Orientador: Simone Appenzeller / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T16:23:29Z (GMT). No. of bitstreams: 1 Santos_Elizangelados_D.pdf: 1569830 bytes, checksum: 0312d7e3143dbf6847b4b3af7e90d245 (MD5) Previous issue date: 2013 / Resumo: Objetivo: Verificar se há uma associação entre a espondilose cervical, sinais e sintomas auditivos e alterações no fluxo da artéria vertebral. Material e método: Foram selecionados 150 indivíduos que freqüentavam a Universidade Aberta à Terceira Idade da Universidade Federal de Alfenas. Foram excluídos indivíduos com traumas, doenças sistêmicas ou locais que pudessem interferir com o sistema auditivo e vestibulococlear . No total, 102 indivíduos [91 (89,2%) do sexo feminino; média de idade de 59,4± 12,0 anos (variação de 30 a 91 anos)]. A presença de sinais e sintomas auditivos foi avaliada através de uma anamnese elaborada específicamente para esse fim. Radiografias nas posições anteroposterior, perfil e oblíquas foram realizadas em todos os indivíduos e analisadas por dois radiologistas, cegos em relação a sintomatologia. Ultrassonografia (US) Doppler foi realizada nas artérias vertebrais direita e esquerda em posição anatômica em todos os indivíduos, por um ultrassonografista cego quanto às manifestações clínicas ou radiográficas. A análise estatística foi realizada no programa SAS e Systat. Os testes estatísticos aplicados foram selecionados de acordo com a natureza das variáveis. Resultados: A prevalência de sintomas vestibulococleares foi observada em 83 (81,4%) dos indivíduos da amostra. Espondilose cervical foi observada em 71 (69,6%) dos indivíduos. A média de fluxo da artéria vertebral direita foi significativamente menor [85,3 ± 43,1 ml/min (variação 18,1 ¿ 208,9 ml/min)] quando comparados aos indivíduos sem espondilose cervical [101,2 ± 44,3 ml/min (variação 43,8 ¿ 282,3 ml/min; p=0,02). Não observamos alterações no fluxo arterial vertebral esquerda em pacientes com espondilose cervical, comparado aos indivíduos sem espondilose cervical. Não houve relação entre a alteração do fluxo arterial vertebral, a presença de espondilose cervical e sintomas vestibulococleares. Conclusão: Observamos uma elevada prevalência de sintomas vestibulococleares e espondilose em nossa amostra. O fluxo da artéria vertebral direita estava reduzido em indivíduos com espondilose, porém não houve associação com sintomas clínicos / Abstract: Objective: To determine the relationship between in signs and symptoms of hearing, espondylosis and vertebral artery flow. Methods: A total of 150 individuals from the Universidade aber ta a tercei ra idade da Universidade Federal de Al fenas were invi ted. Individuals wi th t rauma, systemic or local diseases that could inf luence vest ibulococlear symptoms were excluded. A total of 102 individuals[91 (89.2%) female; median age 59,4± 12,0 years (range 30 a 91 years)] were included. Vestibulocolcear symptoms were evaluated by clinical interview. X-ray of the cervical spine were done in anterior-posterior, lateral and oblique view and reviewed by two radiologist blind to the individuals' symptoms. Doppler ultrasound (US) of the vertebral artery was done in anatomic position in all individuals by an ultrasound expert blind to individuals characteristics. Statistics was performed using SAS and Systat according to the nature of the variable. Results: The prevalence of signs and symptoms of hearing was observed in 83 (81.4%) and spondylosis in 71 (69.6%) individuals. The mean right vertebral flow was significant smaller in individuals with spondylosis [85.3 ± 43.1 ml/min (range18.1 ¿ 208.9 ml/min)] when compared to individuals without spondylosis. We did not observe a difference regarding the left vertebral flow. No relation between arterial vertebral flow, spondylosis and vestibulocolear symptoms was observed. Conclusion: A high prevalence of vestibulococlear symptoms and spondylosis was observed in this cohort. The right vertebral artery had reduced flow in individuals with spondylosis, however no relation to symptoms was observed / Doutorado / Clinica Medica / Doutora em Clínica Médica

Orientadores: Fernanda Garanhani de Castro Surita, José Guilherme Cecatti / Texto em português e inglês / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T19:09:45Z (GMT). No. of bitstreams: 1 Figueira_CamillaOlivares_M.pdf: 1964790 bytes, checksum: 9f40cd5a6b3e989c4a5740350753fde4 (MD5) Previous issue date: 2014 / Resumo: Objetivo: Estudar longitudinalmente os parâmetros Dopplervelocimétricos de artérias fetais e uterinas em mulheres com gestação de baixo risco, construindo intervalos de referência para as artérias uterinas (AUT), umbilical (AU), cerebral média (ACM), e renal (AR), correlacionando esta última com índice de líquido amniótico. Métodos: estudo de coorte longitudinal descritivo em 63 mulheres com gestação de baixo risco no Hospital prof. Dr. José Aristodemo Pinotti ¿ Centro de Atenção Integral à Saúde da Mulher- CAISM/UNICAMP. Foram aferidos o índice de pulsatilidade (IP) e a velocidade sistólica (VS) dos vasos estudados em intervalos de 4 semanas até a 36ª. semana e após, a cada 2 semanas até o parto para construção do intervalo longitudinal dos parâmetros. Para análise estatística foram calculadas as médias por intervalos de idade gestacional, valores dos percentis 5, 50 e 95 para cada parâmetro estudado e ainda, os índices de correlação intra classe e inter classe para cada artéria estudada. Foi estabelecido um nível de significância de 5% e para os procedimentos de análise foram utilizados os programas Epi.Info e SAS. Resultados: Foram construídos intervalos de referência e estabelecidos os percentis 5, 50 e 95 para IP e VS das artérias uterinas, umbilical, cerebral média e renais ao longo da gestação. A evolução dos parâmetros dopplervelocimétricos na população estudada foi semelhante ao padrão encontrado na literatura, entretanto foram observadas algumas diferenças nos valores absolutos. O ILA foi aferido e correlacionado ao Doppler da artéria renal, porém não houve associação entre eles. O Coeficiente de Correlação intra classe mostrou valores adequados pra a maioria dos parametros, indicando boa reprodutibilidade. Conclusões: Foram estabelecidos valores de intervalos de referência para a avaliação de VS e IP das principais artérias estudadas durante a gestação em um seguimento longitudinal. Os intervalos de referência mostram a evolução esperada dos parâmetros de uma gestação de baixo risco e são úteis no acompanhamento das gestações de alto risco. As avaliações intra e inter observador indicaram boa reprodutibilidade do método / Abstract: Objective: To study longitudinal Dopplervelocimetry parameters of uterine and fetal arteries in women of low risk pregnant women, and to develop reference interval values for uterine (UtA), umbilical (UA), middle cerebral (MCA), and renal arteries (RA) and correlate the latter with amniotic fluid index (AFI). Methods: longitudinal cohort study with 63 low risk pregnant women at prof. Dr. José Aristodemo Pinotti Hospital- CAISM/UNICAMP. Pultasility index (PI) and sistolic velocity (SV) of the arteries studied were measured at a 4 week interval until 36 weeks and then every 2 weeks to construct the longitudinal interval. Means for intervals of gestational age and percentiles 5, 50 and 95 were calculated for each parameter and Spearman correlation index was used to correlate the AFI with RA parameters. The Intra Class Correlation Coefficients were also calculated to evaluate the intra and inter observer variability for each vessel. A 5% significance level was established and programs Epi.Info and SAS were used for analysis. Results: Longitudinal reference intervals were constructed and the 5th, 50th and 95th percentiles for PI and SV of uterines, umbilical, middle cerebral and renal arteries established during pregnancy. AFI was measured and correlated with renal artery Doppler, but we found no association between these two parameters. The Intraclass Correlation Coefficient showed adequate values for the majority of the parameters, indicating good reproducibility. Conclusions: We have established a curve of reference intervals for the assessment of SV and PI of the main arteries studied during pregnancy after a longitudinal follow up. Reference intervals show the expected evolution of low risk pregnancy parameters and are useful in monitoring high risk pregnancies. Intra and inter observer evaluation indicated good reproducibility of the method / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde

A vascularização arterial do baço do eqüino foi estudada por meio de radiografias contrastadas, cintilografias, dissecações e moldes. O baço está situado no antímero esquerdo e a sua posição na cavidade abdominal determina uma face parietal lisa e levemente convexa, enquanto que a face intestinal, onde estão localizados os vasos, nervos e ligamentos, é levemente côncava determinando uma área com menor espessura. O estudo da vascularização arterial demonstrou uma área paucivascular que coincide justamente com a área côncava onde a espessura é menor. Este comportamento foi observado tanto nos adultos como nos fetos. Baseado na distribuição dos vasos arteriais a região onde a espessura é menor foi indicada como local de eleição para a incisão no caso de esplenectomias parciais, dividindo o baço do eqüino em dois segmentos anátomo-cirúrgicos. A cirurgia de ressecção parcial do baço não foi descrita, no cavalo, conforme atesta a literatura atual. Duas cirurgias experimentais foram realizadas para comprovar a indicação, demonstrando que a proposta é exeqüível. A análise proporcional da área mostrou que a ressecção parcial na região indicada preserva em média 50% do parênquima. / Observation on the mode of parenchymal distribution of equine splenic artery was studied using arteriography, scintigraphy, dissection and corrosion cast. The spleen is situated in the left region of the abdomen. The parietal surface is convex and the visceral surface, where the blood vessels, nerves and ligaments are situated, is concave. The vascular arrangement may lead to division the organ into two anatomicosurgical segments. No literature is available on partial splenectomy in horses. Two partial resection was performed successfully by the method described, this partial resection preserve 50% of spleen parenchyma.

Orientadores: Jose Ranali, Darceny Zanetta Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-04T04:03:18Z (GMT). No. of bitstreams: 1 Oliveira_PatriciaCristinede_D.pdf: 14172731 bytes, checksum: a824d5516bc922567d636ef268423166 (MD5) Previous issue date: 2005 / Resumo: Este estudo avaliou a variação de parâmetros cardiovasculares em 15 portadores de DAC aguda com angina instável e infarto agudo do miocárdio prévio, submetidos a tratamento odontológico sob anestesia local com epinefrina e felipressina. MAPA e ECG foram usados para avaliar a pressão arterial sistólica (PAS), pressão arterial diastólica (PAD), freqüência cardíaca (FC), extrassístoles ventriculares (EV) e supraventriculares (ESV), depressão e elevação do segmento SI. Adicionalmente foram avaliados a alteração na troponina I (Tn-I), a saturação de oxigênio (Sp02) com oxímetro de pulso, o grau de ansiedade (através da Escala de Ansiedade Dental de Corah - EADC) e a sensação dolorosa (pela Escala de dor de 11 pontos em caixa - EC), em quatro fases: 0- basal, monitoramento com holter por 24 horas; 1 ¿ simulação do atendimento odontológico, holter por 24 horas, MAPA por 5 horas, oxímetro de pulso por 1 hora que corresponde ao período do atendimento odontológico; 2 e 3 - similar à fase 1 porém com atendimento odontológico que constituiu de anestesia local infiltrativa vestibular e submucosa palatina com 1,8mL de lidocaína 2% com adrenalina 1:100.000 ou de prilocaína 3% com felipressina 0,03Ul/mL seguida de raspagem periodontal. As soluções anestésicas foram distribuídas de forma aleatória em cada uma das fases, em um estudo cruzado, cego para o atendimento e duplo-cego para a análise dos dados. As fases 2 e 3 foram acompanhadas por um cardiologista no período correspondente ao do atendimento odontológico. Antes do início das sessões, aplicou-se a EADC e, após o atendimento odontológico (fases 2 e 3), aplicou-se a EC. Os dados de ansiedade, dor, PAS, PAD e FC foram avaliados pelo teste de Wilcoxon pareado com nível de significância de 5%, ou com fator de correção de Bonferroni para os casos de três (a= 0,016) ou quatro (a= 0,0125) testes, e as variáveis do ECG pelo teste exato de Fisher (u= 0,05). A PAS apresentou diferença significante durante o atendimento odontológico com epinefrina e a Sp02 foi diferente com tendência de apresentar menor valor na fases inicial do estudo (Fase 1). Não foram encontradas diferenças significantes entre as fases para EV, ESV, depressão de ST, Tn-I, ansiedade e dor. Pode-se concluir que a epinefrina e a felipressina tiveram tendência de alterar a PAS, PAD e Sp02 embora somente a epinefrina tenha influenciado de forma significante. Porém este aumento não foi suficiente para induzir alterações eletrocardiográficas no grupo de pacientes avaliados, podendo-se dizer que ambas as soluções, na dose e concentração utilizadas, são bem toleradas por portadores de DAC aguda o tipo AI e IAM prévio, não contra-indicando, portanto o atendimento - deste grupo de pacientes / Abstract: The purpose of this study was to evaluate the changes of cardiovascular parameters in 15 volunteers with acute CAD (instable angina and previous myocardial infarction) during dental treatment under local anesthesia with epinephrine and felypressine. Ambulatory monitoring (BPAM) and ECG were utilized to evaluate systolic (SBP) and diastolic (OBP) blood pressures, heart rate (HR), ventricular (VA) and supraventricular arrhythmias (SVA), ST depression and ST elevation, and SpO2(by pulse oximeter), troponin I (Tn-I), anxiety (by Corah's Dental Anxiety Scale - CDAE) and painful sensibility (by The 11-point Box Scale - BS-11), in 4 phases: 0- baseline, 24 hours holter monitoring; 1 - dental treatment simulation, 24 hours holter, 5 hours MAPA, 1 hour pulse oximeter, corresponding the dental treatment; 2 and 3 - similar to phase 1, more dental treatment with periodontal scaling, made under maxillary and palatine local anesthesia using 1.8ml of 2% lidocaine with 1:100.000 epinephrine (Epi) or 3% prilocaine supplemented 0,03 IUlml of felypressine (Fel), in a double blind cross-over study. Phases 2 and 3 were looked closely by a cardiologist. The COAE was applied at the beginning of the sections and after the dental treatment (phases 2 and 3) was applied the BS-11. The anxiety date, painful sensibility, SBP, DBP and HR were evaluated by Wilcoxon test (5% levei of significance or Bonferroni correction factor for the cases of three, u= 0.016 or four, u= 0.0125 tests) and the data of ECG were analyzed by Fisher test (u= 0.05). The SBP presented significant difference during dental treatment with epinephrine and SpO2was different with tendency to showed lowers values in phase 1. Significant differences were not found among the phases for VA, SVA, ST depression, Tn-I, anxiety and painful sensation. It can be concluded that epinephrine and felypressine resulted changes in SBP, OBP and SpO2, but only' epinephrine caused significant difference. However the SBP did not increased sufficiently to cause ECG alterations in this group, and both of them, in utilized doses and concentrations are well tolerated by patients with acute CAD (instable angina and myocardial infarction), it did not presented absolute contraindications to dental treatment in this grou / Doutorado / Farmacologia, Anestesiologia e Terapeutica / Doutor em Odontologia

Many populations have low intakes of n-3 fatty acids, yet there is substantial evidence that the long chain n-3 fatty acid docosahexaenoic acid (DHA; 22:6n-3), found at high concentrations in the brain, is required for the proper development of the nervous system. However, less is known about requirements of long chain n-3 fatty acids for maintenance and function of the nervous system in later life. Several recent studies have reported that high amounts of long chain n-3 fatty acids reduce the extent of brain damage caused by cerebral ischemia in animals. However, whether or not a dietary deficiency of n-3 fatty acids increases the extent of injury when cerebral ischemia occurs has not been previously reported. The present studies, therefore, sought to determine if a diet deficient in n-3 fatty acids influences the extent of brain injury in the rat following cerebral ischemia. Male rats were fed an n-3 fatty acid adequate (control), an n-3 fatty acid deficient, or a high DHA diet for 5 weeks from weaning. Middle cerebral artery occlusion (MCAO) was induced and infarct volume was measured by 2,3,5,-triphenyltetrazolium chloride staining 24 hours after the procedure. Brain and platelet fatty acids were analyzed by gas liquid chromatography. DHA (22:6n-3) was 21-28% lower in brain phospholipids, and 17% lower in brain total fatty acids in the n-3 fatty acid deficient compared to control group, while 22:6n-3 was 12% higher in total brain fatty acids in the high DHA group than the control group. There was no significant difference in infarct volume (203, 220 and 218 mm³) among the control, n-3 fatty acid deficient, and high DHA groups, respectively. Platelet fatty acids and platelet aggregation were assessed to determine if these were influenced by the high DHA diet, and could possibly explain the observation of an apparent, but not statistically significant, higher number of rats with hemorrhages in the high DHA diet group. Platelet lipid arachidonic acid was not lower and platelet aggregation, assessed ex vivo using whole blood with a platelet function analyzer, was not longer in rats fed the high DHA compared to control or n-3 fatty acid deficient diets. In summary, dietary n-3 fatty acid deficiency did not increase the extent of brain injury following cerebral ischemia. The possibility that high dietary 22:6n-3 might increase susceptibility to cerebral hemorrhage will require further study. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

Cardiovascular diseases form one of the most dangerous events that affect human life. They are usually the result of high blood pressure. Thus controlling blood pressure within patient specific healthy limits is a goal that we must target. There are two control loops for blood haemostasis inside the body either long term or short term. Baroreceptors control the short term blood pressure regulation. They are nerve endings that exist in certain locations within the blood vessel walls and they report blood pressure into the brain and the central nervous system. However the basics of their function are not yet known. We propose here that the baroreceptors work by converting circumferential and axial pressure into a stress into their respective direction and they start to send nerve signals based on a threshold of strain energy of the location they are embedded in. Thus baroreceptors A fibre is highly likely to exist in the stiffer adventitia, while the media will contain C fibres. This explains the reason behind having identical fibres with different threshold. We were able to arrive to this solution by getting a relationship between stress–strain relationship for the whole wall and for the arterial vessels. These findings are quiet significant as they allow a method to identify different stress in the arterial wall layers using whole wall experimental data and also as they were able to differentiate between different fibres based on their locations inside the arterial wall. A complete modelling of the baroreceptors function might lead to the formation of biosynthetic material that could interact with the body on the cellular level, so as to give humans the mean to the control of short term blood regulation thus preventing hypertension and its accompanying diseases such as atherosclerosis.

Abstract This thesis describes the development of pressure sensor arrays and a range of methods suitable for the long-term measurement of heart rate and blood pressure determination using a cuff and a pressure sensor array on the radial artery. This study also reviews the historical background of noninvasive blood pressure measurement methods, summarizes the accuracies achieved and explains the requirements for common national and international standards of accuracy. Two prototype series of pressure transducer arrays based on electro-mechanical film (EMFi) were designed and tested. By offering high (∼TΩ) resistance, EMFi is an excellent material for low-current long-term measurement applications. About 50 transducer arrays were built using different configurations and electrode materials to sense low-frequency pressure pulsations on the radial artery in the wrist. In addition to uniform quality, essential requirements included an adequate linear response in the desired temperature range. Transducer sensitivity was tested as a function of temperature in the range of 25–45 °C at varying static and alternating pressures. The average sensitivity of the EMFi used in the transducers proved adequate (∼2.2 mV/mmHg and ∼7 mV/mmHg for normal and high sensitive films) for the intended purpose. The thesis also evaluates blood pressure measurements by the electronic palpation method (EP) and compares the achieved accuracy to that of the oscillometric method (OSC) using average intra-arterial (IA) blood pressure as a reference. All of these three measurements were made simultaneously for each person. In one test group, measurements were conducted on healthy volunteers in sitting and supine position during increasing and decreasing cuff pressure. Another group, comprising elderly cardiac patients, was measured only in the supine position during cuff inflation. The results showed that the EP method was approximately as accurate as the OSC method with the healthy subjects and slightly more accurate with the cardiac patient group. The advantage of the EP method is that also the wave shape and velocity of arterial pressure pulses is available for further analysis, including the assessment of arterial stiffness.

Abstract Interest in off-pump coronary surgery and ischaemic preconditioning has been increasing. The aim of this study was to evaluate surrogate indicators of haemodynamic, myocardial, and cerebral outcome during off-pump surgery and preconditioning. Haemodynamics and myocardial preservation were monitored in a pilot study of twelve patients undergoing off-pump coronary surgery. Indicators of myocardial metabolism and tissue injury as well as cerebral damage were evaluated in a randomized study of thirty-three patients undergoing on-pump (11) or off-pump surgery with (11) or without (11) preceding myocardial ischaemic preconditioning for five minutes followed by reperfusion for five minutes. The pilot study showed minimal haemodynamic changes and myocardial derangements during off-pump surgery as evaluated intraoperatively based on transcardiac differences of ATP degradation products and lactate and postoperatively based on MB mass of creatine kinase and troponin T. In the following studies, myocardial ischaemic metabolism was evaluated intraoperatively by measuring transcardiac differences of ATP degradation products, lactate, and pH, which increased significantly from the baseline values in all study groups. However, the maximum values of lactate and pH were significantly higher in the cardiopulmonary bypass group (p = 0.02 and p = 0.007, respectively). There were no statistical differences between the preconditioning and non-preconditioning groups. Myocardial tissue injury was evaluated by postoperative leakage of MB mass of creatine kinase and troponin I. Their peak values were significantly higher (p < 0.001 and p = 0.008) after cardiopulmonary bypass (15.1 μg/l and 13.8 μg/l) than after off-pump surgery without preconditioning (6.3 μg/l and 5.2 μg/l). The respective values were 14.8 μg/l and 7.4 μg/l after preconditioning, and there were no statistically significant differences between the off-pump groups with and without preconditioning. Cerebral damage was evaluated based on the intra- and postoperative serum concentrations of neuron-specific enolase, which were corrected with respect to haemolysis. The corrected values were significantly higher after on-pump than off-pump surgery (p = 0.003 and p = 0.005). In conclusion, multi-vessel off-pump coronary artery surgery is a haemodynamically feasible procedure offering better myocardial preservation compared to on-pump surgery. Ischaemic preconditioning of the myocardium does not seem to improve myocardial preservation in off-pump surgery. The slightly lower levels of neuron-specific enolase also suggest less cerebral damage.

Abstract The purpose of this prospective, clinical longitudinal survey was to describe, explain and understand the subjective quality of life and life course of patients with coronary artery disease. The study subjects' quality of life was assessed at the time of the onset of coronary artery disease, during the treatment process and during rehabilitation. Altogether 280 patients participated, of whom 80 were treated with medication, 100 with transluminal angioplasty, and 100 with bypass surgery. The study population consisted of 189 men and 91 women. At the baseline, the study subjects' self-care agency was measured with the Self-As-Carer Inventory (SCI). The subjects health-related quality of life was assessed with the Nottingham Health Profile (NHP) at the baseline as well as at 6 and 12 months after the procedure. The qualify of life of coronary artery disease patients was compared to the quality of life of an age- and sex-matched Finnish adult population (N = 3600) by using a previous standardisation of the NHP instrument. One year after the treatment, 19 patients who had undergone either bypass surgery or angioplasty attended thematic interviews at their homes. Triangulation of methodologies, methods and data collection was used in the study. The qualitative analysis of personal experiences was carried out using the method of phenomenological psychology described by Amedeo Giorgi based on Husserl's descriptive phenomenology. Before the treatment procedures, the quality of life of the coronary artery disease patients was significantly poorer than that of the age-matched adult population on the dimensions of energy, pain, emotional reactions, sleep and mobility. Moreover, the female patients with coronary artery disease had poorer health-related quality of life than the corresponding male patients, especially on the dimensions of energy, sleep, emotional reactions and mobility. The quality of life of the patients who had undergone angioplasty or bypass surgery was statistically significantly better one year after surgery on the dimensions of energy, pain and mobility. Their quality of life had, however, deteriorated on the dimensions of emotional reactions and social isolation. The thematic interviews revealed two kinds of life course: one with an active attitude towards treatment and a re-orientation of life course and another with a passive attitude towards treatment and a maintenance of the old principles in one's life course. A need for rehabilitation was indicated by an onset of the illness suddenly at a relatively young age, termination of an active working career, financial problems, dissatisfaction with the outcome of treatment, problems in family relations, and a desolate view of the future. An increased need for psychosocial support was especially common among women, subjects with recurrence and both male and female subjects in the youngest age group. According to the subjects, after-care failed to meet their needs or to address their problems. No continuous and confidential therapeutic relationships emerged. The problems included inadequate knowledge of one's condition and a lack of detailed instructions concerning the permissible degree of exertion after treatment. The patients felt they needed rehabilitation groups with coronary artery disease patients similar to themselves. The study yielded new knowledge about the health-related quality of life of coronary artery disease patients, the connections between the treatment methods and the changes in the patients' quality of life during one year and the patients' experiences at the time of the diagnosis and during the periods of treatment and after-care. This evidence-based knowledge can be used to develop the treatment and rehabilitation of coronary artery disease patients and to plan further research.

This doctoral thesis deals with the description of the mechanical behavior of arterial walls under supra-physiological loading conditions. After a brief description of the continuum mechanical basis, the focus is first set to continuum damage mechanics (CDM) formulations for soft biological tissues. Thereby, different phenomenological damage equations are introduced yielding smooth and non-smooth material tangent moduli at the induction of initial damage, respectively. The performance of the latter formulations is investigated in numerical calculations of inhomogeneous boundary value problems. Afterwards, a micromechanically motivated damage approach for arterial tissues is derived in the CDM framework, taking into account statistically distributed microscopical parameters. The model response is adjusted to experimental data of human arteries and used in a numerical simulation of a simplified atherosclerotic artery model showing the applicability of the proposed formulation in a finite element framework. Moreover, a relaxed incremental variational formulation from the literature, which in contrast to the CDM formulations avoids a potential loss of convexity, is extended in this work to account for arterial tissues by the inclusion of fiber dispersion and hysteresis behavior. A framework denoted as ’Optimal Uncertainty Quantification’ is utilized to compute bounds on the probability of failure in a simplified diseased artery model after several overexpansions. Therefore, a virtual experimental data set and two different rupture criteria are considered, which are based on fiber stretch and fiber damage, respectively. / Diese Dissertation behandelt die Beschreibung des mechanischen Verhaltens von Arterienwänden unter supraphysiologischen Belastungszuständen. Nach einer kurzen Beschreibung der kontinuumsmechanischen Grundlagen, wird der Schwerpunkt zunächst auf Formulierungen im Rahmen der Kontinuumsschädigungsmechanik (KSM) für biologische Weichgewebe gelegt. Dabei werden unterschiedliche phänomenologische Schädigungsfunktionen eingeführt, die zu stetigen bzw. unstetigen Tangentenmoduln bei Schädigungsiniziierung führen. Das Verhalten dieser Formulierungen wird in numerischen Berechnungen inhomogener Randwertprobleme untersucht. Danach wird ein mikromechanisch motivierter Schädigungsansatz im Rahmen der KSM unter Berücksichtigung statistisch verteilter mikroskopischer Parameter hergeleitet. Die Modellantwort wird an experimentelle Daten menschlicher Arterien angepasst und in einer numerischen Simulation eines vereinfachten atherosklerotischen Arterienmodells verwendet, wobei die Anwendbarkeit der vorgeschlagenen Formulierung im Rahmen der Finite-Elemente-Methode gezeigt wird. Zusätzlich wird eine inkrementelle Variationsformulierung für Schädigung aus der Literatur, die im Vergleich zu den KSM-Formulierungen einen möglichen Konvexitätsverlust vermeidet, durch Einbindung von Faserstreuung und Hystere-Verhalten für die Beschreibung arteriellen Gewebes erweitert. Im Rahmen einer Methode, die als ’Optimale Unsicherheitsquantifizierung’ bezeichnet wird, werden Grenzwerte für die Versagenswahrscheinlichkeit an einem vereinfachten Modell einer erkrankten Arterie nach mehreren Überdehnungen berechnet. Dafür werden ein virtueller experimenteller Datensatz und zwei unterschiedliche Versagenskriterien berücksichtigt, die auf der Faserdehnung bzw. auf der Faserschädigung basieren.