GMFCS) levels I-III, aged between 4 and 18 years, will be recruited from an established movement disorder service in London, UK. Standardised clinical and patient reported outcome measures within all ICF domains; body structures and function, activity (including quality of movement), goal attainment, participation and HRQoL, will be collected preinjection and at 6 weeks, 6 months and up to 12 months postinjection. A representative subgroup of children and carers will participate in a qualitative component of the study, exploring how their experience of BoNT-A treatment relates to clinical outcome measures. ETHICS AND DISSEMINATION: Central London Research Ethics Committee has granted ethics approval (#IRAS 211617 #REC 17/LO/0579). Findings will be disseminated in peer-reviewed publications, conferences and via networks to participants and relevant stakeholders using a variety of accessible formats including social media

Efeito da profundidade de colocação do tubo de rega gota-a-gota na uniformidade de rega e na eficiência do uso da água em tomate de indústria

RESUMO A influência da profundidade da colocação dos gotejadores na uniformidade de rega e na eficiência do uso da água foi avaliada, durante dois anos, num ensaio em “split-plot”, com quatro repetições, sendo o tratamento principal a profundidade de colocação do tubo de rega: à superfície do solo (P0), a 20 cm (PI) e a 40 cm (PII) e o secundário a cultivar: Brigade e H3044. Nos dois anos, o débito médio dos gotejadores foi semelhante nos diferentes tratamentos. Os coeficientes de uniformidade (CU) e de variação (CV) e a uniformidade de distribuição (UD), determinados após a colheita da cultura, não foram afectados pela profundidade de colocação do tubo, tendo variado respectivamente, entre 96,5 e 98,2%, 1,91 e 4,15% e 94,5 e 97,4%. A rega gota-a-gota subsuperficial, comparativamente com a superficial, contribuiu para o aumento da eficiência do uso da água (Produção comercial/ETa) em 14%, fundamentalmente devido a uma diminuição da ETa, na fase inicial da cultura

Osteocytic connexin 43 is not required for the increase in bone mass induced by intermittent PTH administration in male mice

Objective: To investigate whether osteocytic connexin 43 (Cx43) is required for the bone response to intermittent PTH administration, and whether the connexin is involved in maintaining the bone matrix. Methods: Human PTH(1-34) was injected to adult male mice expressing (Cx43fl/fl) or not osteocytic Cx43 (Cx43fl/fl;DMP1-8kb-Cre) daily (100 μg/kg/d) for 14 days. Results: Cx43fl/fl;DMP1-8kb-Cre mice have no difference in body weight and BMD from 1 to 4 months of age. Intermittent PTH administration increased BMD and BV/TV and induced a similar increase in type I collagen, alkaline phosphatase, runx2, osteocalcin, and bone sialoprotein expression in mice from both genotypes. On the other hand, osteocytic deletion of Cx43 did not alter mRNA levels of glycosaminoglycans, proteoglycans, collagens and osteoblast-related genes. In addition, expression of collagens assessed by immunohistochemistry was not affected by deleting osteocytic Cx43. However, PTH administration increased type II collagen only in Cx43fl/fl control mice, whereas hormone increased type I collagen expression only in Cx43fl/fl;DMP1-8kb-Cre mice. Furthermore, PTH increased maturity of collagen fibers in control, but not in Cx43-deficient mice. Conclusion: Expression of Cx43 in osteocytes is dispensable for bone anabolism induced by intermittent PTH administration; but it can modulate, at least in part, the effect of PTH on the bone matrix environment