Darbo tikslas. Ištirti slaugytojo vaidmenį prižiūrint centrinių venos kateterius reanimacijos ir intensyvios terapijos skyriuje. Darbo uždaviniai. Nustatyti centrinės venos kateterizacijos įtaką pagrindiniams pacientų gyvybinių funkcijų rodikliams. Ištirti, kokios dažniausiai pasitaiko centrinių venų komplikacijos ir jų priežastis. Išsiaiškinti slaugytojo veiksmus, padedančius sumažinti komplikacijų atsiradimo riziką. Ištirti reanimacijos ir intensyvios terapijos slaugytojų centrinių venų kateterių priežiūros žinias . Tyrimo medžiaga ir metodai. Teorinė mokslinės literatūros, leidinių, publikacijų apžvalga. Dokumentų analizės metodas (panaudotas pacientų su centrinių venų kateteriais tyrimui). Asmeninio stebėjimo metodas. Atliktas 97 pacientų po centrinių venų kateterizacijų, pagrindinių gyvybinių funkcijų stebėjimas reanimacijos ir intensyvios terapijos skyriuje. Reanimacijos ir intensyvios terapijos slaugytojų anketinė apklausa žinioms ištirti, dirbant su centrinių venų kateteriais. Gautų rezultatų aptarimas ir jų analizė. Statistinė analizė atlikta naudojant „Microsoft Office Excel 2003“ ir SPSS 16,0 for Windows versijos statistinę programą Tyrimo rezultatai ir išvados. Tam, kad būtų išsiaiškintas slaugytojos vaidmuo prižiūrint centrinius venos kateterius buvo atliktas stebėjimo tyrimas pacientų po centrinių venos kateterizacijų. Tyrimo metu Vilniaus Universiteto ligoninėje Santariškių klinikos I reanimacijos ir intensyvios terapijos skyriuje nustatyta, kad centrinių venos... [toliau žr. visą tekstą] / The goal of the study: to determine the role of a nurse in the maintenance of the central venous catheter (CVC) in the resuscitation and intensive care department. The objectives: to determine the influence of the central venous catheterization to the indexes of the main vital functions of the patients. To specify the most frequent venous complications and the reasons why they occur. To find out what nurses’ actions can reduce the risk of complications. To examine the professional knowledge of the nurses who work with central venous catheters in the resuscitation and intensive care departments. Research material and methods. Theoretical review of scientific literature, publications and articles. Document analysis method (utilized for the reasearch of patient’s with central venous catheters). Personal observation method. Observation of the main vital functions of 97 patients after central venous catheterization in the resuscitation and intensive care department. The questionnaire-based survey in order to examine the professional knowledge of the nurses who work with central venous catheters in the resuscitation and intensive care department. Discussion and analysis of the obtained results. Analysis of the statistical data using the Microsoft Office Excel 2003 and SPSS 16,0 for Windows software packages. The results and conclusions of the study. In order to determine the role of a nurse for the maintenance of central venous catheter, the observation research was conducted with... [to full text]

Toxinas que atuam em canais para Na+ operados por voltagem são as principais responsáveis pelos efeitos tóxicos do envenenamento escorpiônico e podem ser divididas em duas classes: a- e b-neurotoxinas. TsTX-V e TsTX-I da peçonha de Tityus serrulatus (TsV) são, respectivamente, exemplos destas toxinas. Neste trabalho, foram avaliados os efeitos da TsV e destas toxinas sobre a pressão arterial média (PAM) e liberação de catecolaminas em ratos conscientes e não imobilizados, previamente cateterizados, bem como a captação de GABA, dopamina (DA) e glutamato (Glu) em sinaptosomas isolados de cérebro de ratos e a concentração citoplasmática de Ca+2 ([Ca+2 ]C) em células de músculo liso vascular de aorta de ratos. As toxinas foram isoladas por cromatografia de troca iônica (TsTX-I) seguida por CLAE de fase reversa (TsTX-V). As toxinas (15 e 30 g/kg) e TsV (50 e 100 g/kg) foram injetadas intravenosamente. A PAM foi monitorada continuamente através do cateter femoral. Os níveis plasmáticos de adrenalina (ADR) e noradrenalina (NA) foram determinados por CLAE de fase reversa com detector eletroquímico, em 10 min antes e 2,5, 30 e 90 min após os tratamentos. Efeitos pressores máximos foram observados em 2,5?3,5 min. TsV induziu um intenso aumento de longa duração na PAM, bem como a TsTX-I. A TsTX-V mostrou efeitos pressores menores. TsV mostrou os maiores efeitos sobre a liberação de catecolaminas, seguido pela TsTX-I e TsTX-V com um efeito máximo em 2,5 min, seguido por uma gradual redução, permanecendo, todavia, maior que os controles. Embora ambas as classes de toxinas atuem em canais para Na+, TsTX-I mostrou efeitos mais significantes e intensos sobre a liberação de catecolaminas e pressão arterial que a TsTX-V. Parece que a toxicidade da TsTX-V não está somente relacionada à sua capacidade de liberar catecolaminas, indicando que outros neutrotransmissores podem estar envolvidos em sua toxicidade. Nem a TsV ou suas toxinas foram capazes de afetar a captação de 3H-Glu. TsTXI inibiu somente a captação de 3H-DA (IC50 = 28,41 nM). Por outro lado, TsV (0,43ng/mL) inibiu a captação de 3H-GABA e 3H-DA (~50%). TsTX-V mostrou IC50 = 9,37 nM e 22,2 nM para a captação de 3H-GABA e 3HDA, respectivamente. Esses efeitos foram abolidos pelo pré-tratamento com TTX, indicando o envolvimento de canais para Na+ neste processo. Na ausência de Ca+2 e em baixas concentrações de toxinas, a redução não é tão singnificante como na presença de Ca+2. TsTX-V não reduziu a captação de 3H-GABA em células COS-7 expressando os transportadores de GABA, GAT-1 e GAT-3, sugerindo que esta toxina reduz indiretamente o transporte. A redução da captação de 3H-GABA pelos sinaptosomas pode ser devido a rápida e intensa despolarização celular, como revelado por microscopia confocal em células de glioma C6. Assim, TsTX-V causou redução da captação de 3H-GABA e 3H-DA de uma maneira independente de Ca+2, não afetando diretamente os transportadores de GABA, mas em consequencia da despolarização, envolvendo canais para Na+ operados por voltagem. TsV e suas toxinas foram capazes de aumentar a ([Ca2+ ]C , provavelmente por interargir com canais para Na+. Quando comparado aos efeitos despolarizantes do KCl 60 mM (100 %), TsV (100 e 500 g/mL) exibiu um aumento de 49,60 ± 2,58 % e 103,66 ± 5,17 %, respectivamente, enquanto que a TsTX-I e TsTX-V (50 e 100 g/mL de cada) exibiu 43,92 ± 3,06 % e 121,8 ± 8,9 %; 52,56 ± 8,33 % e 79,5 ± 6,1 % de aumento, respectivamente. TsTX-I (100 g/mL) mostrou-se mais potente nesta preparação, visto que uma dose de 100 g/mL causou efeito muito mais intenso do que a TsTX-V na mesma concentração. É possível que as diferenças observadas sobre os efeitos induzidos pela TsTX-I e TsTX-V sejam conseqüência de alterações estruturais entre canais para Na+ presentes em vários tipos de tecidos e inervações. / Voltage-gated Na+ channel toxins are mainly responsible for the toxic effects of scorpion envenoming and can be classified into two classes: a- and b-neurotoxins. TsTX-V and TsTX-I from Tityus serrulatus venom (TsV) are, respectively, examples of these toxins. In this work, were evaluate the effects of TsV and its toxins on mean arterial pressure (MAP) and catecholamines release in conscious unrestrained rats previously catheterized, as well as GABA, dopamine (DA) and glutamate (Glu) uptake in isolated rat brain synaptosomes and cytosolic Ca2+ concentration ([Ca2+ ]C) in vascular smooth muscle cells from rat aorta. Toxins were isolated by ion exchange chromatography (TsTX-I) followed by RP-HPLC (TsTX-V). The toxins (15 and 30 g/kg) and TsV (50 and 100 g/kg) were injected intravenously. MAP was continuously monitored through femoral catheter. Epinephrine (E) and norepinephrine (NE) plasma levels were determined by RP-HPLC with electrochemical detection, at 10 min before and 2.5, 30 and 90 min after treatments. Maximal pressor effects were observed at 2.5 3.5 min. TsV induced intense long lasting increase in MAP, as did TsTX-I. TsTX-V showed the lowest pressor effects. TsV showed the highest effects on catecholamines release, followed by TsTX-I and TsTX-V with maximal effect at 2.5 min, followed by a gradual reduction, however remaining higher than controls. Although both toxins act on Na+ channels, TsTX-I displayed significant and more intense effects on catecholamines release and blood pressure than TsTX-V. It seems that the toxicity of TsTX-V is not related only with its ability to release catecholamines, indicating that other neurotransmitters, may be involved in its toxicity. Neither the TsV or its toxins was capable to affect the 3H-Glu uptake. TsTX-I inhibited only 3H-DA uptake (IC50 = 28.41 nM). On the other hand, TsV (0.43ng/mL) inhibited both 3H-GABA and 3H-DA uptake (~50%). TsTX-V showed IC50 = 9.37 nM and 22.2 nM for 3H-GABA and 3H-DA uptake, respectively. These effects were abolished by pre-treatment with TTX, indicating the involvement of Na+ channels in this process. In the absence of Ca2+ and at low concentrations of toxin, the reduction is not as significant as in the presence of Ca2+. TsTX-V did not reduce 3H-GABA uptake in COS-7 cells expressing GABA transporters GAT-1 and GAT-3, suggesting that this toxin indirectly reduces the transport. The reduced 3H-GABA uptake by synaptosomes could be due to fast and intense cell depolarization as revealed by confocal microscopy of C6 glioma cells. Thus, TsTX-V causes reduction on 3H-GABA and 3H-DA uptake in a Ca2+-independent manner, not affecting directly GABA transporters, but, in consequence of depolarization, involving voltage-gated Na+ channels. TsV and its toxins were able to increase the ([Ca2+ ]C , probably by interact with Na+ channels. When compared to KCl 60 mM depolarizing effect (100 %), TsV (100 and 500 ?g/mL), showed an increase of 49.60 ± 2.58 % and 103.66 ± 5.17 %, respectively, whereas TsTX-I and TsTX-V (50 and 100?g/mL of each) showed 43.92 ± 3.06 % and 121.8 ± 8.9 %; 52.56 ± 8.33 % and 79.5 ± 6.1 %, respectively. TsTX-I (100 ?g/mL) showed most potent effects in this type of preparation, since induced most intense effect that TsTX-V in the same concentration. Thus, it is possible that the differences observed on the effects induced by both toxins are consequence of structural changes among Na+ channels present in several types of tissues and innervations .

Perioperative hypotension (PH), commonly a side effect of anesthesia,is one of the main mortality causes during the 30 posterior days of asurgical procedure. Novel research lines propose combining machinelearning algorithms with the Arterial Blood Pressure (ABP) waveform tonotify healthcare professionals about the onset of a hypotensive event withtime advance and prevent its occurrence. Nevertheless, ABP waveformsare heterogeneous among patients, consequently, a general model maypresent different predictive capabilities per individual. This project aimsat improving the performance of an artificial neural network (ANN) topredict hypotension events with time advance by applying personalizedmachine learning techniques, like data grouping and domain adaptation. Wehypothesize its implementation will allow us to cluster patients with similardemographic and ABP discriminative characteristics and tailor the modelto each specific group, resulting in a worst overall but better individualperformance. Results present a slight but not clinical significant improvementwhen comparing AUROC values between the group-specific and the generalmodel. This suggests even though personalization could be a good approach todealing with patient heterogeneity, the clustering algorithm presented in thisthesis is not sufficient to make the ANN clinically feasible. / Perioperativ hypotoni (PH), vanligtvis en sidoeffekt av anestesi, är en av dehuvudsakliga dödsorsakerna under de första 30 dagarna efter ett kirurgiskt ingrepp. Nya forskningslinjer föreslår att kombinera maskininlärningsalgo-ritmer med vågformen av det arteriella blodtrycket (ABP) för att förvarna sjukvårdspersonalen om uppkomsten av en hypotensiv episod, and därmedförhindra förekomsten. ABP-vågformen är dock heterogen bland patienter,så en allmän modell kan ha olik prediktiv förmåga för olika individer.I det här projektet används personaliserade maskininlärningstekniker, somdatagruppering och domänanpassning, för att försöka förbättra ett artificielltneuralt nätverk (ANN) som förutspår hytotensiva episoder. Vår hypotes är attimplementeringen kommer låta oss klustra patienter med liknande demografioch ABP-karakteristik för att skräddarsy modellen till varje specifik grupp,vilket leder till en sämre övergripande men bättre individuell prestanda. Resultaten visar små men inte kliniskt signifikanta förbättringar när AUROC-värden jämförs mellan den gruppspecifika och den allmänna modellen. Detta tyder på att även fast personalisering kan vara en bra tillnärmning till patientersheterogenitet, är inte klusteralgoritmen som presenteras här tillräcklig förklinisk användning av ANN.

Exploiting photoplethysmography signals (PPG) for non-invasive blood pressure (BP) measurement is interesting for various reasons. First, PPG can easily be measured using fingerclip sensors. Second, camera based approaches allow to derive remote PPG (rPPG) signals similar to PPG and therefore provide the opportunity for non-invasive measurements of BP. Various methods relying on machine learning techniques have recently been published. Performances are often reported as the mean average error (MAE) on the data which is problematic. This work aims to analyze the PPG- and rPPG based BP prediction error with respect to the underlying data distribution. First, we train established neural network (NN) architectures and derive an appropriate parameterization of input segments drawn from continuous PPG signals. Second, we use this parameterization to train NNs with a larger PPG dataset and carry out a systematic evaluation of the predicted blood pressure. The analysis revealed a strong systematic increase of the prediction error towards less frequent BP values across NN architectures. Moreover, we tested different train/test set split configurations which underpin the importance of a careful subject-aware dataset assignment to prevent overly optimistic results. Third, we use transfer learning to train the NNs for rPPG based BP prediction. The resulting performances are similar to the PPG-only case. Finally, we apply different personalization techniques and retrain our NNs with subject-specific data for both the PPG-only and rPPG case. Whilst the particular technique is less important, personalization reduces the prediction errors significantly.