https://tede.unioeste.br/handle/tede/6314 2026-11-02T19:54:26Z https://tede.unioeste.br/handle/tede/8726 Title: Perda de força muscular do assoalho pélvico em portadoras de câncer de mama e mecanismos moleculares associados Autor: Silva, Cristiane Dallastra Candido da Primeiro orientador: Ribeiro, Lucinéia de Fátima Chasko Abstract: Breast cancer is the neoplasm that most affects women worldwide, in both developed and developing countries. Among the risk factors are hereditary, genetic, and environmental factors, with exposure to pesticides being correlated with an increased probability of disease development. Due to its inflammatory and systemic nature, survivors may develop new diseases or dysfunctions. Evidence demonstrates that breast cancer patients present loss of muscle strength, including that of the pelvic floor (PF). Pro-inflammatory mediators such as tumor necrosis factor alpha (TNF-α) and oxidative stress metabolites participate in the molecular mechanisms associated with this loss. Although there is no direct established correlation between elevated levels of pro-inflammatory cytokines and specific weakness of PF muscles, it is plausible that similar mechanisms affect this musculature given its composition and function. Thus, the objective of this study was to characterize pelvic floor muscle strength in breast cancer patients and investigate the clinical profile and associated molecular markers. The sample consisted of a total of 122 participants with infiltrating ductal carcinoma (IDC) treated at the 8th Regional Health Unit of Paraná – Brazil. After collecting sociodemographic data, clinical and gynecological data, and occupational pesticide exposure, pelvic floor muscle strength was measured through perineometry tests, with reference values between 0 and 46.4 mmHg, and bidigital palpation through pelvic floor assessment (PFA) with a scale between 0 and 5. Plasma levels of TNF-α and oxidative stress levels were quantified through lipoperoxide measurements by high sensitivity chemiluminescence, as well as levels of nitric oxide metabolites (NOx). Quantitative variables were evaluated with appropriate statistical tests, using GraphPad Prism 9.0, RStudio, and SPSS software, and p-values below 0.05 were considered statistically significant. Pelvic floor muscle strength of 73.8% of women was classified as mild to moderate through perineometry, and 61.5% of women had weak and non-resistant perineal function through PFA. A negative correlation was observed between perineometry values and TNF-α and NOx, indicating worse pelvic floor muscle conditions with increased levels of these inflammatory markers (p=2.06e-07 and p=1.700e-02). A significant correlation was also identified between PFA and the patients' pesticide exposure profile (p=0.0223), as well as a significant negative correlation with perineometry (p=0.0404). The group exposed to pesticides (n=66) presented lower perineometry values (95% CI: 0.007-0.409). Significant differences were also found between patients with unsatisfactory PFA and perineometry results with elevated TNF-α values, suggesting that this cytokine may be a mediator of pelvic floor strength loss in breast cancer (p=0.0001). Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese 2026-06-23T00:00:00Z https://tede.unioeste.br/handle/tede/8601 Title: Modulação dos processos inflamatórios e da morfofisiologia periarticular promovida pelo treinamento resistido preventivo em modelo experimental de artrite reumatoide Autor: Silva, Flávia Heloísa da Primeiro orientador: Bertolini, Gladson Ricardo Flor Abstract: Introduction: Rheumatoid arthritis (RA) is a chronic, autoimmune, and systemic inflammatory disease, characterized by joint inflammation that causes progressive degradation of joint and periarticular tissues, resulting in pain, stiffness, and functional loss. Associative complementary strategies, such as resistance training, have been explored due to their potential benefits in reducing inflammation and improving patient functionality. However, protocols are applied after the onset of RA symptoms, when the inflammatory process and tissue degradation are already advanced, and little is known about their prophylactic effects. Objective: To analyze the effects of resisted stair climbing exercise (TRSE), as a prophylactic strategy to reduce the inflammatory process and morphofunctional damage in periarticular tissues, in an experimental model of RA. Methods: For this purpose, 34 Wistar rats, with an initial age of 12 weeks, were distributed into four experimental groups: control group (GC, n=9), arthritis group (GA, n=9), exercise group (GE, n=8), and exercise + arthritis group (GEA, n=8). The animals in the exercise groups underwent progressive intensity and volume TRSE for nine weeks, configuring a high-intensity protocol, and were subjected to it before the induction of RA, which was promoted through intra-articular administration of Complete Freund's Adjuvant (CFA). To measure the edema and functionality of the affected limb, five assessments were performed: joint diameter, joint disability, grip strength, nociceptive sensitivity, and motor function. The animals were euthanized in the 11th week of the experiment by a CO2 and guillotine associative method. The following was collected: synovial fluid, for leukocyte migration analysis; peritoneal lavage, for macrophage counting and function analysis; plasma and lymph node, for oxidative system enzyme analysis; the rectus femoris muscle, for histomorphometric and histopathological analyses, fiber typing, histochemistry of the Neuromuscular Junctions – NMJs, and oxidative stress biomarkers. For statistical analysis, the Generalized Linear Model (GLM) was used, through the JAMOVI Program, with a significance level of p<0.05, using post-hoc tests, Tukey, or Bonferroni adjustment. Results: The TRSE promoted the reduction of the inflammatory process, oxidative stress, histopathological index, and intramuscular connective tissue of the rectus femoris in the GEA group, when compared to the GA group. In some markers, such as TNF-α, muscular IL1-β, and plasma SOD activity, there was no difference between the GEA and GE groups. The similarity of superoxide levels, macrophage count, and lysosomal retention between the GEA and GC groups, associated with the reduction of H2O2, NO, and macrophage adhesion rate in the peritoneal lavage, suggests modulation of systemic inflammation by TRSE. However, these outcomes were not reflected in a significant improvement in the functional outcomes assessed. Conclusion: High-intensity preventive TRSE showed a limited protective effect, with a reduction in inflammatory and oxidative markers, partially preserving the morphology of the rectus femoris muscle, without significant functional repercussions. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese 2026-03-20T00:00:00Z https://tede.unioeste.br/handle/tede/8564 Title: Impactos do exercício físico contra resistido de salto em meio aquático em modelo experimental de artrite reumatoide associada à periodontite Autor: Schnaufer, Thaís Caroline Primeiro orientador: Nassar, Patrícia Oehlmeyer Abstract: Introduction: Rheumatoid arthritis (RA) and periodontitis are chronic inflammatory diseases that share similar immune-inflammatory mechanisms. The bidirectional relationship between these diseases involves genetic, environmental, and immune inflammatory factors, contributing to systemic exacerbation. Furthermore, not all alterations associated with RA are reversed by pharmacological treatment, and in periodontitis, physical exercise has shown potential as a complementary strategy. In this context, resistance exercise in an aquatic environment emerges as a promising approach due to its potential immunomodulatory effects. Objective: To analyze the impacts of an aquatic resisted jumping exercise protocol as a complementary strategy for minimizing inflammatory, tissue, and functional damage caused by the simultaneous presence of experimentally induced rheumatoid arthritis and periodontitis in Wistar rats. Methodology: Forty-six male Wistar rats were distributed into six groups: control group (CG, n=7), exercise group (EXG, n=8), periodontitis group (PG, n=8), rheumatoid arthritis group (RAG, n=8), periodontitis + rheumatoid arthritis group (PRAG, n=7), periodontitis + rheumatoid arthritis + exercise group (PRAEXG, n=8). RA was induced by inoculation of Freund’s Complete Adjuvant, and periodontitis was induced by ligature placement. Eight assessments of nociceptive threshold and joint diameter were performed. After 22 days, the animals were euthanized, and synovial fluid from the right knee was collected for analysis of total leukocyte count and IL-17. The left hemimandibles and right knee joints were collected and processed for histomorphometric analysis. Results: The RA-induced groups showed an increase in joint diameter, confirming the onset of the disease. However, PRAEXG showed a significant reduction in diameter as early as EV4, whereas the PRAG showed a reduction only starting at EV5. Regarding leukocyte migration, althought there was no statistically significant difference, the PRAG presented a higher number of leukocytes compared to PRAEXG, however, no difference was observed in IL-17 expression. The nociceptive threshold decreased in the RA groups; however, the PRAEXG showed an increase at EV5, whereas the PRAG did not show a significant increase throughout the evaluation period. In the synovial membrane score analysis, the RA groups presented higher scores; however, morphologically, the PRAG showed clusters of inflammatory cells, a feature that was absent in the exercise group. In the histometric of the hemimandibles, the groups with periodontitis showed alveolar bone resorption; however, the PRAEXG presented the lowest value for the distance between the alveolar bone crest and the cementoenemal junction, as well as a lower number of osteoclasts compared to the PRAG group. Conclusion: Although some variables did not show a statistically significant difference, aquatic resisted jumping exercise had positive impacts, particularly in reducing edema and increasing the nociceptive threshold, suggesting its potential as a complementary strategy in the management of these chronic inflammatory conditions. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese 2026-03-06T00:00:00Z https://tede.unioeste.br/handle/tede/8560 Title: Disfunções evacuatórias após a cirurgia bariátrica: avaliação clínica, funcional e resposta à fisioterapia pélvica. Autor: Sousa, Marcieli Schuster Primeiro orientador: Bonfleur, Maria Lúcia Abstract: Obesity is a major public health concern and is associated with multiple comorbidities, including pelvic floor muscle dysfunctions (PFMD), which negatively affect quality of life. Although bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity, further studies are needed to investigate its effects on anorectal function, particularly regarding the occurrence of symptoms, functional alterations, and therapeutic approaches during the postoperative period. The aim of this thesis was to analyze the occurrence of defecatory dysfunctions and functional alterations in patients who underwent bariatric surgery, as well as to evaluate the effects of pelvic floor physiotherapy combined with electromyographic biofeedback on the treatment of these alterations. This thesis comprised a retrospective observational study and a longitudinal physiotherapeutic intervention study conducted at a gastroenterology and pelvic floor physiotherapy center in Cascavel, Paraná, Brazil. Data were collected between January and September 2022. A total of 1,639 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2019 were included, comprising 1,184 women (72.3%) and 455 men (27.7%). In the first study, the occurrence of anorectal symptoms and anorectal manometric alterations was investigated, with comparative analyses according to sex. In the second study, patients presenting symptoms of defecatory dysfunction who were referred for pelvic floor physiotherapy combined with electromyographic biofeedback were evaluated using the Constipation Scoring System (CSS), the Cleveland Clinic Fecal Incontinence Score (CCFIS), and electromyographic assessment before and after the intervention. Statistical analyses were performed using a significance level of 5% (p < 0.05). Among the 1,639 patients evaluated, 477 (29.1%) presented anorectal symptoms after bariatric surgery, with constipation being the most frequently reported symptom. Of these, 91 patients underwent anorectal manometry, and 64 received physiotherapeutic treatment. Differences in symptom profiles were observed between men and women; however, manometric alterations, such as sphincter hypotonia and anismus, occurred similarly in both sexes. Patients who underwent physiotherapeutic intervention showed significant improvement in constipation and fecal incontinence, accompanied by increased pelvic floor muscle activity. In conclusion, anorectal symptoms are common after bariatric surgery and are associated with relevant functional alterations. Furthermore, pelvic floor physiotherapy combined with electromyographic biofeedback proved to be an effective strategy for treating these dysfunctions. Publisher: Universidade Estadual do Oeste do Paraná Tipo do documento: Tese 2026-06-10T00:00:00Z