by Stephen Eugene Parr. / Typescript. / Thesis (Ph. D.)--Florida State University, 2000. / Includes bibliographical references (leaves 445-456).

Orientador: Meliza Goi Roscani / Resumo: Os efeitos favoráveis de um programa de exercício físico combinado (EFC) em pacientes com insuficiência cardíaca (IC) e fração de ejeção ventricular esquerda reduzida (FEVER) são bem reconhecidos na literatura. Acredita-se que os efeitos benéficos do EF não se devam à melhora da FEVE. Por outro lado, alguns estudos apontaram para efeitos benéficos do EF na função diastólica do VE. Tendo em vista a importância da pressão de enchimento do VE na sintomatologia dos pacientes com IC, levantou-se a hipótese de que de que um programa de EFC e supervisionado é capaz de promover melhora na função diastólica em pacientes com IC com FEVE < 50%, e que esse efeito está associado à diminuição dos sintomas, refletindo em melhora da CF e da QV nesses pacientes. Objetivos: avaliar o efeito do EFC na função diastólica de pacientes com IC de FEVE reduzida e investigar se a melhora na função diastólica é fator associado à melhora dos sintomas, capacidade funcional e qualidade de vida desses pacientes. Metodologia: trata-se de um ensaio clínico prospectivo, randomizado e controlado, que incluiu pacientes com IC e FEVE <50%, acima de 18 anos. A amostra foi composta por 42 pacientes, distribuídos em 2 grupos pareados por idade e sexo: grupo controle (GC) n=20 - submetidos à prescrição já realizada nas consultas de rotina para prática de atividade física regular não supervisionada. Grupo intervenção (GI) n=22 - submetidos a um programa de exercício físico supervisionado composto por exercício aerób... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The favorable effects of a combined exercise program (CEP) in patients with heart failure (HF) and reduced left ventricular ejection fraction (RLVE) are well recognized in the literature. There is consensus that physical exercise (PE) improves quality of life (QOL) and functional capacity (FC) in patients with HF. It is believed that the beneficial effects of PE are not due to the improvement of LVEF. On the other hand, some studies indicated beneficial effects of PE on LV diastolic function. Given the importance of LV filling pressure in symptoms of HF patients, the hypothesis of this study was that an CEP supervised program should promote improvement in diastolic function in patients with HF with LVEF <50% and this effect may be associated with decreased symptoms, reflecting improvement in FC and QOL in these patients. Objective: evaluate the effect of ECF in diastolic function in patients with reduced LVEF IC and investigate whether the improvement in diastolic function is r associated with improvement in symptoms, functional capacity and quality of life of these patients. Methodology: Prospective clinical trial, randomized and controlled, which included patients with HF and LVEF <50%, above 18 years. The sample consisted of 42 patients, divided into two groups matched for age and sex: the control group (CG) n = 20 - submitted to prescription in clinical practice of regular physical activity, not supervised. Intervention group (IG) n = 22 - underwent a physical exercise pr... (Complete abstract click electronic access below) / Mestre

Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...

Na hipertensão, a hipertrofia ventricular esquerda desenvolve-se como um mecanismo de adaptação ao aumento da pós-carga para manter o estresse da parede e preservar a função sistólica do ventrículo esquerdo. Paradoxalmente, estudos epidemiológicos identificaram a hipertrofia como um fator de risco de maior mortalidade cardiovascular. É possível que mudanças estruturais associadas, tais como a diminuição da reserva coronariana, possam comprometer esta adaptação e, assim, produzir hipertrofia patológica. O resultado esperado é a diminuição da sobrevida. Pacientes com miocardiopatia dilatada hipertensiva têm sobrevida menor quando comparados a pacientes com função sistólica preservada. É possível que na miocardiopatia a sobrevida seja pior quando a diminuição da reserva resultar em maior prejuízo da função ventricular. O objetivo deste trabalho foi investigar o papel da reserva coronariana na fisiopatologia da hipertrofia cardíaca por meio do estudo prospectivo da função ventricular esquerda e da sobrevida de pacientes com miocardiopatia dilatada hipertensiva. De 1996 a 2000, 45 pacientes com hipertensão arterial, 30 homens, com idade média de 52±11 anos e fração de encurtamento do ventrículo esquerdo <30% foram incluídos e acompanhados até 2006. O Doppler transesofágico da artéria coronária descendente anterior foi utilizado para a medida da reserva da velocidade do fluxo coronariano. O seguimento clínico foi de 6,9±1,9 anos (mediana=6,9; mínimo=1,8; máximo=10,3 anos). Dezesseis pacientes apresentaram aumento Z10% da fração de encurtamento do ventrículo esquerdo após 17±6 meses. A reserva da velocidade do fluxo coronariano foi a única variável relacionada de modo direto e independente com a melhora da função sistólica. Quatorze pacientes faleceram após 5,2±2,0 anos (1,8 a 8,0 anos). A sobrevida em 10 anos foi 62%. A análise univariada identificou associações significativas e positivas da mortalidade com o gênero masculino, a idade e o índice de massa do ventrículo esquerdo; e associações significativas e negativas da mortalidade com a reserva da velocidade do fluxo coronariano, a pressão arterial e a fração de encurtamento do ventrículo esquerdo. O modelo de riscos proporcionais de Cox identificou a reserva da velocidade do fluxo coronariano (razão de chance=0,814, IC95%=0,719-0,923, P=0,001), o índice de massa do ventrículo esquerdo (razão de chance=1,121, IC95%=1,024-1,228, P=0,014), a pressão arterial diastólica (razão de chance=0,940, IC95%=0,890-0,992, P=0,025) e o gênero masculino como fatores de risco independentes para a mortalidade. Estes resultados sugerem que a diminuição da reserva coronariana afeta negativamente o prognóstico tardio da miocardiopatia dilatada hipertensiva, possivelmente por impedir a melhora da disfunção ventricular esquerda / In hypertension, left ventricular hypertrophy develops as an adaptive mechanism to compensate for increased afterload in order to maintain wall stress and thereby preserve systolic function. Paradoxically, epidemiological studies identified hypertrophy as an independent risk factor for cardiovascular mortality. Associated structural changes such as coronary reserve impairment may potentially interfere with this adaptive mechanism and produce pathologic hypertrophy. A poorer outcome is likely to result. Survival is expectedly shorter in patients with hypertensive dilated cardiomyopathy as compared to patients with preserved systolic function is expected. We speculate that survival would be further impaired as long as left ventricular function is put in jeopardy by inappropriate coronary reserve. The aim of this study was to evaluate the role of coronary reserve in the progress of left ventricular hypertrophy by prospectively investigating systolic function and survival in patients with hypertensive dilated cardiomyopathy. From 1996 to 2000, 45 hypertensive patients, 30 men, aged 52±11 years, with left ventricular fractional shortening <30% were enrolled and followed up until 2006. Coronary flow velocity reserve was assessed by means of transesophageal Doppler of the left anterior descendent coronary artery. The duration of follow-up was 6.9±1.9 years (1.8 to 10.3 years). Sixteen patients showed a Z10% improvement in left ventricular fractional shortening after 17±6 months of follow-up. Coronary flow velocity reserve was the only variable independently and positively related to the improvement in systolic function. Fourteen patients died after 5.2±2.0 years (1.8 to 8.0 years). The 10-year survival rate was 62%. Univariate analysis identified significant and positive associations of mortality with male gender, age, creatinine, and left ventricular mass index. Negative associations were found for coronary flow velocity reserve, blood pressure and left ventricular fractional shortening. The Cox proportional hazards model identified coronary flow velocity reserve (hazard ratio=0.814, 95%CI=0.719-0.923, P=0.001), left ventricular mass index (hazard ratio=1.121, 95%CI=1.024-1.228, P=0.014), diastolic blood pressure (hazard ratio=0.940, 95%CI=0.890-0.992, P=0.025), and male gender as independent predictors of mortality. The present findings suggest that coronary reserve impairment affects negatively the long term outcome of hypertensive dilated cardiomyopathy possibly by impeding the improvement of left ventricular systolic dysfunction

O objetivo desta dissertação é construir uma hipótese de mecanismo causal do esquerdismo nos governos de esquerda renovadora da América Latina a partir do estudo de caso do racha à esquerda do Frente Amplio (FA) do Uruguai, e testar esta hipótese com o caso do racha à esquerda do Partido dos Trabalhadores (PT) do Brasil. Utilizando theory building process-tracing, a partir da literatura sobre partidos políticos foram elaboradas, e testadas no caso uruguaio, três hipóteses de partes de mecanismo causal, as quais estabelecem: (i) o movimento ao centro feito pelo FA para atingir objetivos eleitorais é parte do mecanismo causal do racha da fração 26M; (ii) as situações de crise com o governo do Presidente Tabaré Vázquez se constituíram em parte do mecanismo causal do racha do 26M; e (iii), a diminuição das oportunidades do 26M de incidir na toma de decisões do FA, combinada com sua perda de zonas de incerteza dentro do partido, tornou- se parte do mecanismo causal do racha desta fração. As evidências apresentadas para cada hipótese suportaram o Hoop test, o que deu um alto poder confirmatório das hipóteses, porém, não permitiu descartar hipóteses alternativas. Com base nos resultados do caso Uruguaio, se construiu uma hipótese de mecanismo causal dos processos de esquerdismo nos governos de esquerda renovadora da América Latina que contém 8 partes, as entidades (atores) e ações envolvidas em cada uma delas. Por fim, utilizando theory-testing process-tracing, se fizeram apontamentos sobre o funcionamento da hipótese no caso do processo das frações que racharam com o PT e formaram o Partido Socialismo e Liberdade (PSOL). As evidências apresentadas neste caso não foram submetidas a testes empíricos, porém, de maneira geral, não diminuíram nossa confiança na hipótese de mecanismo causal. Inclusive, se produzindo uma trajetória divergente entre as frações que derivou na estruturação em dois momentos do PSOL, não foi necessário adicionar de maneira ad-hoc partes para o mecanismo, pois as foças causais foram transmitidas pelas partes nele estabelecidas, encurtando-o no caso das frações que racharam no primeiro momento, e percorrendo-o parte por parte, no caso da fração que rachou no segundo momento. / The aim of this Master\'s dissertation is to construct a causal mechanism hypothesis of leftism in the Latin American renovation of left-wing governments. This will be reviewed in two parts: starting with the case study of the split in the left of the Frente Amplio (FA) party of Uruguay, and furthermore to test the hypothesis with the case study of the split in the left of the Partido dos Trabalhadores (PT) of Brazil. Using theory- building process-tracing from literature about political parties, three hypotheses of parts of causal mechanism were elaborated and tested in the Uruguayan case, which established that: (i) the movement towards the center made by the FA to achieve electoral objectives was part of the causal mechanism of the split of the fraction 26M; (ii) crisis situations with the government of President Tabaré Vázquez were part of the causal mechanism of the split of 26M; and (iii) the reduction of 26M\'s opportunities to influence FA decision-making process, combined with the loss of zones of uncertainty within the party, became part of the causal mechanism of fracture of this fraction. The evidences presented for each hypothesis withstood the Hoop test, which gave a high confirmatory power to the hypotheses, however, they did not allow for the disregard of alternative hypotheses. Based on the results in the case of Uruguay, a hypothesis of causal mechanism of the leftist processes in the Latin American renovation of left-wing governments was constructed, which contains 8 parts, the entities (actors) and actions involved in each one of them. Finally, using theory-testing process-tracing, notes were made on the functionality of the hypothesis in the process of fractions that broke with the PT and formed the Partido Socialismo e Liberdade (PSOL). The evidence presented in this case was not subjected to empirical tests, however, in general, it did not diminish our confidence in the causal mechanism hypothesis. Even if there was a divergent trajectory between the fractions that resulted in the structuring in two moments of PSOL, it was not necessary to add parts to the mechanism ad-hoc, because the causal forces were transmitted to the parties in it, shortening it in the case of the fractions that broke initially, and going part by part, in the case of the fraction that broke after.

INTRODUÇÃO: A doença de Chagas tem patogênese não totalmente conhecida. Ao contrário das funções sistólica e diastólica do ventrículo esquerdo, a função do átrio esquerdo carece de informações. OBJETIVOS: Em portadores de doença de Chagas, com ou sem alterações eletrocardiográficas, com ou sem disfunção sistólica de ventrículo esquerdo, verificar se há diferença nos parâmetros de função atrial esquerda e se há correlação entre dados de função de átrio esquerdo e parâmetros ecodopplercardiográficos de função ventricular sistólica e diastólica de ventrículo esquerdo MÉTODOS: 85 indivíduos: 10 controles (GC), 26 na forma indeterminada (GI), 30 com alterações eletrocardiográficas somente (GII) e 19 com disfunção ventricular (GIII), submetidos a ecocardiograma para avaliação da função atrial e das funções sistólicas e diastólicas ventriculares. Para analise estatística foi utilizado teste de Kruskal-Wallis e o coeficiente de Spearman. RESULTADOS: Função de reservatório (FET: fração de esvaziamento total): Houve diferença entre os grupos (p < 0,0001), média menor no GIII comparado ao GC (p = 0,003), ao GI (p < 0,001) e GII (p < 0,001), sem diferença entre GC, GI e GII. Fluxo de veias pulmonares: na onda S houve diferença entre os grupos (p = 0,003), média menor no GIII comparada ao GC (p = 0,01). Função de conduto (FEP: fração de esvaziamento passivo): houve diferença entre os grupos (p = 0,004), média menor no GIII, sem significância estatística comparando entre os grupos (GIII e GC, p = 0,06, GI e GII, p = 0,06, e GII e GIII, p = 0,07). Função de bomba propulsora (FEA: fração de esvaziamento ativo): houve diferença entre os grupos (p = 0,0001), média menor no GIII comparado ao GC (p = 0,05), ao GI (p < 0,0001) e ao GII (p = 0,002). Correlações: E/e\'média e FET: fraca correlação negativa (r = - 0,263; p = 0,02), moderada correlação negativa no GIII (r = - 0,58; p = 0,02). E/e\'média e FEP: não houve correlação (r = - 0,09; p = 0,44). E/e\'média e FEA: moderada correlação negativa (r = -0,36; p = 0,002) e no GIII (r = - 0,57; p = 0,04). e\'média e FET: moderada correlação positiva (r = 0,53; p < 0,0001). e\'média e FEP: moderada correlação positiva (r = 0,49; p < 0,0001). e\'média e FEA: moderada correlação positiva (r = 0,39; p = 0,001). Fração de ejeção do VE e FET: moderada correlação positiva (r = 0,35; p = 0,003) e no GIII (r = 0,52; p = 0,04). Fração de ejeção do VE e FEP: moderada correlação positiva (r = 0,42; p < 0,0001). Fração de ejeção do VE e FEA: moderada correlação positiva (r = 0,35; p = 0,003). CONCLUSÕES: Em pacientes com miocardiopatia chagásica com disfunção sistólica de ventrículo esquerdo, houve comprometimento das funções de reservatório, de conduto e bomba propulsora do átrio esquerdo e aqueles com função sistólica normal não apresentaram alterações nessas funções / BACKGROUND: Chagas disease (CD) pathogenesis is not fully known. Unlike the systolic and diastolic function of the left ventricle, the left atrial function still lacks information. OBJECTIVES: The aim of this study was to observe differences in patients with CD regarding the parameters of left atrial function and correlate them with Doppler echocardiographic parameters CASUISTIC AND METHODS: 85 subjects: 10 controls (GC), 26 in the indeterminate form (GI), 30 with ECG changes and normal left systolic function (GII) and 19 with left ventricular dysfunction (GIII) underwent echocardiography to assess left atrial and ventricular systolic and diastolic functions RESULTS: Reservoir function (TEF: total emptying fraction): there was a difference between groups (p <0.0001), lower mean in GIII compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001) with no difference between GC, GI and GII. Pulmonary veins flow: the S wave was no difference between groups (p = 0.003), lower mean in GIII compared to the CG (p = 0.01). Conduit function (PEF: passive emptying fraction): there was a difference between groups (p = 0.004), lower mean in GIII, without statistical significance between groups (GIII and GC, p = 0.06, GI and GII, p = 0.06, and GII and GIII, p = 0.07). Pump function (AEF: active emptying fraction): there was a difference between groups (p = 0.0001), lower mean in GIII compared to CG (p = 0.05), GI (p <0.0001) and GII (p = 0.002). Correlations: E/e\'mean and TEF: weak negative correlation (r = - 0.263, p = 0.02), moderate negative correlation in GIII (r = - 0.58, p = 0.02). E/e\'mean and PEF: no correlation (r = - 0.09, p = 0.44). E/e\'mean and AEF: moderate negative correlation (r = -0.36, p = 0.002) and GIII (r = - 0.57, p = 0.04). e\'mean and TEF: moderate positive correlation (r = 0.53, p <0.0001). e\'mean and PEF: moderate positive correlation (r = 0.49, p <0.0001). e\'mean and AEF: moderate positive correlation (r = 0.39, p = 0.001). LV ejection fraction and TEF: moderate positive correlation (r = 0.35, p = 0.003) and GIII (r = 0.52, p = 0.04). LV ejection fraction and PEF: moderate positive correlation (r = 0.42, p <0.0001). LV ejection fraction and AEF: moderate positive correlation (r = 0.35, p = 0.003). CONCLUSIONS: In patients with Chagas\' cardiomyopathy with left ventricular systolic dysfunction, there was impairment of the functions of reservoirs, conduit and pump of the left atrium

Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...

The purpose of this thesis is to investigate the phenomenon of populism in Sweden among the Sweden Democrats and the Left Party, as well as their youth unions young Swedes and young left. The study applies the tool VDP analysis in which it is used as an instrument on the parties and their youth unions to identify ideas that mainly constitute their policy. To define populism, one uses Cas Mudde's definition as well as the four subtypes of populism: Complete populism, Exclucionary populism, Anti-elitist populism and Empty populism. The criteria for the different subtypes are tested with the help of the information from the VDP analyzes in order to apply a subtype and to identify differences between moderators and youth associations. The study shows that the Sweden Democrats' survey criteria for complete populism are similar to their youth union. The Left Party and the Young Left result is in criteria for anti-elitist populism. The study also shows that parties and youth unions do not differ in populist subtypes, but youth unions tend to stand out more in their policies compared to their parent parties. / Studies syfte är att undersöka fenomenet populism i Sverige hos Sverigedemokraterna och Vänsterpartiet, samt deras ungdomsförbund Ungsvenskarna och Ung Vänster. Studien tillämpar verktyget VDP-analys som används som ett instrument på partierna och deras ungdomsförbund för att identifiera de idéer som huvudsakligen utgör deras politik. För att definiera populism använder sig studien av Cas Muddes definition samt de fyra subtyperna tunn-centrerad populism, anti-elitistisk populism, exkluderande populism och fullständig populism. Kriterierna för de olika subtyperna prövas med hjälp av informationen från VDP-analyserna för att dels applicera en subtyp, dels för att identifiera skillnader mellan moderparti och ungdomsförbund. Studien visar att Sverigedemokraterna uppfyller kriterierna för fullständig populism likt deras ungdomsförbund. Vänsterpartiet och Ung Vänster uppfyller kriterierna för anti-elitistisk populism. Studien visar också att partierna och ungdomsförbunden inte skiljer sig i populistisk subtyp men ungdomsförbunden tenderar att sticka ut mer i sin politik jämfört med deras moderpartier.

Crocodiles are ectothermic, intermittent breathing reptiles with low metabolic rates. Additionally, they are diving animals that can stay submerged for long periods, which poses special demands on their cardiovascular system. The crocodilian heart is four-chambered with completely separated ventricles, making it unique among other reptiles. It has special anatomical structures that give it the capability to shunt blood away from the lungs, which results in mixing of deoxygenated and oxygenated blood. The purpose of this study was to morphologically describe the heart and review its functions and the significance of its circulatory patterns. Dissection of two crocodilian hearts was performed for morphological characterization of the heart, including the special features that contribute to the shunting: the left aorta, the foramen of Panizza and the cog-teeth-like valves. Obstruction of the pulmonary outflow tract by the cog-teeth-like valves decreases pulmonary blood flow and generates an increased right ventricular pressure, diverting venous blood into the ‘extra’ left aorta and the systemic circulation. Thus, during shunting conditions, venous blood from the left aorta and arterial blood from the right aorta is mixed. The functional significance of this shunting pattern has been extensively discussed and several hypotheses have been proposed. A recent study showed that the absence of the right-to-left shunt does not affect the diving physiology of crocodiles negatively, but it did result in cardiac hypertrophy, indicating that the shunt might have a significance for the circulation and physiology of extant crocodiles.

Indiana University-Purdue University Indianapolis (IUPUI) / In 1956 a cadre of Marxist historians in Britain created what would come to be known as the New Left. The New Left in Britain took the form of a loose affiliation of scholars and intellectuals whose goal it was to create a space for socialist change within and between the existing structures in the British labor movement. These intellectuals greatly influenced socialist thought in the aftermath of Stalinsim and paved a way forward for future socialist activism. Existing works on the group analyze its impact and assess its successes and failures. By placing an emphasis on understanding the conditions that existed during the making of the First New Left, the following historical analysis argues that these assessments within the historiography require revision.