Made available in DSpace on 2015-04-14T13:30:36Z (GMT). No. of bitstreams: 1 461460.pdf: 3408472 bytes, checksum: 83ab10ad1632af7f932c8259fd899ec5 (MD5) Previous issue date: 2014-08-06 / Purpose: The pharyngeal airway may change after mandibular advancement in patient using intraoral device in obstructive sleep apnea (OSA) treatment. The aim of this study was to evaluate the dimensional and volumetric changes of superior airway promoted by an adjustable mandibular advancement device (AMAD) and the polysomnographic results in patients with OSA facial pattern facial Cl II. Materials and Methods: The present prospective study selected 11 patients with OSA (5 males and 6 females) and radiographs and ct scans, and polysomnographic exam were performed with and without the use of AMAD. The airway was assessed in the following aspects: superior pharyngeal space (S1), posterior palatal space (S2), median pharyngeal space (S3), posterior pharyngeal space (S4), inferior pharyngeal space (S5), pharyngeal volume (CT1), anterior-posterior lengths of the smallest cross-sectional area (CT2), lateral lengths of smallest cross-sectional area (CT3), pharyngeal smallest cross-section area (CT4). The analyzed variables of the polysomnographic data were: AH total (total number of apnea and hypopnea), AHI (apnea and hypopnea index - calculated as the average number of respiratory events per hour of sleep); AI (Apnea index), HI (Hypopnea index), Apnea duration, Hypopnea duration, Lowest O2% saturation. Results: The use of the AMAD induced an insignificant decrease of the pharyngeal airway as observed in the S1 (20.091 to 20.01mm decrease of -0,26%) and S4 (11.08 to 10.59mm decrease of -4.2%). A not statistically significant increase was observed in S2 (8.33 to 9.43mm increase of 13.67%), S3 (18.23 to 18.34mm increase of 1,2%) and CT1 (13393 to 15948 mm3 increase of 19,07%). Statistically significant increases were observed in S5 (11.92 to 15.67mm increase of 47.08%), CT2 (media of 5.81 to 7,71mm increase of 32,7%), CT3 (17,3 mm to 22,33 mm increase of 29.07%) and CT4 (79,77 to 119,38 mm2 increase of 49.65%), and determined a significant decrease of the variables total AH (159,9 to 54,8 reduction of 34,27%), AHI (21,57 to 7,54 decrease of 34.95%) and AI (17,33 to 3,99 reduction 23,1%). A nonsignificant reduction in the duration of apnea (16,4 to 14,7 reduction of 10.36%), Hypopnea (18.42 to 16,94 reduction of 8.03%). A nonsignificant increase of HI (3.26 to 3.29 increase of 0.92%), Lowest O2% saturation (76.6 to 82.9 increase of 8.22%). Conclusions: A correlation between the mandibular advancement and changes in the measurements of pharyngeal airway were significant with the use of AMAD in the inferior pharyngeal space (S5), anterior posterior lengths of smallest pharyngeal cross-sectional area (CT2), lateral lengths of smallest pharyngeal cross-sectional area (CT3), and pharyngeal smallest cross-section area (CT4), and polysomnographic data showed a significant improvement with the reduction of the variables AH total, AHI, HI. Results showed that the use of the AMAD allows an increase of the superior airway and improves important variables of the polysomnography exam, being the lateral teleradiography, CT scan and polysomnography are effective methods for the diagnosis and evaluation of the treatment s progress. / Objetivo: A via a?rea faringiana pode mudar ap?s o avan?o mandibular promovido por aparelhos intra-orais para o tratamento de apn?ia obstrutiva do sono (OSA). O objetivo deste estudo foi avaliar as altera??es dimensionais e volum?tricas da via a?rea superior promovida pelo o uso de um aparelho intra-oral ajust?vel de avan?o mandibular (AMAD) bem como os resultados polissonograficos em pacientes com OSA padr?o facial Cl II. Materiais e M?todos: O estudo prospectivo selecionou 11 pacientes (5 homens e 6 mulheres) sendo realizados telerradiografias de perfil, tomografias computadorizadas, e exame polissonografico com e sem o uso do AMAD. A via a?rea foi avaliada nos seguintes aspectos: espa?o faringeano superior (S1), espa?o palatal posterior (S2), espa?o faringiano m?dio (S3), espa?o faringiano posterior (S4), espa?o faringiano inferior (S5), volume faringiano (CT1), di?metro antero-posterior da menor ?rea de sec??o faringeana (CT2), dimens?o lateral da menor ?rea de sec??o far?ngea (CT3), ?rea de menor sec??o faringiana transversal (CT4), e os exames polissonogr?ficos foram avaliados as vari?veis AH total (numero total de apn?ias e hipoapn?ias), AHI (?ndice de apn?ia e hipoapn?ia), AI (?ndice de apn?ia), HI (?ndice de hipoapn?ia), dura??o de apn?ia, dura??o de hipoapn?ia, menor satura??o O2%. Resultados: O uso do AMAD gerou uma redu??o da via a?rea faringiana n?o significativa observada em S1 (20.091 para 20.01mm - diminui??o de -0,26%) e S4 (11.08 para 10.59mm - diminui??o de -4.2%). Um aumento estatisticamente n?o significante foi observado em S2 (8.33 para 9.43mm - aumento de 13.67%), S3 (18.23 para 18.34mm - aumento de 1.2%) e CT1 (13393 para 15948 mm3 aumento de 19.07%). Um aumento estatisticamente significante foi observado em S5 (11.92 para 15.67mm aumento de 47.08%), CT2 (5.81 para 7.71mm aumento de 32.7%), CT3 (17,3 mm para 22,33mm - aumento de 29.07%) e CT4 (79,77 para 119,38 mm2 aumento de 49.65%), e determinou uma diminui??o significativa das vari?veis AH total (159.9 para 54.8 redu??o de 34.27%), AHI (21.57 para 7.54 redu??o de 34.95%) e Al (17.33 para 3.99 redu??o de 23.1%). Uma redu??o n?o significativa da dura??o de apn?ia (16,4 para 14,7 redu??o de 10,36%), hipoapn?ia (18,42 para 16,94 redu??o de 8,03%). Um aumento n?o significativo do HI (3,26 para 3,29 aumento de 0,92%), menor satura??o de O2% (76,6 para 82,9 aumento de 8,22%). Conclus?es: A rela??o entre o movimento de avan?o mandibular e as altera??es das medidas da via a?rea faringiana foram observadas de forma significativa com o uso do AMAD nos espa?o faringiano inferior (S5), dimens?o antero-posterior da ?rea de menor sec??o transversa da faringe (CT2), dimens?o lateral da ?rea de menor sec??o transversa da faringe (CT3), e ?rea de menor secc?o transversa (CT4), bem como os dados polissonogr?ficos demonstraram uma melhora significativa com a redu??o das vari?veis AH total, AHI, e HI. Os resultados demonstraram que o uso do AMAD promove um aumento da via a?rea superior e melhora vari?veis importantes do exame polissonogr?fico, sendo a a teleradiografia lateral, tomografia computadorizada e a polissonografia m?todos eficazes para o diagn?stico e evolu??o do progresso dos tratamentos.

Made available in DSpace on 2015-04-14T13:30:43Z (GMT). No. of bitstreams: 1 379482.pdf: 432300 bytes, checksum: 8e1c6e8fb25bee18cc6031da14769d13 (MD5) Previous issue date: 2006-03-31 / Foi realizado um estudo "antes-e-depois", com o objetivo de avaliar a resposta ao uso de um aparelho intra-oral (AI) para o tratamento de pacientes obesos m?rbidos portadores da S?ndrome das Apn?ias/Hipopn?ias Obstrutivas do Sono (SAHOS) grave. A amostra foi composta por 5 pacientes com ?ndice de massa corporal (IMC) maior que 40 kg/m2 e ?ndice de Apn?ias/Hipopn?ias (IAH) maior que 30 eventos/h, observados em uma polissonografia inicial. Os pacientes utilizaram um aparelho intra-oral por uma m?dia de 34,6 dias, e foram submetidos a uma segunda polissonografia, para comparar o IAH, a satura??o de oxig?nio arterial (SaO2), a menor SaO2 (nadir) e a efici?ncia do sono, e question?rios de sonol?ncia (Epworth) e satisfa??o, antes e depois do uso do aparelho. Em que pese os resultados tenham demonstrado mudan?as nos par?metros avaliados, estas n?o foram estatisticamente significativas pelo teste dos sinais (p > 0,05). O IAH teve redu??o de 18,17%, por?m, tal melhora apenas reduziu a gravidade da SAHOS. Sugere-se que tratamento de SAHOS grave com AIs em pacientes obesos m?rbidos seja rigorosamente controlado por polissonografia

Despite best available care, uncontrolled chronic kidney disease (CKD) - a complex disease that impacts millions in the United States, will eventually progress to end stage renal disease which is associated with high morbidity and mortality. New evidence suggests management of earlier stages of CKD is effective in delaying disease progression. This project evaluated the impact of a CKD class, led by a nephrology nurse practitioner, on preventing disease progression in advanced CKD patients with diabetes and hypertension. The purpose of the class was to validate the need for the advanced practice nurse (APN) in the care continuum of CKD. CKD education is a quality improvement project based on the chronic illness trajectory nursing model by Corbin and Strauss. Using a case-control method and a simple descriptive statistic to compare the mean values, retrospective data from 52 patients were analyzed. Twelve non-participating patients had a mean 7% increase in serum creatinine levels at the 1-year mark. Forty participating patients saw a mean decrease of 30% serum creatinine. With significant evidence suggesting that disease progression is delayed and renal function is improved in all study markers for patients who participated in a CKD education class led by a nephrology nurse practitioner and who received usual care - an argument can be made for updating the APN role in the continuum of care for those with CKD. The results may contribute to social change by providing improved access to quality care that addresses the socioeconomic devastation of end stage renal disease.

Simulation as a pedagogy is used extensively to educate healthcare professionals in both academic and clinical arenas with the intent to improve the delivery of care and patient outcomes. Advanced practice nursing (APN) programs use simulation as a pedagogy even though APN accreditation and certification organizations prohibit substituting simulation hours for the minimum 500 clinical hours. The purpose of this qualitative study was to explore faculty perceptions of educating APN students using simulation. Focus groups were conducted with a convenience sample of APN simulation faculty. Disruptive innovation theory was used by the researchers to guide the data analysis. Themes emerging during analysis included: 1) extrinsic tension and pressure in the midst of chaos, 2) internal vulnerability, and 3) passion and tenacity to remain resilient. The study results provide clarity to understand integration of APN simulation in the current environment, and introduce the impact of simulation as a disruptive innovation.

Made available in DSpace on 2015-04-14T13:32:36Z (GMT). No. of bitstreams: 1 380037.pdf: 427173 bytes, checksum: dd58ac356bab719f2e622dadcac6a4ec (MD5) Previous issue date: 2006-05-26 / Objetivo: Sintomas de dist?rbios respirat?rios do sono (DRS) s?o comuns na inf?ncia, e sua preval?ncia n?o ? conhecida em crian?as brasileiras. Esse estudo tem por objetivo verificar a preval?ncia e fatores de risco de sintomas de DRS em uma amostra de escolares de 8 a 13 anos de Uruguaiana-RS. M?todo: Estudo transversal (n =1.119), utilizando question?rios sobre sintomas de DRS, asma e rinite respondidos pelos pais. Atopia foi investigada por testes cut?neos. Resultados: Foram obtidos 998 question?rios. Ronco habitual (RH) foi descrito em 27,6% das crian?as, apn?ia em 0,8%, respira??o oral (RO) diurna em 15,5% e sonol?ncia diurna excessiva (SDE) em 7,8%. Crian?as com SDE apresentaram maior risco de RH (OR 2,7; IC 95%1,4 5,4), apn?ia (OR 9,9; IC95% 1,2 51 ), RO (OR 13,1; IC 95% 6,2 27,4) e problemas de aprendizado (OR 9,9; IC95% 1,9 51,0). Regress?o log?stica m?ltipla mostrou que RH estava significativamente associado a tabagismo materno, atopia e rinite. Fatores de risco para RO foram tabagismo materno, morar em zona pobre, hist?ria familiar de rinite, asma, atopia e bronquiolite. Apn?ia foi mais comum em escolares com asma, bronquiolite, rinite, atopia. Rinite ativa ocorreu em 18,9% das crian?as, com atopia associada em 21%. Conclus?es: Sintomas de DRS s?o muito comuns em crian?as de 8 a 13 anos de Uruguaiana-RS. A preval?ncia de RH foi quase duas vezes a descrita nessa faixa et?ria. RH esteve associado ? atopia. A maioria das crian?as com rinite apresentava teste cut?neo negativo. Crian?as de melhor n?vel s?cio-econ?mico foram mais propensas a apresentar rinite e apn?ia. SDE foi significativamente associada a RH, apn?ia, RO e problemas de aprendizado.

Made available in DSpace on 2015-04-14T13:32:52Z (GMT). No. of bitstreams: 1 434658.pdf: 305027 bytes, checksum: f2fdad4a5c84cd6cf9fe0edec84a35ed (MD5) Previous issue date: 2011-08-30 / OBJETIVO: Avaliar o efeito da suc??o n?o nutritiva (SNN) com chupeta em rec?m-nascidos prematuros de muito baixo peso numa unidade de tratamento intensivo neonatal (UTIN). M?TODOS: Acompanhamos quarenta e quatro rec?m-nascidos prematuros com idade gestacional &#8804;32semanas e peso de nascimento <1500g, ap?s 7 dias de vida, n?o necessitando de ventila??o mec?nica ou press?o positiva cont?nua nas vias a?reas. Ap?s obtermos consentimento informado, os rec?m-nascidos prematuros foram randomizados em 2 grupos: com chupeta, oferecida durante a interna??o na unidade de tratamento intensivo neonatal (grupo 1) e sem chupeta (grupo 2). No grupo 1 a recomenda??o foi oferecer chupeta durante a dieta por gavagem e nos momentos em que os pacientes estivessem acordados. As informa??es foram obtidas posteriormente atrav?s dos registros do monitor, avalia??o das filmagens e resultado do registro poligr?fico. RESULTADOS: Os grupos estudados apresentaram caracter?sticas bastante semelhantes na entrada ao estudo, entretanto, n?o houveram diferen?as estatisticamente significativas entre os 2 grupos n?o se evidenciando modifica??es nos padr?es respirat?rios dos prematuros avaliados, comparando a utiliza??o ou n?o da suc??o n?o nutritiva com o uso da chupeta. CONCLUS?O: Os resultados sugerem que a suc??o n?o-nutritiva com o uso da chupeta, n?o altera o padr?o respirat?rio, numa popula??o de prematuros que freq?entemente utiliza surfactante, press?o positiva cont?nua nas vias a?reas e xantinas precocemente

Vectorial Boolean functions are used as S-boxes in cryptosystems. To design inequivalent vectorial Boolean functions resistant to known attacks is one of the challenges in cryptography. Verifying whether two vectorial Boolean functions are equivalent or not is the final step in this challenge. Hence, finding a fast technique for determining whether two given vectorial Boolean functions are equivalent is an important problem. A special class of the equivalence called restricted extended affine (REA) equivalence is studied in this thesis. We study the verification complexity of REA-equivalence of two vectorial Boolean functions for some types, namely types I to VI. We first review the verification of the REA-equivalence types I to IV given in the recent work of Budaghyan and Kazymyrov (2012). Furthermore, we present the complexities of the verification of REA-equivalence types I and IV in the case basic simultaneous Gaussian elimination method is used. Next, we present two new REA-equivalence types V and VI with their complexities. Finally, we give the algorithms of each type I to VI with their MAGMA codes.

L'Aminopeptidase-N (APN ou CD13) [EC.3.4.11.2] est une ectoenzyme homodimérique de nature glycoprotéique appartenant à la famille M1 des zinc-aminopeptidases. Elle est surexprimée à la surface des cellules endothéliales angiogéniques, ainsi que sur un certain nombre de cellules tumorales. Et il existe une corrélation étroite entre l'élévation de l'expression de l'APN, une activité enzymatique accrue et le pouvoir invasif de nombreux types de cellules tumorales. Des inhibiteurs puissants et sélectifs de l'APN, appartenant à la famille des composés de type amino-benzosubérone, ont été synthétisés au laboratoire. Ces composés ont été testés in vitro et in vivo, et il est apparu qu'ils présentaient une affinité variant du nano au picomolaire. En parallèle à ces essais, un nouveau projet a débuté il y a quelques années au laboratoire, visant à déterminer la structure tridimensionnelle de l'APN humaine. La connaissance de cette structure constitue un enjeu majeur car des co-cristallisations avec ces inhibiteurs permettraient de résoudre le mode de liaison de cette nouvelle famille de composés à l'APN. La difficulté de cette étude réside dans le fait que l'APN est une glycoprotéine membranaire particulièrement difficile à purifier à partir de tissus ; de plus, cette protéine étant ancrée dans la membrane de la cellule, sa cristallisation en est d'autant plus complexe. Plusieurs stratégies de clonage et de surexpression de l'APN humaine ont été envisagées, avec pour objectif final, l'obtention d'une protéine cristallisable, glycosylée ou non.

Liposomal nanocarriers offer much promise in chemotherapeutic drug delivery because they may be specifically targeted to tumors thereby shielding healthy organs from toxic side effects of incorporated drugs. Passive targeting of liposomes is achieved through the inclusion of PEG to evade the RES and prolong circulation in the bloodstream. Since tumor vasculature exhibits increased permeability, prolonged circulation results in passive accumulation of liposomes to tumor. Active targeting is accomplished through the inclusion of agents targeted to over-expressed receptors on tumor cells. In vitro studies have demonstrated increased cytotoxicity of actively targeted liposomes due to specific uptake by tumor cells. In vivo, however, actively targeted liposomal nanocarriers have failed to meet the expectations established by the promising outcomes of in vitro studies. This is attributed to the fact that the inclusion of targeting agents results in accelerated clearance from the bloodstream and reductions in passive targeting to tumor thereby offsetting the benefits of active targeting. The central focus of this thesis was to engineer a multi-functional nanoscale drug delivery system which would enable active targeting without compromising RES evasion and passive accumulation to tumor. It was shown that the use of folate in liposomal formulations significantly reduced blood circulation times. To prevent RES recognition of folate on targeted liposomal formulations, a cysteine cleavable phospholipid-PEG conjugate was utilized to "mask" targeting ligands while liposomes were in circulation. Once passive accumulation at the tumor was achieved, cysteine was administered to detach PEG chains, expose folate, and promote uptake by tumor cells. In vivo studies demonstrated that cleavable DSPE-PEG5000 was capable of concealing folate on liposomes to maintain prolonged circulation times. In vitro studies verified the ability to conceal and expose folate on demand, permitting receptor mediated targeting and delivery of drug to target cells. Studies conducted to analyze drug uptake by tumor cells in vivo confirmed that delivery was enhanced when tumor-inoculated animals received targeted liposomes containing cleavable PEG chains followed by a cysteine infusion to expose folate. These results indicate that detachable PEG chains can be used in targeted liposomal formulations to enhance efficacy of chemotherapy in the treatment of glioma.

Made available in DSpace on 2015-04-14T14:51:39Z (GMT). No. of bitstreams: 1 396843.pdf: 208677 bytes, checksum: 50ebe2518a717c97f6596659cfc38e2f (MD5) Previous issue date: 2006-07-31 / Embasamento te?rico e objetivos: a s?ndrome das apn?ias-hipon?ias obstrutivas do sono (SAHOS) ? uma comorbidade associada ? obesidade m?rbida principalmente em fun??o da grande circunfer?ncia do pesco?o. Dependendo da sua gravidade, a SAHOS pode interferir na homeostasia de in?meros sistemas, como por exemplo o sistema nervoso central (SNC). A enolase neur?nio-especifica (NSE) e a prote?na S100B, proveniente do astr?cito, s?o considerados marcadores sens?veis para les?o cerebral. Nesse estudo avaliamos os n?veis s?ricos de S100B e NSE com o intuito de marcar poss?veis inj?rias causadas pela SAHOS ao SNC. Pacientes e m?todos: n?s estudamos dados provenientes de 25 pacientes obesos m?rbidos portadores de SAHOS e realizamos a coleta de sangue antes e ap?s o exame polissonogr?fico (PSG) para a dosagem das prote?nas S100B e NSE. Tamb?m foram analisados dados relativos a depress?o e sonol?ncia diurna excessiva. Resultados: Os valores de S100B foram maiores ap?s [0,029 (0,010-0,199)] em compara??o com antes [0,010 (0,010-0,025)] ?g/l da PSG (P=0,002). Os valores s?o expressos em mediana e IQ25-IQ75. Os valores de NSE n?o mostraram diferen?as significativas entre antes e depois do sono. Conclus?es: o estudo mostra varia??es significativas em n?veis de S100B quando comparados antes e depois exame polissonogr?fico.