Neste trabalho, buscou-se avaliar se o uso do balão intragástrico (BI) durante um período de seis meses por pacientes obesos ou com sobrepeso e com síndrome metabólica (SM) traz melhora nos parâmetros de função pulmonar, distribuição da gordura corporal e SM. Trata-se de um estudo longitudinal e intervencionista com indivíduos adultos que foram submetidos à avaliação antropométrica, da bioquímica sérica, dos parâmetros de função pulmonar e do padrão de distribuição da gordura corporal, antes da instalação do BI, durante o acompanhamento de seis meses e após a sua retirada. Nos dados obtidos três meses após a colocação do BI, os pacientes apresentaram aumento da capacidade de difusão ao monóxido de carbono com correlação positiva entre esta e o percentual total de gordura corporal (rs=0,39; p=0,05), o padrão ginoide (rs=0,41; p=0,05) e o padrão torácico (rs=0,42; p=0,01). Também foi observado que, após três meses da colocação do BI, houve redução significativa do índice de massa corpórea (IMC) (p=0,0001) e da força muscular inspiratória (p=0,009). Também houve aumento significativo da capacidade vital forçada (CVF) (p=0,0001), da capacidade pulmonar total (CPT) (p=0,001) e do volume de reserva expiratório (VRE) (p=0,0001). Ao fim do estudo, foi observada elevação estatisticamente significante da CPT (p=0,0001), capacidade residual funcional (p=0,0001), volume residual (VR) (p=0,0005) e VRE (p=0,0001). Também foi observada redução significativa do IMC, cuja mediana passou de 39,1 kg/m2 no início da avaliação para 34,5 kg/m2 no final dos seis meses (p=0,0001). Ao fim do estudo, 31 pacientes (77,5%) não apresentavam mais critérios diagnósticos para SM. Em relação aos parâmetros de distribuição da gordura corporal, também houve mudanças importantes com redução significante (p=0,0001) do percentual de gordura nos quatro padrões analisados (tronco, androide, ginoide e total). Houve correlação significante entre o delta da CPT e o delta da circunferência abdominal (ρ=-0,34; p=0,03), entre o delta da CRF e o delta do IMC (ρ=-0,39; p=0,01) e entre o delta do VRE e os deltas do IMC (ρ=-0,44; p=0,005) e do colesterol HDL (ρ=-0,37; p=0,02). Também houve correlação significante entre o delta do VRE com os deltas das gorduras de tronco (ρ=-0,51; p=0,004), androide (ρ=-0,46; p=0,01), ginoide (ρ=-0,55; p=0,001) e total (ρ=-0,59; p=0,0005). / This work aimed to evaluate if the use of intragastric balloon (IB) for a period of six months in obese patients or overweight and metabolic syndrome (MS) brings improvement in the parameters of pulmonary function, body fat distribution and MS. This is a longitudinal and interventional study with adults who underwent anthropometric measurements, serum biochemistry, pulmonary function parameters and the pattern of distribution of body fat before the IB installation, during follow-up of six months and after their withdrawal. In data obtained three months after the placing of BI we observed a statistically significant positive correlation between the capacity of diffusion and the percentage of whole-body fat mass (rs=0.39; p=0.05), gynoid fat mass (rs=0.41; p=0.05), and trunk fat mass (rs=0.42; p=0.01). It was also noted that, after three months of placement of BI, there was a significant reduction in the body mass index (BMI) (p=0.0001) and the maximal inspiratory pressure (p=0.009). We also observed a significant increase in the forced vital capacity (FVC) (p=0.0001), total lung capacity (TLC) (p=0.001), and expiratory reserve volume (ERV) (p=0.0001). At the end of the study it was observed that the TLC (p=0.0001), functional residual capacity (FRC) (p=0.0001), residual volume (p=0.0005), and ERV (p=0.0001) were significantly increased by IB. The BMI significantly decreased from a median of 39.1 kg/m2 at the beginning of the study to 34.5 kg/m2 at the end of the six-month period (p=0.0001). At this time, 31 participants (77.5%) no longer met the diagnostic criteria of MS. The parameters of body fat distribution also exhibited remarkable changes. The percentage of fat in all four investigated patterns of distribution (truncal, android, gynoid, and total) exhibited significant reductions (p=0.0001). Significant correlations were found between delta TLC and delta abdominal circumference (ρ=-0.34; p=0.03), delta FRC and delta BMI (ρ=-0.39; p=0.01), delta ERV and delta BMI (ρ=-0.44; p=0.005), and delta ERV and delta high-density lipoprotein (HDL) (ρ=-0.37; p=0.02). Significant correlations were also found between delta ERV and delta truncal (ρ=-0.51; p=0.004), android (ρ=-0.46; p=0.01), gynoid (ρ=-0.55; p=0.001), and total fat (ρ=-0.59; p=0.0005).

Extenderes: vídeo-ações são ações registradas e apresentadas em vídeo, nas quais meu corpo estabelece relações com vestíveis e com balões no espaço de um quarto. Essas vídeo-ações foram desenvolvidas entre os anos de 2011 e 2013. Assim criei situações que levavam meu corpo a explorar outras formas de movimentação e percepção do espaço a minha volta. Ao longo desta dissertação são esmiuçados alguns conceitos que se referem à relação do meu corpo com o objeto no momento da ação, são eles o conceito de jogo tratado por Hans-Georg Gadamer, o conceito de secundidade desenvolvido por Charles Peirce e o conceito de tarefa introduzido na dança por Ana Halprin. Também são pensadas algumas questões presentes nessas ações do grupo Extenderes como a repetição, a vulnerabilidade do corpo e a exaustão. O processo de criação é abordado segundo a função do fantasma na psicanálise, e também, segundo a experimentação, e a ludicidade como forma de construção. / Extenderes: video-actions are actions recorded on video, in which my body establishes relationships with wearable pieces and balloons in the space of a room. This video-actions were developed between 2011 and 2013. So I created situations that led my body to explore others forms of movement and perception of the space around me. Throughout this dissertation are scrutinized some concepts that refer to the relationship of my body with the object at the time of action. They are the play concept by Hans Georg Gadamer, the concept of secondness developed by Charles Peirce and the concept of the task introduced in dance by Ana Halprin. Also are thought some questions present in those actions Extenderes group as repetition, body vulnerability and exhaustion. The creation process is discussed according to the function of the fantasy in psychoanalysis, and also according playfulness as a way of building.

Introducción: La intervención coronaria percutánea primaria durante las 24 primeras horas de inicio del dolor torácico reduce la mortalidad por infarto de miocardio con ST elevado (IMA STE). El objetivo del estudio fue evaluar la mortalidad intrahospitalaria a 30 días según el tiempo puerta-balón y el tiempo total de isquemia en pacientes con IAM STE sometidos a intervención coronaria percutánea (ICP) primaria en un hospital de referencia. Métodos: Estudio retrospectivo de cohorte de pacientes con IMA STE sometidos a ICP primaria en un hospital de referencia de Lima, Perú. Analizamos la asociación entre el tiempo total de isquemia menor a 12 horas y tiempo puerta balón menor a 90 minutos con mortalidad a 30 días, mediante Regresión de Cox, ajustado por otros factores. Resultados: Durante el periodo 2010-2014, 296 sujetos con IMA STE fueron sometidos a ICP primaria. El 82,4% fueron varones y la media de edad fue 66,5 años ±11,8. La mortalidad intrahospitalaria a 30 días fue 8,11%. El 82,43% tuvo un tiempo total de isquemia menor a 12 horas y el 33,11% un tiempo puerta-balón menor a 90 minutos. No se encontró asociación entre ambos tiempos y mortalidad intrahospitalaria. El paro cardiaco (HR: 2,9 IC 95% 1,09-7,72), shock cardiogénico al ingreso (HR: 7,06 IC 95% 2,84-17,59) y un flujo TIMI menor a 3 post ICP (HR: 4,21 IC 95% 1,73-10,19) se asociaban a mayor mortalidad. Conclusión: No hubo asociación entre los tiempos estudiados con la mortalidad intrahospitalaria. Se sugieren intervenciones para disminuir los tiempos en esta población. / Introduction: Primary percutaneous coronary intervention reduces mortality in patients with ST elevated myocardial infarction (STE MI). The objective was to evaluate the 30 days in-hospital mortality according to door-to-balloon time and total ischemic time in patients treated with primary PCI. Methods: A retrospective cohort study was performed including patients with STE MI who underwent primary PCI at a national reference hospital in Lima, Peru. A Cox Regression analysis was performed for door-to-balloon time less than 90 minutes and total ischemic time less than 12 hours as predictors and in-hospital mortality as outcome. Results: During 2010’2014, 296 STE MI patients underewent PCI. From them, 82,4% were male. The mean age was 66,5 ±11,8 years. The 30-day mortality was 8,11%. The proportion of patients with total ischemic time less than 12 hours and door-to-balloon time was 82,43% and 33,11% respectively. No association between these intervals and 30-day mortality was found. Cardiac arrest (HR: 2,9 95%CI 1,09-7,72), cardiogenic shock at the admission (HR: 7,06; 95%CI: 2,84- 17,59) and TIMI flow less than 3 after primary PCI (HR: 4,21; 95%CI: 1,73-10,19) were associated with higher 30-day mortality.. Conclusion: No association between mortality and lower total ischemia time or door to ballon time mortality was found. A significant delay was observed in hospital arrival and performing revascularization.

Nous avons développé un nouveau ballonnet pour l'occlusion trachéale fœtale par endoscopie (FETO) qui permet une levée de l'occlusion facile, par contrôle externe et non-invasive. Ce ballonnet "Smart-TO" permet d'éviter les problèmes liés au rétablissement des voies aériennes. La solution technique est basée sur une valve magnétique dont l'ouverture est contrôlée par le champ de fuite d'une IRM. L'ouverture de la valve provoque la vidange du ballonnet, qui est ensuite expulsé par les sécrétions pulmonaires. Les tests d'imperméabilité, d'occlusion et de fonctionnement sont prometteurs. Une toute première expérimentation sur le modèle du singe a montré la bonne fonctionnalité et fonctionnement du ballonnet "Smart-TO". D'autres tests in vitro ainsi que d'autres tests animaux sont prévus. Un brevet a été déposé en 2016. Une analyse de risques préliminaire, une exploration des chemins réglementaires et une étude de marché ont été initiés mais sont encore en cours. / We developed a new balloon for Fetal Endoscopic Tracheal Occlusion (FETO) which allows an easy, remotely controlled, and non-invasive reversal occlusion. This "Smart-TO" balloon to overcome issues related to the airway reestablishment. The technology is based on a magnetic valve whose opening is actuated by the fringe field of an MRI scanner. The opeing of the valve induces the deflation of the balloon, which is then washed out by the fluid coming out from the lungs. The impermeability, occlusion and operation tests are promising. A very first experimentation on the monkey model showed appropriate functionality and operation of the "Smart-TO" balloon. Further in vitro and animal tests are planned. A patent has been filed in 2016. Preliminary risk analysis, regulatory routes exploration, and market study have been started but are still ongoing.

La traumatologie est la première cause de mortalité chez les sujets de moins de 40 ans dans les pays industrialisés. Le choc hypovolémique lié à une hémorragie du tronc est une cause fréquente de décès, à la fois sur les lieux de l’accident mais également pendant la prise en charge pré-hospitalière et intra-hospitalière. L’existence d’un hémopéritoine est un facteur de sous estimation du traumatisé grave.Le contrôle lésionnel, mieux connu sous les anglicismes « damage control ressucitation » et « damage control surgery », est le paradigme moderne de la prise en charge du choc hémorragique d’origine traumatique. Il comprend une mise en condition minimaliste privilégiant la réalisation d’une hémostase chirurgicale précoce et rapide, suivie d’une réanimation intensive associant transfusion massive, réchauffement et optimisation de la coagulation. Le traitement chirurgical exhaustif des lésions traumatiques est différé au delà de la période d’instabilité.Chez le blessé hémorragique agonique, la thoracotomie de ressuscitation avec clampage de l’aorte thoracique est une pratique courante mais dont les bases factuelles ne sont pas bien établies. En revanche en pathologie artérielle, la voie d’abord endovasculaire a très largement fait preuve de son efficacité.Nous avons émis l’hypothèse qu’un clampage aortique endovasculaire de l’aorte thoracique par voie rétrograde est possible et que cette technique améliore le profil hémodynamique dans le territoire myocardique et cérébral tout en augmentant la survie en cas de choc hémorragique lié à un traumatisme abdominal.Nos résultats suggèrent que cette technique de sauvetage est efficace, même s’il semble exister des limites corrélées à la durée de l’ischémie/reperfusion viscérale et médullaire. / Trauma is the leading cause of mortality in industrialized countries for people aged below 40 years. Fifty percent of the pre hospital and in hospital mortality from severe blunt and penetrating abdominal traumas is due to an hemorrhagic shock. Peritoneal bloody effusion is the main reason to under estimate the seriousness of trauma.Damage control resuscitation (DCR) and damage control surgery (DCS) typify the current paradigm of hemorrhagic torso trauma management. Damage control includes a basic pre operative management before a short surgical control of bleeding followed by intensive resuscitation care based on massive blood transfusion, palliation of hypothermia and correction of biological coagulation disorders. According to this strategy, the curative surgical treatment is postponed until the patient has been stabilized.Some authors have reported on the efficacy of resuscitation thoracotomy with aortic crossclamping in the emergency room in patients with severe abdominal trauma . However, the end results of such a procedure are contrasted and its use is still debated. More recently, endovascular approach has emerged in the management algorithm of some vascular emergencies. We hypothesized that an endovascular retrograde occlusion of the thoracic aorta would be a safe and efficient to preserve hemodynamic profile in cardiac and cerebral area, and to improve survival in case of uncontrolled hemorrhagic shock caused by an abdominal trauma.Our results sustain this hypothesis, even if its benefits seem time-limited, according to the medullar and visceral side-effects of ischemia/reperfusion.

M.Cur. / The intra-aortic balloon pump is a volume displacement device that is used to provide partial support to the left ventricle. The IABP is an effective and general used circulatory support device. The nursing of a patient on IABP therapy requires demonstration of specific clinical competence by the critical care nurse. Clinical competence is defined as the ability of the critical care nurse to integrate his/her knowledge, skills and values and to demonstrate it during nursing of a patient on IABP with the aim to promote the patient's health. The aim of this research had been to evaluate the clinical competence of the critical care nurse during the nursing of a patient on IABP, and to make recommendations according to that regarding education, the practice and research. The relationship between the components of clinical competence namely knowledge, skills and values that were set as aim, were also established. A quantitative, contextual, descriptive, correlational research design had been used in the study to compile a self-developed evaluation instrument that had been used to evaluate the clinical competence of the critical care nurse. The evaluation instrument consisted of a questionnaire that evaluated the knowledge of the critical care nurse, a check list that evaluated the skills of the critical care nurse and a semantic differential scale that evaluated the values of the critical care nurse during the nursing of a patient on IABP therapy. After the data was analyzed, it appeared that critical care nurses don't possess the necessary knowledge and skills to nurse patients on IABP, and as such are not clinically competent to nurse patients on IABP. iii Recommendations were made regarding education, the practice and research in order to improve the clinical competence of critical care nurses during the nursing of a patient on IABP therapy

Extenderes: vídeo-ações são ações registradas e apresentadas em vídeo, nas quais meu corpo estabelece relações com vestíveis e com balões no espaço de um quarto. Essas vídeo-ações foram desenvolvidas entre os anos de 2011 e 2013. Assim criei situações que levavam meu corpo a explorar outras formas de movimentação e percepção do espaço a minha volta. Ao longo desta dissertação são esmiuçados alguns conceitos que se referem à relação do meu corpo com o objeto no momento da ação, são eles o conceito de jogo tratado por Hans-Georg Gadamer, o conceito de secundidade desenvolvido por Charles Peirce e o conceito de tarefa introduzido na dança por Ana Halprin. Também são pensadas algumas questões presentes nessas ações do grupo Extenderes como a repetição, a vulnerabilidade do corpo e a exaustão. O processo de criação é abordado segundo a função do fantasma na psicanálise, e também, segundo a experimentação, e a ludicidade como forma de construção. / Extenderes: video-actions are actions recorded on video, in which my body establishes relationships with wearable pieces and balloons in the space of a room. This video-actions were developed between 2011 and 2013. So I created situations that led my body to explore others forms of movement and perception of the space around me. Throughout this dissertation are scrutinized some concepts that refer to the relationship of my body with the object at the time of action. They are the play concept by Hans Georg Gadamer, the concept of secondness developed by Charles Peirce and the concept of the task introduced in dance by Ana Halprin. Also are thought some questions present in those actions Extenderes group as repetition, body vulnerability and exhaustion. The creation process is discussed according to the function of the fantasy in psychoanalysis, and also according playfulness as a way of building.

The aim of this work is to revitalize the public space of náměstí Míru on Kraví hora. The work tries to find further functional use of the, which would include rebuilding the currently unused former military premises at Lerchova street while respecting the current state of the surrounding buildings and greenery. The proposed solution of a new square design signifies urban space as the center of the Masaryk's Quarter. The design takes into account the current location of the tramway balloon loop, which is located in the middle of the area and shapes the unique character of the location. This element of transport is thus left at the heart of the entire urban design. It forms an islet made up of designed buildings with a square created inside. The intention is to build a lively core of the district attracting attention not only from a local populace.

This thesis concerns the development of a mobile application for the Apple iPhone plat- form for hot-air balloon pilots. The main functionality is to create up-to-date map of wind strength and direction for each flight level and navigation tools. Accompanying functions include pilot logbook management, flight recording and recall. A crucial aspect of this appli- cation is the GUI design, which meets the conditions in which the application will be used. The application will also be evaluated in test conditions during an actual balloon flight.

This thesis describes the phase and amplitude correction of 12.7 mm diameter, Type-1 microphones for three frequency bands, including within the infrasound regime, and its application to acoustic measurements. Previous data stem from acoustic intensity measurements using two-dimensional, four-microphone probes, which emphasized the requirement of having the acoustic phase and amplitude difference be much greater than the interchannel mismatch. Although correcting the amplitude/phase is well-known, obtaining the necessary transfer functions in the infrasound regime is challenging because (1) signal-to-noise ratios are often poor, (2) long measurement times are required for averaging, and (3) microphone responses vary significantly across these low frequencies. In this paper, a convenient infrasound source previously studied for infrasound adverse effects on humans is intended for performing a relative calibration. This work also seeks to elaborate recommendations for probe spacing, averages or length recordings, and instrument mismatch. The last two chapters show the PAGE method application in infrasonic sources. Those chapters have the intensity measurements using free-field microphones with larger separation distances than commercial intensity probes but compact compared to state of the art in infrasonic arrays.