Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-10-17T20:41:06Z No. of bitstreams: 2 Tese - Giselle Bonifacio Neves Mendonça - 2013.pdf: 4442248 bytes, checksum: fd3c1ae469f5bfd89f5767680dc30981 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-17T20:45:01Z (GMT) No. of bitstreams: 2 Tese - Giselle Bonifacio Neves Mendonça - 2013.pdf: 4442248 bytes, checksum: fd3c1ae469f5bfd89f5767680dc30981 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-17T20:45:01Z (GMT). No. of bitstreams: 2 Tese - Giselle Bonifacio Neves Mendonça - 2013.pdf: 4442248 bytes, checksum: fd3c1ae469f5bfd89f5767680dc30981 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-12-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Peripheral nerves are constant targets of traumatic injuries such as crushing and partial or complete sections resulting in decrease or loss of motor function and sensitivity of the innervated area, its severity will depend on the involvement of nervous structures. The worst damage frame is that of total nerve collapse (neurotmesis), which invariably requires surgical treatment. This study aimed to evaluate the morphological and functional effects of rat’s sciatic nerve regeneration after surgical section tubing with silicone chamber and treatment with low-intensity laser (830 nm) in 126 days. We used two groups, control (GC) and laser (GL) with six animals in each. All animals underwent left sciatic nerve neurotmesis followed by tubing with silicone chamber with five mm distance between nerve stumps. Animals in GL received radiation with a wavelength of 830 nm, energy density of 4.13 J/cm², on eight points from the spinal cord to nerve injury site, totaling 40 days of irradiation divided into two distinct periods. The first stage began at the immediate post-operative period where 20 laser applications were performed on alternate days. The second stage occurred 40 days before performing euthanasia in animals submitted to more than 20 days of laser applications on alternate days. During the experiment, we performed functional assessment through the Sciatic Functional Index and Ankle Angle. After 126 days, the animals were euthanized and the fragments of the nerves were removed and fixed in 10% formalin buffered for histological analysis with HE, Luxol Fast Blue and Picrosirius Red staining, and immunohistochemistry with neurofilament antibody (NF), FGF-2 and S-100. Microscopically, we observed the presence of axonal growth, Wallerian degeneration, inflammatory infiltrate and fascicular reorganization. For HE analysis, we stablished descriptive scores and for the other histological data we carried out quantitative analysis through program Image J. In GL we observed better axonal growth, reorganization of issues, absence of inflammatory infiltrate, greater amount of myelin and less collagen, increased expression of S-100 and NF and lower expression of FGF-2. Regarding the function of the sciatic nerve, no functional improvement was observed. / Os nervos periféricos são alvos constantes de lesões de origem traumática, como esmagamento e secções parciais ou totais que resulta em diminuição ou perda da motricidade e da sensibilidade no território inervado, cuja severidade dependerá do acometimento de estruturas nervosas. O pior quadro de lesão é aquele em que ocorre ruptura total do nervo (neurotmese), o qual requer invariavelmente tratamento cirúrgico. Este estudo teve o objetivo de avaliar os efeitos morfológicos e funcionais da regeneração do nervo isquiático de rato após secção cirúrgica, tubulização com câmara de silicone e tratamento com laser de baixa intensidade (830 nm) em 126 dias. Utilizaram-se dois grupos, controle (GC) e laser (GL) com seis animais em cada. Todos os animais foram submetidos à neurotmese do nervo isquiático esquerdo, seguido de tubulização com câmara de silicone com cinco mm de distância entre os cotos nervosos. Os animais do GL receberam radiação com comprimento de onda de 830nm, densidade de energia de 4,13J/cm², em oito pontos, desde a região da medula espinhal até o local de lesão do nervo, totalizando 40 dias de irradiação divididos em dois momentos distintos. O primeiro momento iniciou-se no pós-cirúrgico imediato em que foram realizadas 20 aplicações de laser, em dias alternados. O segundo momento ocorreu 40 dias antes de realizar a eutanásia dos animais com mais 20 dias de aplicações de laser, em dias alternados. Durante o experimento procedeu-se avaliação funcional por meio do Índice Funcional do Ciático e Ângulo do Tarso. Após 126 dias os animais foram submetidos à eutanásia e os fragmentos dos nervos foram retirados e fixados em formol tamponado a 10% para análise histológica, com as colorações de HE, Luxol Fast Blue e Picrosirius Red, e imunoistoquímica com os anticorpos neurofilamento (NF), S100 e FGF-2. Microscopicamente, avaliou-se a presença de proliferação axonal, degeneração Walleriana, reorganização fascicular e infiltrado inflamatório. Para a análise do HE estabeleceram-se escores descritivos e para os demais dados histológicos procedeu-se análise quantitativa por meio do programa Image J. Observou-se no GL melhor proliferação axonal, reorganização dos fascículos, ausência de infiltrado inflamatório, maior quantidade de mielina e menor quantidade de colágeno, maior expressão de S-100 e NF e menor expressão de FGF-2. Com relação à função do nervo isquiático, não se observou melhora funcional.

Xu, Dandan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 209-231). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Alguns ramos da Medicina vêm empregando lasers ou LEDs de baixa potência em diversas especialidades. Estes lasers e LEDs são classificados como luz de baixa potência (LBP) e são usados na área de Fototerapia com comprimentos de onda na faixa do vermelho e do infravermelho. Por outro lado, a área de dosimetria utiliza dispositivos (dosímetros) capazes de estimar a energia depositada devido a exposição prévia à radiação ionizante usando luz visível como estímulo para obtenção de um sinal luminoso - esta técnica é a luminescência opticamente estimulada (OSL). O objetivo deste trabalho é avaliar a possibilidade de estimar a energia entregue por iluminação com laser e LED de baixas potências com comprimentos de onda na faixa do vermelho e infravermelho, utilizados na Fototerapia, empregando a dosimetria OSL. Foram empregados dosímetros de óxido de alumínio, óxido de berílio e fluorita natural, irradiados previamente com radiação beta (dose absorvida de aproximadamente 50 mGy), e iluminados com laser de 658 nm ou LED de 870 nm. Utilizamos o laser com potências de 10, 20, 50 e 100 mW, na faixa de energias de 0,1 a 13,2 J, e os LEDs com potências de 14,5, 58,0 e 130,5 mW, com faixa de energia entre 0,2 e 23,5 J. Para a medida de OSL foi utilizado o leitor TL/OSL Risø (modelo TL/OSL-DA-20) no modo de leitura CW-OSL e estimulo com LED de luz azul de 72 mW. A análise das curvas de emissão OSL foi feita observando tendências na modificação do sinal inicial OSL (integrado no primeiro 1s de leitura) e no sinal OSL total (integrado em 100 s) normalizados por sinal OSL obtido para irradiação padronizada. Os resultados obtidos mostraram que a iluminação com laser de 658 nm reduz o sinal OSL das amostras de óxido de alumínio para energias entre ~0,1 e ~12 J, e o sinal OSL de fluorita em uma faixa de energias mais baixa, entre ~0,1 e ~4 J. Para a iluminação com LED de 870 nm somente as amostras de fluorita mostraram redução do sinal OSL, no intervalo de ~0,1 e ~15 J de energia luminosa incidente; essa mudança foi mais acentuada para o sinal inicial da curva OSL do que para o sinal integrado. As mudanças observadas são independentes das potências luminosas empregadas. As amostras de óxido de berílio não mostraram mudanças na emissão OSL para nenhum dos feixes de luz no intervalo de energia utilizados. Além destes resultados também foi observado que a iluminação com diferentes energias luminosas incidentes nas amostras muda o formato das curvas de emissão OSL das amostras de fluorita: o tempo característico de decaimento das curvas de emissão cresce à medida que mais energia luminosa (infravermelho) é depositada nas amostras. Os resultados mostraram que a técnica OSL poderia ser utilizada para a avaliar de energia luminosa incidente no óxido de alumínio, iluminado com laser de 658 nm, e na fluorita natural, iluminada com LED de 870 nm. Para a fluorita, a mudança nas curvas de emissão OSL das amostras também pode estar relacionada com a energia luminosa incidente nela, fato que deverá ser mais bem estudado em trabalhos posteriores. / Some branches of Medicine are using low power lasers and LEDs in various specialties. These devices are classified as low-power or low-level lasers and LEDs and they are used in phototherapy in the red and infrared wavelength range. On the other hand, in dosimetry some devices (dosimeters) are used to estimate the deposited energy due to a previous exposure to ionizing radiation through a visible light stimulus to get a light signal - this technique is the optically stimulated luminescence (OSL). The objective of this study is to evaluate the possibility of assessing the energy delivered by illumination with laser and LED in the red and infrared wavelength ranges, used in the phototherapy, using the OSL technique. OSL dosimeters of aluminum oxide, beryllium oxide and natural fluorite were used. They were previously exposed to beta radiation (absorbed dose of about 50 mGy) and illuminated with 658 nm laser or 870 nm LED. The laser powers were 10, 20, 50 and 100 mW, and the light energy was in the range 0.1 to 13.2 J; and the chosen LED powers were 14.5, 58.0, 130.5 mW, delivering energies in the range 0.2 to 23.5 J. The OSL emission curves were measured with the TL/OSL Risø (TL/OSL-DA-20 model), CW-OSL mode, stimulating light provided by blue LEDs of 72 mW. The analysis of the OSL curves was carried out through the observation of trends in the variations of initial OSL signal (integrated in the first 1 s) and the whole OSL signal (integrated in 100 s) normalized by an OSL signal due to a standard irradiation. The results showed that the illumination with 658 nm laser reduces the OSL signal from aluminum oxide samples in the energy range between ~0.1 and ~12 J, and from fluorite in the energy range from ~0.1 to ~4 J. For the 870 nm LED illumination, only fluorite samples showed a reduction in the OSL signal in the range from ~ 0.1 to ~ 15 J of incident light energy. This change was more pronounced for the initial OSL signal than for the integrated signal. The observed changes were independent of the light power used in the illumination. The OSL signal of beryllium oxide samples showed no changes for any of the light beams used. It was also observed that illumination with different incident light energy changes the shape of fluorite OSL curves. The characteristic decay time of the emission curves grows as the light energy (infrared) deposited on the samples of fluorite increases. The results showed that the OSL technique could be used to evaluate the light energy incident on aluminum oxide, illuminated with 658 nm laser, and on fluorite, illuminated with 870 nm LED. For fluorite samples, the change in the OSL emission curve can also be related to the incident light energy. This fact needs further studies for a better understanding.

Purpose: To explore the difference between continuous and pulsed photobiomodulation (PBMT) versus a placebo treatment when using a red-blue light combination over multiple treatment sessions to decrease the symptoms of muscle damage in the quadriceps muscle after a bout of muscle damaging exercise. Methods: Thirty-six healthy, nonactive male and female participants were randomly assigned to one of three groups: continuous PBMT, pulsed PBMT, and placebo treatment. Participants were assessed for muscle damage with knee extension maximal isometric and isokinetic contractions, as well as Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) scores. Blood creatine kinase (CK) was also analyzed. Participants were given treatment immediately prior to undergoing a bout of damaging eccentric exercise. Participants were treated with PBMT for the next 4 consecutive days for a total of 5 treatments. Results: The continuous treatment group lost significantly less isokinetic average peak torque than the placebo treatment when averaged across all time points postexercise. However, for isometric testing, the continuous group had more reduction in force compared to the placebo group. Between the treatment groups, the continuous treatment group had significantly more muscle soreness measured by the VAS and had significantly less function in daily tasks reported on the LEFS patient-oriented outcome scale. There was no significant difference in level of creatine kinase between the treatment groups. Conclusion: Pulsed photobiomodulation treatments had no significant effect when compared to the placebo group. Continuous photobiomodulation helped to reduce isokinetic force loss, yet exacerbated all other muscle damage markers following exercise relative to the placebo condition.

Orientador: Carlos Eduardo Vergani / Resumo: Há diversas possibilidades para o controle microbiano, dentre elas, o uso de microcristais associados à prata (Ag), e a inativação fotodinâmica antimicrobiana (do inglês, aPDI). Devido à capacidade de fotoexcitação no comprimento de onda de luz azul, fosfato de prata (Ag3PO4) foi submetido à exposição a luz em 455nm. Este trabalho teve como objetivo sintetizar, caracterizar e verificar a capacidade fotocatalítica e antimicrobiana dos microcristais de Ag3PO4, utilizando culturas de C. albicans em suspensão e biofilme, na presença e ausência de luz. Os microcristais foram sintetizados pelo método da co-precipitação, e foram determinados o "gap" de energia e o espectro de absorção do material através de análise de espectro de UVVIS. Para caracterizar Ag3PO4, realizou-se a difração de raios-X (DRX), microscopia eletrônica de varredura por emissão de campo (MEV-EC) e atividade fotocatalítica (degradação de rodamina) após 4 exposições à luz. Para os ensaios microbiológicos (UFC/mL), determinou-se a concentração fungicida mínima (CFM) em suspensão e biofilme, na ausência e presença de luz (55,8 J/cm²). Para análise dos resultados, aplicou-se o teste de análise de variância de dois fatores, com teste posterior de Tukey. Os resultados demonstraram que o espectro de absorção abrange a faixa azul do comprimento de onda, apesar do maior sinal estar localizado na região de luz UV. Nos espectros de DRX observou-se a produção de prata cúbica e hexagonal no decorrer das exposições, juntament... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: There are several possibilities for microbial control, among them the use of microcrystals associated with silver (Ag), and antimicrobial photodynamic inactivation (aPDI). Due to the ability of photoexcitation in the blue light wavelength, silver phosphate (Ag3PO4) was subjected to light exposure at 455nm. Thus, the aim was to synthesize, characterize and verify the photocatalytic and antimicrobial capacity of Ag3PO4 microcrystals using cultures of C. albicans in planktonic and biofilm form, in the presence and absence of light. Microcrystals were synthesized by the coprecipitation method, the energy band gap and the absorption spectrum of the material were determined by UV-VIS spectrum analysis. To characterize Ag3PO4, Xray diffraction (XRD), field emission scanning electron microscopy (FE-SEM) and photocatalytic activity (rhodamine degradation) were performed after 4 exposures to light. For the microbiological tests (CFU/mL), the minimum fungicidal concentration (MFC) in planktonic and biofilm was determined, in the absence and presence of light (55.8 J/cm²). To analyze the results, a two-way analysis of variance (ANOVA) was applied, followed by Tukey post-test. The results showed the absorption spectrum covers the blue wavelength range, although the largest peak is located in the UV light region. The XRD spectra produced cubic and hexagonal silver during the exposures, with an increase of amorphous material. The microcrystal size was observed (0.12 μm) by FE-SEM images, wi... (Complete abstract click electronic access below) / Mestre

This thesis consists of two major chapters, each with its own introduction, experimental section and discussion. The TG4T/daunomycin and G4/daunomycin complexes described in Chapter One are two out of only five crystallographic quadruplex/ligand structures reported to date. In both structures daunomycin molecules stack onto a terminal G quartet preventing the G4 quadruplex from destacking and unwinding. The number of interacting ligand molecules depends on the quadruplex structure itself. The G4 quadruplex can accommodate four daunomycin molecules within one layer, while the TG4T tetraplex only accommodates three. In both structures daunosamine moieties form hydrogen bonds with the quadruplex but only daunosamine moieties from the TG4T/daunomycin structure make slight incursions into the quadruplex grooves. Both structures are stabilised by π-π interactions, hydrogen bonds, Van der Waals contacts and electrostatic interactions. The daunomycin/TG4T complex is the first ever reported and the only structure where a ligand interacts directly with the quadruplex groove. Chapter Two describes nine crystal structures of Hoechst 33258 analogues with d(CGCAAATTTGCG)2 and d(CGCGAATTCGCG)2 oligonucleotides, and is divided into two sections. Section A includes seven structures with Halogenated Hoechst 33258 analogues that are potential agents in radiotherapy, phototherapy, radioimmunotherapy or photoimmunotherapy, and the structure of the precursor. In all of the examined complexes the ligand binds to the minor groove but not all halogen substituents refine to 100% occupancy. The refined occupancies of the halogen atoms reveal that the degree of carbon-halogen cleavage is highest for ortho and lowest for para substitution. Among meta substituents pointing outside the minor groove, bromine atoms had a higher occupancy than the larger iodines. The position of the halogen atom in the minor groove is influenced by additional substituents on the phenyl ring. In most cases the bulky halogen atom is facing outside of the minor groove. Only in the 3-iodo-5-isopropylHoechst complex is iodine positioned towards the floor of the groove allowing the big isopropyl group to face outside. Section B describes the structure of a carborane-containing ligand (JW-B) bound to the minor groove of d(CGCAAATTTGCG)2. The analysis shows that is possible to position boron-rich moieties close to the cell nucleus, and JW-B may have potential in Boron Neutron Capture Therapy. / Data file restricted at the request of the author, but available by individual request, use the feedback form to request access.

<p>En stor del av personalen inom Hälso- och Sjukvården har sin arbetstid förlagd till natten. Vi vet idag att det är mycket ogynnsamt att arbeta nattetid och att det höjer risken att utveckla flera sjukdomar. Nattarbete och roterande skiftarbete stör och påverkar den naturliga dygnsrytmen i kroppen. Kan vi hjälpa kroppen att anpassa sig bättre till nattskiftsarbete med hjälp av ljusterapins effekter? Ljusterapi är, vad vi känner till idag, en säker behandling med få eller inga biverkningar. Den är lätt att administrera, relativt billigt och flexibel att utföra. Det optimala verkar vara, enligt vår nuvarande kunskap, att få ljusterapibehandling intermittent under nattpasset, kombinera detta med att använda sig av mörka solglasögon när man tar sig hem samt sedan att lägga sig att sova så snart som möjligt efter hemkomsten i ett mörkt rum. Ljusterapi hjälper speciellt inför längre perioder av nattpass men har också en mycket god effekt på att återställa den inre klockan till dag-dygnsrytm igen efter avslutad nattperiod. Ljusterapibehandling visar sig hjälpa även mot problem med ett förtidigt uppvaknande, som är ett vanligt fenomen vid nattarbete, och effekten av behandlingen kan kvarstå i upp till en månad. Den positiva höjningen av funktionsnivån som även inträffar kan också kvarstå så länge.</p>

Bilirubin is a degradation product of haem, which is constantly formed in all mammals. Increased levels of bilirubin in humans lead to jaundice, a condition that is very common during the first days after birth. This neonatal jaundice can routinely be treated by phototherapy without any serious side effects. During this treatment, bilirubin undergoes a photoreaction to isomers that can be excreted. The most efficient photoreaction is the isomerisation around a double bond (Z-E-isomerisation), which results in more soluble photoproducts. The work presented in this thesis shows results of a femtosecond optical spectroscopy study, combined with quantum-mechanical investigations, of the mechanism of isomerisation of bilirubin. The spectroscopic research was conducted with bilirubin in organic solvents, and in buffer complexed by human serum albumin. This albumin complex is present in the blood, and has thus medical importance. Quantum-chemical calculations (CASSCF) on a bilirubin model were used to explain experimental results. The fluorescence decay observed with femtosecond spectroscopy shows an ultrafast component (~120 fs), which is explained by exciton localisation, followed by processes with a lifetime of about 1-3 ps. These are interpreted as the formation of a twisted intermediate, which decays with a lifetime of 10-15 ps back to the ground state, as observed by absorption spectroscopy. CASSCF calculations, in combination with the experimental results, suggest the ca. 1-3 ps components to be relaxation to the twisted S1 minimum, followed by the crossing of a barrier, from where further relaxation takes place through a conical intersection back to the ground state. Time-dependent DFT calculations were utilised to analyse the absorption spectrum of bilirubin. Good agreement with the measured spectrum was achieved, and low-lying states were observed, that need further investigation. The theoretically obtained CD spectrum provides direct evidence that bilirubin preferentially binds to human serum albumin in the enantiomeric P-form at neutral pH. / Bilirubin är en nedbrytningsprodukt av hem som ständigt bildas hos alla däggdjur. En förhöjd bilirubinkoncentration i den mänskliga kroppen kan leda till gulsot, något som är mycket vanligt under de första dagarna efter födelsen (neonatal gulsot). Fototerapi används rutinmässigt som säker behandlingsmetod, under vilken bilirubin genomgår en fotoreaktion till en isomer som kan utsöndras. Den mest effektiva fotoreaktionen är en Z-Eisomerisation, vilken leder till lösligare fotoprodukter. Arbetet som presenteras i denna avhandling visar resultaten av en kombinerad femtosekund optisk-spektroskopisk och kvantmekanisk undersökning av mekanismen bakom bilirubins isomerisation. Den spektroskopiska studien genomfördes med bilirubin, löst i organiska lösningsmedel och i buffert i komplex med humant serumalbumin. Detta albuminkomplex finns i blodet, och är därför av medicinskt intresse. Kvantmekanistiska CASSCFberäkningar på en bilirubinmodell användes för att förklara de experimentella resultaten. Det uppmätta fluorescence sönderfallet visar ultrasnabba komponenter (~120 fs). Dessa tolkas som excitonlokalisering, som följs av bildandet av ett vridet intermediat med en hastighetskonstant på ca. 1 ps-1(beroende på lösningsmedlet). Absorptionsmätningar visar att detta intermediat sönderfaller tillbaka till grundtillståndet med en livstid på 10-15 ps. CASSCF beräkningar, i kombination med de experimentella resultaten, tyder på att sönderfallet med livslängden på ca. 1 ps är en relaxation till det vridna S1-tillståndet. Reaktionsvägen därifrån antas passera en barriär till en konisk genomskärning, som möjliggör snabb relaxation till grundtillståndet. Tidsberoende DFT-beräkningar användes för att analysera bilirubins absorptionsspektrum, vilket gav bra överensstämmelse med uppmätta data. Dessutom hittades ett tillstånd med låg excitationsenergi, som kräver ytterligare studier. Med hjälp av det beräknade CD-spectret kunde det visas att bilirubin binder till albumin i P-formen vid neutralt pH.

En stor del av personalen inom Hälso- och Sjukvården har sin arbetstid förlagd till natten. Vi vet idag att det är mycket ogynnsamt att arbeta nattetid och att det höjer risken att utveckla flera sjukdomar. Nattarbete och roterande skiftarbete stör och påverkar den naturliga dygnsrytmen i kroppen. Kan vi hjälpa kroppen att anpassa sig bättre till nattskiftsarbete med hjälp av ljusterapins effekter? Ljusterapi är, vad vi känner till idag, en säker behandling med få eller inga biverkningar. Den är lätt att administrera, relativt billigt och flexibel att utföra. Det optimala verkar vara, enligt vår nuvarande kunskap, att få ljusterapibehandling intermittent under nattpasset, kombinera detta med att använda sig av mörka solglasögon när man tar sig hem samt sedan att lägga sig att sova så snart som möjligt efter hemkomsten i ett mörkt rum. Ljusterapi hjälper speciellt inför längre perioder av nattpass men har också en mycket god effekt på att återställa den inre klockan till dag-dygnsrytm igen efter avslutad nattperiod. Ljusterapibehandling visar sig hjälpa även mot problem med ett förtidigt uppvaknande, som är ett vanligt fenomen vid nattarbete, och effekten av behandlingen kan kvarstå i upp till en månad. Den positiva höjningen av funktionsnivån som även inträffar kan också kvarstå så länge.

Eine Erhöhung des Bilirubins über 2 mg/dl betrifft 90 % aller Neugeborenen. Sie ist meist physiologisch und tritt optisch sichtbar bei 60-70 % dieses Kollektivs auf. In der pathologischen, exzessiv erhöhten Form ist sie der häufigste Grund für eine stationäre Wiederaufnahme während der ersten sieben Lebenstage. Ihre schwerste Komplikation, der Kernikterus, scheint - trotz allgemein verfügbarer, preiswerter und sicherer Therapiemöglichkeiten - wieder vermehrt aufzutreten. Die Gründe liegen im Überwachungsdefizit bei früher Entlassung von schlecht aufgeklärten Eltern, Nichtbeachtung der Besonderheiten der Neugeborenen ≤ 38 Schwangerschaftswochen und der zunehmenden Tendenz zum Stillen bei häufig unzureichender Anleitung. Ferner werden ikterische Kinder nur zu oft lediglich visuell bezüglich des Grades der Bilirubinämie eingeschätzt und die Therapie somit erheblich verzögert. Gegenstand dieser Arbeit ist die Frage, ob aus der Dynamik des Serumbilirubinspiegels von der Geburt bis zum 3. Lebenstag die Wahrscheinlichkeit des Auftretens einer phototherapiepflichtigen Hyperbilirubinämie abgeschätzt werden kann. Dazu wurde der Serumbilirubinspiegel direkt postnatal aus dem Nabelschnurblut, bzw. am 3. Lebenstag gleichzeitig mit dem Stoffwechselscreening ermittelt und der Phototherapiebedarf im Verlauf festgehalten. Um die Aussage zu präzisieren, wurde die Studienpopulation aus 2573 Kindern weiter unterteilt in 2180 reife tAGA- (hier Eu- und Hypertrophe), 267 reife tSGA-Kinder (Hypotrophe) und 126 FG (Frühgeborene). In allen 3 Gruppen korrelierten das Nabelschnurbilirubin und der Serumbilirubinwert vom 3. Lebenstag positiv mit der Entwicklung einer Hyperbilirubinämie. Anhand dieser Ausgangswerte konnten Grenzen für Hoch-, Mittelhoch-, Mittelniedrig- und Niedrigrisikogruppen definiert werden, welche die Entwicklung einer Hyperbilirubinämie mit einer Wahrscheinlichkeit von ≥ 20 %, 5-20 %, 0 < x <5 % und 0 % voraussagen. Damit kann man bereits früh eine Vorabselektion entsprechend dem Gefährdungspotential treffen und die Verlaufskontrollen entsprechend terminieren. Als Risikofaktoren einer therapiepflichtigen Hyperbilirubinämie wurden außerdem Frühgeburtlichkeit, seltener tSGA, geringes Geburtsgewicht und niedriges Gestationsalter (in der vorliegenden FG-Gruppe nicht signifikant) gefunden. Im Falle einer Sectiogeburt und bei Zuhilfenahme von Hilfsmitteln im Rahmen einer vaginalen Entbindung nahm der Bedarf an Phototherapie in der tAGA- und tSGA-Gruppe zu.