Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (Ph.D.)--University of California, San Francisco, 2004. / Bibliography: leaves xxx-xxx. Also available online.

Thesis (M.S.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains viii, 99 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 96-99).

Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.D.S.)--University of Hong Kong, 2000. / Includes bibliographical references (leaves 106-152).

Orientador: Eliana Marisa Ganem / Banca: Norma Sueli Pinheiro Módolo / Banca: Angélica de Fátima de Assunção Braga / Resumo: A dificuldade na intubação traqueal é causa de mortalidade em anestesiologia e pode estar relacionada à obesidade. Reconhecer o paciente com intubação difícil contribui para o sucesso da abordagem da via aérea, contudo os parâmetros preditores de intubação difícil não estão bem estabelecidos. A classificação de Mallampati, a distância interincisivos, a circunferência do pescoço, a distância tireomentoniana, a conformação da face e a presença da síndrome da apnéia obstrutiva do sono (SAOS) são parâmetros que podem indicar a intubação difícil. O tratamento cirúrgico da obesidade proporciona redução do índice de massa corpórea (IMC), com estabilização deste por volta de dois anos. Assim, o objetivo desta pesquisa foi reavaliar os parâmetros acima descritos com os valores obtidos antes da cirurgia. Cinquenta e um pacientes de ambos os sexos, foram avaliados no período pré-operatório, quanto ao IMC, a classificação de Mallampati, a circunferência do pescoço, a distância interincisivos, a distância tireomentoniana e o grau da SAOS por meio da polissonografia. Após dois anos da cirurgia e redução do IMC para valores inferiores a 35 kg.m-2 os valores preditores de intubação difícil foram reavaliados por outro médico anestesiologista que possuía apenas o conhecimento do IMC prévio. Foram excluídos nove pacientes, uma gestante, dois por não redução do IMC e seis por recusa. Executada reavaliação dos parâmetros supracitados. Para os pacientes que não realizaram nova polissonografia foi aplicada a escala de sonolência de Epiworth. Dos 42 pacientes reavaliados, 17 foram do sexo masculino e os restantes do feminino. Todos apresentaram redução do IMC, da circunferência do pescoço da distância interincisivos e tireomentoniana. Apenas um paciente apresentou redução na escala de Mallampati e somente 4 pacientes realizaram a polissonografia ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Difficulty in intubation is a cause of mortality in anesthesiology and may be related to obesity. Recognize the patient with difficult intubation contributes to a successful approach to air, however the parameters predictive of difficult intubation is not well established. The Mallampati classification, the distance interincisal, neck circumference, the distance thyromental, the conformation of the face and the presence of the syndrome of obstructive sleep apnea (OSA) are parameters that may indicate difficult intubation. Surgical treatment of obesity provides a reduction of body mass index (BMI), with this stabilizing around two years. The objective of this research was to reassess the parameters described above with the values obtained before surgery. Fifty-one patients of both sexes were evaluated during the preoperative period, with respect to BMI, Mallampati classification, neck circumference, the distance interincisal, distance thyromental and degree of OSA by polysomnography. After two years of surgery and reduction of BMI to less than 35 kg.m-2 values predicting difficult intubation were reviewed by another anesthesiologist who had only prior knowledge of the IMC. Excluding nine patients, one pregnant, two by not reducing the BMI and six refused. Performed reassessment of the parameters mentioned above. For patients who did not undergo polysomnography was applied to Epiworth Sleepiness Scale. Of the 42 patients reviewed, 17 were male and the rest of feminino.Todos showed reduction in BMI, neck circumference, distance and interincisal thyromental. Only one patient showed a reduction in the scale of Mallampati and only four patients underwent polysomnography. The reduction ... (Complete abstract click electronic access below) / Mestre

Allergen proteases from a number sources including the filamentous fungus A. fumigatus, are thought to be important in the development of severe asthma through protease dependent interactions with the respiratory epithelium. The first aim of the thesis was to determine the effect of a variety of growth substrates on the secretion of proteases from different strains of A. fumigatus. The second aim was to investigate the effects of recombinant allergen proteases Asp f 5 and Asp f 13 expressed in the P. pastoris protein expression system and crude A. fumigatus culture supernatants on airway epithelial cells and determine whether protease induced interleukin 8 (IL-8) release from airway epithelial cells was dependent on the activation of protease activated receptor 2 (PAR-2).Results demonstrated that the AF293 strain of A. fumigatus secreted serine proteases during growth on pig lung homogenate medium and metalloproteases during growth on a casein based medium but suppressed protease secretion in Vogel's minimal medium. Analysis of the secretion and RNA levels of proteases in A. fumigatus showed that the matrix metalloprotease, Asp f 5 and the serine protease, Asp f 13 were up-regulated and secreted during growth in pig lung medium and that the matrix metalloprotease, Lap1 was up-regulated and secreted along with Asp f 5 and Asp f 13 in casein medium. This finding was confirmed using protease inhibitors and by using strains of A. fumigatus in which Asp f 5 and Asp f 13 genes were disrupted. These results suggest that A. fumigatus was able to detect different complex proteins available as substrates in its environment and regulate protease secretion accordingly. Furthermore, in several strains of A. fumigatus, protease activity was not suppressed by growth in Vogel's medium, suggesting differences in the regulation of protease secretion between strains. Both A. fumigatus culture supernatants and recombinant Asp f 5 and Asp f 13 produced in P. pastoris caused epithelial airway cell desquamination, and IL-8 release in a protease and dose-dependent manner. In addition, both recombinant Asp f 5 and Asp f 13 were both shown to cleave PAR-2 at a site that resulted in receptor activation.In conclusion, differences in the secretion of proteases between A. fumigatus strains and during growth of A. fumigatus on different media suggests a requirement for the standardisation of the preparation of A. fumigatus allergen extracts used both in clinical diagnosis of A. fumigatus allergy and in vitro and in vivo research studies. Furthermore, it is proposed that allergen proteases secreted by A. fumigatus may interact with a variety of host proteins including, matrix molecules, enzymes and receptors which may exacerbate allergic airway diseases.

At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.