Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-06-05T11:33:39Z No. of bitstreams: 1 469953 - Texto Completo.pdf: 1534211 bytes, checksum: 7c89a701daa939437af011c80cab458f (MD5) / Made available in DSpace on 2015-06-05T11:33:39Z (GMT). No. of bitstreams: 1 469953 - Texto Completo.pdf: 1534211 bytes, checksum: 7c89a701daa939437af011c80cab458f (MD5) Previous issue date: 2015-03-31 / This study correlates the Robore Agreements with the Brazilian geopolitical thought. As such, it aims to describe how what is written in such agreements is influenced by the thought described by geopoliticians, not only through the thought described by international schools, but also through the one supported in the country for the bilateral relations between Brazil and Bolivia. Accordingly, it aims to figure out how the Brazilian geopolitical thought influenced the goals of the Robore Agreements, starting from an approach of their economic, political, energetic, historical and military aspects as well as the physical integration promoted by the Agreements. This was done through a bibliographical research on the scholars of the Brazilian geopolitics and the Brazilian government?s diplomatic and political performances regarding Bolivia and such treaties. For the study, the analysis of the historical antecedents of the governmental relations between Brazil and Bolivia was necessary as a mean to comprehend the circumstances prior to signing the Agreements. As such, it was possible to develop a study on the Brazilian geopolitical thought, concerning the issues of the international affairs with neighbouring countries, with emphasis on the relations with Bolivia. All ends with the analysis of the Robore Agreements according to the geopolitical thought in order to find out elements in the Agreements which demonstrate that the governmental diplomatic performance in the production of such agreements originated from these thoughts, especially from Mario Travassos?s (1938) masterpiece: ?The Continental Projection of Brazil?. / O presente trabalho correlaciona os Acordos de Robor? e o pensamento geopol?tico brasileiro, de forma que se pretende descrever como as letras destes acordos acabam por se influenciar pelo pensamento descrito pelos geopol?ticos, tanto pelo pensamento descrito pelas escolas internacionais, quanto pelo pensamento esposado no pa?s para as rela??es bilaterais entre Brasil e Bol?via, de forma a saber como o pensamento geopol?tico brasileiro influenciou os prop?sitos dos Acordos de Robor?, a partir de uma abordagem dos seus aspectos econ?micos, pol?ticos, energ?ticos, hist?ricos, militares e de integra??o f?sica promovida pelos Acordos, por meio de pesquisa bibliogr?fica, sobre os pensadores da geopol?tica brasileira e nas atua??es diplom?ticas e pol?ticas do governo brasileiro em rela??o ? Bol?via e tais tratados. Sendo que para o estudo necess?rio foi a an?lise dos antecedentes hist?ricos das rela??es governamentais entre Brasil e Bol?via, como meio para entender as circunst?ncias anteriores ? realiza??o dos Acordos. A partir deste prisma, foi poss?vel a realiza??o do estudo do pensamento geopol?tico brasileiro sobre as quest?es das rela??es internacionais com os pa?ses vizinhos, tendo como foco as rela??es com a Bol?via. Terminando por analisar os Acordos de Robor?, sob o prisma do pensamento geopol?tico, a fim de encontrar nos Acordos elementos que acabassem por demonstrar que a atua??o diplom?tica governamental na confec??o de tais acordos se deu a partir destes pensamentos, principalmente a partir da obra Proje??o Continental do Brasil, de M?rio Travassos (1938).

<p>UVOD. Bilijarna kalkuloza je najče&scaron;će oboljenje hepatobilijarnog sistema, a holecistektomija predstavlja jedan od najče&scaron;će izvođenih operativnih zahvata. Laparoskopska holecistektomija je danas zlatni standard lečenja holelitijaze. Laparoskopska holecistektomija je pokazala pobolj&scaron;anje u klinički značajnim ishodima kao &scaron;to su skraćenje operativnog vremena, kraća hospitalizacija, smanjenje jačine i trajanja postoperativnog bola i brži povratak dnevnim i radnim aktivnostima. Postoperativna bol i vreme potpunog oporavka ostaju dva glavna problema posle nekomplikovane laparoskopske holecistektomije koje bi trebalo pobolj&scaron;ati. Bol koji je povezan sa laparoskopskom holecistektomijom je kompleksan i multifaktorijalan. On nastaje o&scaron;tećenjem tkiva, disekcijom i uklanjanjem žučne kesice iz svoje lože, stimulacijom periportalnih nerava, iritacijom dijafragme, mehaničkim i hemijskim interakcijama gasa i pneumoperitoneuma, incizijama portova. Istraživanja su označila parijetalni i visceralni bol kao dva glavna mehanizma nastanka bola kod laparoskopske holecistektomije. Bol se ne može meriti nego proceniti jer je subjektivni osećaj. Pokazalo se potrebnim da se na čvr&scaron;ćim naučnim osnovama da odgovor na pitanje da li je moguće blokirati parijetalni i visceralni bol posle laparoskopske holecistektomije u akutnoj fazi. CILJEVI. Cilj studije je da uporedi standardnu analgeziju (ne-opioidnu) (grupa O) sa davanjem parijetalne blokade (grupa P), ili davanjem visceralne blokade (grupa V), ili sa obe date blokade (grupa P+V). Primarni ishodi studije su bolesnikov procenjeni bol pre operacije i posle operacije na 1, 2, 4, 6, 12, 24, 48 sati i 7. dana. Sekundarni ishodi studije su bolesnikova procenjena mučnina na 1,2,4,6,12 sati i bolesnikova procenjena mobilnost 1. 2. i 7. dan. HIPOTEZA. Blokada postoperativnog visceralnog bola i blokada postoperativnog parijetalnog bola posle laparoskopske holecistektomije putem intraperitonealne lokalne infiltracije anestetikom i putem lokalne infiltracije anestetikom pristupnih laparoskopskih portova može značajno smanjiti rani postoperativni bol. MATERIJAL I METODE. Ova prospektivna, randomizirana jednostruko slepa studija je započela septembra 2014. godine i trajala je do januara 2016. godine. Istraživanje je sprovedeno na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju i Urgentnom centru Kliničkog centra Vojvodine u Novom Sadu kod bolesnika operisanih metodom laparoskopske holecistektomije. Rad je podeljen u nekoliko celina. 1. Procena veličine uzorka; 2. Procena podobnosti za studiju; 3. Anketiranje i uključivanje u studiju; 4. Razvrstavanje u grupe i operativni rad; 5. Period postoperativnog praćenja; 6. Statistička obrada i pisanje rada.<br />1. Procena veličine uzorka. Studija je realizovana podelom bolesnika u 4 grupe. Neophodni broj bolesnika je izračunat uzimajući podatke iz pilot istraživanja slične studije iz 2012. godine. Veličina uzorka je računata za primarni ishod studije&nbsp; (bolesnikov procenjen bol sa NAS) na pretpostavci da treba biti 20% smanjenja bola u prvom postoperativnom satu, uz verovatnoću Tip 1 gre&scaron;ke &alpha;=0.05 i Tipa 2 gre&scaron;ke &beta;=0.10 da postigne adekvatnu statističku snagu oko 80% i da otkrije 20% razlike u srednjoj vrednosti procenjenog bola jedan sat nakon laparoskopske&nbsp; holecistektomije. Procenjeni broj ispitanika po grupama prema zadatim kriterijumima je bio (P+V=65; P=68; V=68; O=65). Studija je započela uključivanjem prvog bolesnika u studiju a zavr&scaron;ena ispunjenim periodom praćenja sve dok poslednji bolesnik nije doneo upitnike o bolu, mučnini i kretanju. 2. Procena podobnosti za studiju. U periodu studije ukupan broj holecistektomiranih bolesnika je bio 1024 (440 klasično i 584 laparoskopski). Samo pogodni bolesnici su anketirani (584) i pročitali su informacioni list o istraživanju. Uključivanje ili procena podobnosti bolesnika za studiju sprovedena je na osnovu uključnih i isključnih kriterijuma. U studiju nije uključeno ukupno 226 bolesnika. Od tog broja 82 bolesnika je odbilo učestvovati u studiji a 144 bolesnika nije ispunilo uključne postavljene kriterijume. Svojim potpisom potvrdilo je uče&scaron;će u studiji 358 bolesnika. 3. Anketiranje i uključivanje u studiju. Nakon prijema bolesnika u bolnicu ispitivači su uzimali anamnezu i bolesnicima je ponuđen informacioni list i informisani pristanak. Nakon čitanja informacije, potpisivanja informisanog pristanka i zadovoljavanja&nbsp; uključnih i isključnih kriterijuma 358 bolesnika je uključeno u studiju. Obavljena je preoperativna priprema i ispitivači su popunili deo podataka u individualnom listu. 4. Razvrstavanje u grupe i operativni rad. Neposredno preoperativno od strane nezavisne osobe neuključene u studiju napravljena je randomizacija izabranih (n=358) u studijske grupe tablicama slučajnog izbora, tako da bolesnici nisu znali kojoj grupi pripadaju, dok su operater i osoblje to znali na početku operacije (jednostruko slepa studija). Nakon randomizacije i operacije bolesnici pripadaju jednoj od sledeće 4 grupe: Kontrolna grupa O=89, u kojoj su bolesnici sa urađenom laparoskopskom&nbsp; holecistektomijom bez visceralne blokade anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P=88, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom bez visceralne blokade anestetikom i sa parijetalnom blokadom anestetikom. Eksperimentalna grupa V=92, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P+V=89, u kojoj će biti bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i sa parijetalnom blokadom anestetikom. Primenjivan je uobičajni, standardni protokol anestezije za laparoskopske operacije kod svih ispitanika. Svim bolesnicima plasirana je orogastrična sonda koja se nakon operacije odstranjivala. Kod&nbsp; bolesnika kod kojih je primenjivan lokalni anestetik neposredno pre početka operacije pravio se rastvor lokalnog anestetika (Marcaine&reg; 0,25%). Bolesnici su otpu&scaron;teni sa bolničkog lečenja prvog postoperativnog dana, pod uslovom da nisu imali komplikacija. 5. Postoperativno praćenje i ispunjavanje upitnika. Po dolasku na odeljenje&nbsp; bolesnicima je odmah uključivana ista analgezija. Tokom ispunjavanja informisanog pristanka, bolesnici su dobili upitnik na kojoj će sami procenjivati nivo bola, mučnine i kretanja tokom ležanja u bolnici i vremena praćenja od 7 dana kući. Bolesnici su dolazili na unapred zakazane postoperativne kontrole 7 do 10 dana posle operacije i donosili ispunjene upitnike. Otpu&scaron;teno je i za praćenje ostalo n=302 laparoskopski operisanih bolesnika a isključeno iz studije n=20 bolesnika. 6. Statistička obrada i pisanje rada. Ukupno je analizirano 274 listića operisanih bolesnika: u Grupi P+V =67; u Grupi P =70; u Grupi V =70 i u Grupi O =67. Od osnovnih deskriptivnih statističkih parametara za kvalitativnu i kvantitativnu procenu dobijenih rezultata su kori&scaron;ćeni apsolutni brojevi, relativni brojevi, mediana, mod, aritmetička sredina i standardna devijacija (SD). Obrada podataka se vr&scaron;ila&nbsp; osnovnim i naprednim statističkim metodama i programima. Rezultati su prikazani tabelarno i grafički. REZULTATI. Demografski podaci. Ukupno je bilo 188 žena i 86 mu&scaron;karaca, u odnosu 2,2 : 1. Prosečna starost cele grupe je bila 52,1 &plusmn; 15,72 godine. Ukupno je bilo 179 zaposlenih i 95 nezaposlenih. Ukupno je bilo 45 ispitanika sa osnovnim obrazovanjem, 153 ispitanika sa srednjim obrazovanjem i 76 ispitanika sa visokim obrazovanjem. Ukupno je bilo 186 nepu&scaron;ača i 88 pu&scaron;ača. Prosečna vrednost BMI cele grupe je bila 27,24 &plusmn; 4,21 kg/m2. Prosečna vrednost ASA u celoj grupi je bila 2,03 (mediana=2, mod=2). Ne postoji statistički značajna razlika između posmatranih grupa u odnosu na posmatrane parametre. Laboratorijski podaci. Postoji statistički značajna razlika u vrednosti leukocita između posmatranih grupa (p=0,039), u vrednosti uree između posmatranih grupa (p=0,040). Ne postoji statistički značajna razlika u vrednosti eritrocita, trombocita, hemoglobina, &Scaron;UK-a, kreatinina i bilirubina posmatranih grupa. Operativni i postoperativni podaci. Ne postoji statistički značajna razlika u količini upotrebljenog Fentanila između posmatranih grupa. Postoji statistički značajna razlika u dužini trajanja operacije između posmatranih grupa (p=0,003), u trajanju postavljenog abdominalnog drena između posmatranih grupa (p=0,024), u trajanju hospitalizacije između posmatranih grupa (p=0,027), u broju dana do povratka uobičajenim aktivnostima između posmatranih grupa (p=0,000), u broju uzetih tableta između posmatranih grupa (p=0,000). Prosečna ocena zadovoljstva bolesnika posle operacije u celoj grupi je bila 8,80 (mediana=9; mod=10). Najbolju ocenu zadovoljstva bolesnika posle operacije je imala grupa P+V. Procena bola, mučnine i kretanja. Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola pre operacije (p=0,003). Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola 1h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 2h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 4h posle operacije (najbolju procenu bola je imala grupa P); u proceni jačine bola 6h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 12h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 24h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 48h posle operacije (najbolju procenu bola je imala grupa P) i u proceni jačine bola 7 dana posle operacije (najbolju procenu bola je imala grupa P). Procenjena bol se pojačava otprilike 2,5 sata posle operacije sa vrhom 3 sata posle operacije, a smanjuje se na istu vrednost kao 2. sata posle operacije, otprilike 5. sata posle operacije. U vremenskim intervalima 1, 2. i 7. postoperativni dan postoji značajno pobolj&scaron;anje u postoperativnoj mobilnosti bolesnika. U vremenskim intervalima 1, 2, 4, 6 i 12 sati postoji značajno pobolj&scaron;anje u procenjenoj vrednosti mučnine bolesnika. Korelacije. Statistički značajna pozitivna korelacija ocene bola posle 1. sata, posle 2. sata, posle 6. sata, posle 12. sata je utvrđena sa brojem uzetih tableta (p=0,000), kao i procene mučnine (p=0,000). Statistički značajna pozitivna korelacija procene bola posle 4. sata je utvrđena sa brojem uzetih tableta (p=0,006), kao i aktivnosti (p=0,014). Statistički značajna korelacija procene bola posle 24. sata je utvrđena sa brojem uzetih tableta (p=0,000; pozitivna) i trajanjem operacije (p=0,028; negativna). Statistički značajna pozitivna korelacija procene bola posle 48. sata i posle 7 dana je utvrđena sa brojem uzetih tableta (p=0,000). ZAKLJUČCI: Primena lokalnog anestetika datog na bilo koji način značajno smanjuje bol posle laparoskopske holecistektomije. Primena lokalnog anestetika datog i&nbsp; portalno i visceralno (P+V) značajno smanjuje bol u odnosu na samo portalnu (P) ili visceralnu (V) primenu u vremenskim intervalima 2, 6, 12 sat posle laparoskopske holecistektomije. Portalna (P) primena sa ili bez visceralne (V) primene lokalnog anestetika značajno smanjuje bol u vremenskim intervalima 1, 4, 24, 48 sati i 7 dana posle laparoskopske holecistektomije. Najbolje kretanje je bilo u grupi P+V posle laparoskopske holecistektomije. Najbolje smanjenje procenjene mučnine je bilo u grupi P posle laparoskopske holecistektomije. Najraniji povratak uobičajenim aktivnostima zabeležen je u grupi P+V. Najbolja ocena zadovoljstva bolesnika hirur&scaron;kim lečenjem bila je u grupi P+V. Postoperativna bol ima najznačajniju pozitivnu korelaciju sa procenjenom mučninom i brojem tableta uzetih od momenta otpusta do prve kontrole bolesnika.</p> / <p>INTRODUCTION: Biliary calculosis is the most frequent disease of the hepatobiliary system, and cholecystectomy is one of the most frequently performed surgical procedures. Today laparoscopic cholecystectomy represents the golden standard in treating cholelithiasis. Laparoscopic cholecystectomy showed improvement in the clinically significant outcomes, such as: reducing the duration of the surgery, shorter hospital stay, reducing the intensity and duration of postoperative pain and faster return to normal daily and working activities. Postoperative pain and the time of full recovery remain the two major problems after a non-complicated laparoscopic cholecystectomy and they should be improved. The pain related to laparoscopic cholecystectomy is complex and multi-factorial in origin. The pain occurs due to damaged tissues, dissection and removal of gallbladder from its cavity, stimulation of periportal nerves, irritation of the diaphragm, mechanical and chemical interaction of gases and pneumoperitoneum and port incisions. Researches have denoted parietal and visceral pains as two major mechanisms in occurrence of pain in laparoscopic cholecystectomy. Pain cannot be measured, but estimated, as it is a subjective feeling. It was considered necessary to find the answer, based on solid scientific evidence, if it was possible to block parietal and visceral pain after laparoscopic cholecystectomy in its acute phase. OBJECTIVES: The aim of this study is to compare standard, non-opioid, analgesia (group O) with applying parietal blockade (group P), or visceral blockade (group V), or compare with both applied blockades (group P+V). The primary outcomes of the study are the patient&acute;s estimated pain before surgery and 1, 2, 4, 6, 12, 24, 48 hours and 7th day after the surgery. The secondary outcomes of this study are the patient&acute;s estimated nausea level during 1, 2, 4, 6, 12 hours, along with the patient&acute;s estimated mobility 1st, 2nd and 7th day, postoperatively. HYPOTHESIS. Blockade of postoperative visceral pain and blockade of postoperative parietal pain following laparoscopic cholecystectomy, applying intraperitoneal local infiltration with anesthetic and also by local infiltration with anesthetic through accessible laparoscopic ports, can significantly reduce early postoperative pain. MATERIAL AND METHODS: This prospectively randomized single-blinded study started in September 2014 and lasted up to January 2016. The research was carried out at the Clinic for Abdominal, Endocrine and Transplantation Surgery and Emergency Center, Clinical Center of Vojvodina in Novi Sad and it involved patients who underwent laparoscopic cholecystectomy. This study has been divided into several units. 1. Assessment of sample size; 2. Assessment of eligibility for the study; 3. Survey and inclusion in the study; 4. Group formation and operational work; 5. Period of postoperative follow-up; 6. Statistical processing and writing the paper.1. Assessment of sample size. The study was realized by dividing the patients into 4 groups. The number of patients necessary was determined based on the data taken as pilot study from a similar study from 2012. Sample size was calculated for the primary outcome of the study (patient&acute;s estimated pain with NAS) based on the assumption that a pain reduction of 20% should occur during the first postoperative hour, with the probability of Type 1 error &alpha;=0.05 and Type 2 error &beta;=0.10 to reach the adequate statistical power of about 80%, and to reveal 20% difference in the average value of the estimated pain one hour after the laparoscopic cholecystectomy. The assessed number of respondents in groups according to the set criteria was (P+V =65;P =68;V =68; O =65). The study started when the first patient was included and it ended with the complete follow-up period when the last patient handed in the survey about pain, nausea and mobility. 2. Assessment of eligibility for the study. During the study the number of patients undergoing surgery applying the method of cholecystectomy was 1024 (440 classical and 584 laparoscopic). Only the suitable patients were surveyed (584) and given to read the information leaflet about the study. Inclusion and assessment of patients&acute; eligibility was performed on the basis of inclusion and exclusion criteria. A total of 226 patients was not included in the study. Out of that number 82 patients refused to participate in the study and 144 did not fulfill the inclusive criteria set. By signing 358 patients confirmed their participation in the study. 3. Survey and inclusion in the study. After admitting the patients to hospital the surveyors took their anamnesis and the patients were offered an information leaflet and informed consent. Following the reading of the information leaflet, signing the informed consent and satisfying the criteria for inclusion and exclusion, 358 patients were included in the study. Preoperative preparations were performed and the surveyors filled in some of the data on the individual list. 4. Group formation and operational work. Prior to the surgery an independent person not included in the study carried out the randomisation of the patients chosen (n=358) into study groups by random selection tables. The patients did not know which group they belonged to, while it became known to the surgeon and the operation stuff at the beginning of the surgery (singleblinded study). After randomization and surgery the patients belonged to one of the following groups: Control group O=89 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic and without parietal blockade by anesthetic. Experimental group P=88 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic but with parietal blockade by anesthetic. Experimental group V=92 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic but without parietal blockade by anesthetic. Experimental group P+V=89 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic and with parietal blockade by anesthetic. The standard protocol of anesthesia for laparoscopic cholecystectomy was applied to all patients. An orogastric tube used during the surgery, was removed after it. In patients with applied local anesthetic immediately before surgery a solution of local anesthetic was made (Marcaine&reg; 0,25%). The patients were discharged from hospital the first postoperative day, provided that no complications occurred. 5. Postoperative follow-up and completing the questionnaire. When admitted to the ward the patients were given the same kind of analgesia. While completing the informed consent the patients were given a questionnaire for estimating their pain level, nausea and mobility during their stay in hospital and during the 7-day follow-up period at home. The patients were required to come for 7 and 10-day postoperative check-ups by appointment and then they handed in the questionnaires. n=302 patients with performed laparoscopic cholecystectomy were released and designated for follow-up, and n=20 patients were excluded from the study. 6. Statistical processing and writing the paper. In total 274 operated patients&acute; slips were analysed, by groups as follows: in Group P+V =67; in Group P =70; in Group V =70 and in Group O =67. From the basic descriptive statistical parametres for qualitative and quantitative assessment of results obtained, absolute numbers, relative numbers, the median, mode, arithmetic mean and standard deviation (SD) were used. Data processing was carried out using basic and advanced statistical methods and programmes. The results are presented in tabular and graphical manner. RESULTS. Demographic data. In total there were 188 women and 86 men, in proportion 2,2 : 1. The average age of the whole group was 52,1 &plusmn; 15,72 years. In total there were 179 employed and 95 unemployed persons. In total there were 45 surveyed patients with primary education, 153 surveyed patients with secondary education and 76 surveyed patients with higher education. In total there were 186 nonsmokers and 88 smokers. The mean BMI value of the whole group was 27,24 &plusmn; 4,21 kg/m2. The mean value of ASA of the whole group was 2,03 (the median=2, mode=2). There is no significant difference among the groups observed considering the observed parametres. Laboratory data. There is a statistically significant difference in the value of leukocytes among the observed groups (p=0,039), and in the value of urea among the observed groups (p=0,040). There is no statistically significant difference in the value of the erythrocyte, platelets, hemoglobin, blood glucose, creatinine and bilirubin of the&nbsp; observed groups. Operative and postoperative data. There is no statistically significant difference in the amount of Fentanyl&reg; applied among the observed groups. There is statistically significant difference in the length of the surgery among the observed groups (p=0,003), in the duration of the positioning of abdominal drainage among the observed groups (p=0,024), in the duration of hospital stay among the observed groups (p=0,027), in the number of days until getting back to regular activities among the observed groups&nbsp; (p=0,000), in the number of taken pills among the observed groups (p=0,000). The patients&acute; average satisfaction grade after surgery in the whole group was 8,80 (the median=9; mode=10). Group P+V had the best patient&lsquo;s satisfaction grade after the surgery. Assessment of pain, nausea and mobility. There is statistically significant difference in the estimation of pain intensity before surgery among the observed groups (p=0,003). There is statistically significant difference in the estimation of pain intensity 1 hour after surgery among the observed groups (P+V having the best estimated pain); in the estimation of pain intensity 2 hours after&nbsp; surgery (P+V having the best estimated pain); in the estimation of pain intensity 4 hours after surgery (P having the best estimated pain); in the estimation of pain intensity 6 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 12 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 24 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 48 hours after surgery (P having the best estimated pain) also in the estimation of pain intensity 7 days after surgery (P having the best estimated pain). The estimated pain intensifies at about 2,5 hours after surgery and peaks 3 hours after surgery, and decreases to the same level as it was during 2nd hour after surgery approximately during 5th hour after surgery. There is considerable improvement in mobility of patients in the time interval 1st, 2nd and 7th postoperative days. There is considerable improvement in estimated nausea level of patients in the time interval 1, 2, 4, 6 and 12 hours. Correlations. Statistically significant positive correlation in estimated pain after 1st hour, after 2nd hour, after 6th hour and after 12th hour was determined by the number of tablets taken (p=0,000), just like the estimated nausea level (p=0,000). Statistically significant positive correlation in estimated pain after 4th hour was determined by the number of tablets taken (p=0,006), just like the activities (p=0,014). Statistically significant positive correlation in estimated pain after 24th hour was determined by the number of tablets taken (p=0,000; positive), and by the duration of the surgery (p=0,028; negative). Statistically significant positive correlation in estimated pain after 48th hour and after 7 days was determined by the number of tablets taken (p=0,000). CONCLUSIONS: The application of local anesthetic, regardless of how it was applied, considerably reduces pain after laparoscopic cholecystectomy. The application of local anesthetic by port or viscerally (P+V) considerably reduces pain compared to only by port (P) or only visceral (V) application in the time intervals of 2, 6, and 12 hours after laparoscopic cholecystectomy. The application of local anesthetic by port (P), with or without visceral (V), considerably reduces pain in the time intervals of 1, 4, 24, and 48 hours and 7 days after laparoscopic cholecystectomy. The best mobility was shown by group P+V after laparoscopic cholecystectomy. Estimated nausea was most reduced in group P after laparoscopic cholecystectomy. Group P+V presented the earliest return to regular activities. The best patients&acute; satisfaction grade with surgical treatment was shown by group P+V. Postoperative pain is most considerably positively correlated with the estimated nausea and pills taken, from the moment of patient&acute;s release from hospital to the first check-up.<br />&nbsp;</p>

<p>Uvod: Individualno kreiran program vežbi lumbalne stabilizacije, mogao bi da doprinese boljem oporavku pacijenata sa hroničnim bolom u donjem delu leđa. Program vežbi u lečenju hroničnog lumbalnog bola je prilično raznolik, ali je dokazano da su vežbe stabilizacije najefikasnije, posebno vežbe u zatvorenom kinetičkom lancu. Cilj: je bio da se uporedi program vežbi lumbalne stabilizacije u otvorenom i zatvorenom kinetičkom lancu, u odnosu na program vežbi lumbalne stabilizacije i torakalne mobilizacije u zatvorenom kinetičkom lancu kao i da se proceni klinička efikasnost oba programa vežbi. Metode: Istraživanje je sprovedeno kao prospektivna, eksperimentalna studija na 80 ispitanika oba pola (35 mu&scaron;karaca, 45 žena), prosečne životne dobi (48.45+/- 10.22 godina) sa hroničnim lumbalnim bolom. Istraživanje je sprovedeno na Klinici za rehabilitaciju &bdquo;dr Miroslav Zotović&ldquo; u Beogradu u periodu od juna 2017. do marta 2018. godine. Ispitanici su podeljeni u dve grupe od 40 pacijenata. Prva grupa ispitanika je sprovodila program vežbi lumbalne stabilizacije i torakalne mobilizacije u zatvorenom kinetičkom lancu (LSTMZ), a druga program vežbi lumbalne stabilizacije u zatvorenom i otvorenom kinetičkom lancu (LSZO). Pored op&scaron;tih demografskih, antropometrijskih podataka o ispitanicima, kori&scaron;ćeni su sledeći upitnici i testovi: za procenu intenziteta bola u leđima i donjim ekstremitetima- vizuelna analogna skala (VAS), za procenu neuropatske komponente bola- DN4 (Douleur Neuropathique en 4 Questions), za procenu funkcionalnog statusa kori&scaron;ćen je Osvestrijev upitnik o onesposobljenosti (ODI), procena sagitalne pokretljivosti lumbosakralne kičme Schober testom, procena mi&scaron;ićne snage - manuelnim mi&scaron;ićnom testom; Ispitivanje senzitivnosti na ključnim senzornim tačkama za dermatome je vr&scaron;eno prema ASIA (American Spinal Injury Association) skali, testom istezanja ishiadičnog (Lazarevićev) i femoralnog nerva ispitivano je prisustvo kompresije nervnih korenova, za procenu stabilnosti lumbosakralne kičme- je kori&scaron;ćen test nestabilnosti u proniranom položaju (Prone Instability test). Ispitanici su ergonomski edukovani, sprovedena je transkutana elektro-nervna stimulacija (TENS) i primenjivana je laseroterapija male snage. Pacijentima je određena osmonedeljna kineziterapija koja je obuhvatala vežbe za jačanje dubokih stabilizatora lumbalne kičme. Retestiranje je rađeno nakon 4 i 8 nedelja. Rezultati: Kod obe grupe ispitanika u svim intervalima merenja je nađena visoka statistički značajna (p&lt; 0,001) redukcija intenziteta bola prema VAS skali za lumbalnu kičmu i donje ekstremitete,&nbsp;&nbsp; pobolj&scaron;anje funkcionalnog statusa (Oswestry) i sagitalne pokretljivosti (Schober). Statistički značajan (p&lt;0,05) oporavak ispitanika grupe 1 u odnosu na grupu 2, ostvaren je u svim intervalima merenja kod parametara: Intenzitet bola (VAS LS i VAS za nogu), stepen onesposobljenosti (ODI),vrednost motornog skora za trup merenog ASIA skalom i vrednost neuropatske komponente bola (DN4). Statistički značajan (p&lt; 0,05) oporavak ispitanika u grupi 2 u odnosu na grupu 1, ostvaren je posle 8 nedelja kod parametra za procenu vrednosti&nbsp; senzornog skora dodir prema ASIA skali. Utvrđeno je da veće početne vrednosti intenziteta bola prema skalama Vas ls i Vas za nogu i stepena onesposobljenosti prema ODI, negativno utiču na krajnji ishod ovih parametara kod pacijenata sa HLB-om u obe grupe (p&lt;0,05). Pacijenti sa pozitivnom neuropatskom komponentom bola imaju lo&scaron;iji ishod lečenja HLB-a vežbama stabilizacije i torakalne mobilizacije (p&lt;0,05). Zaključci: Pacijenti koji su radili program vežbi lumbalne stabilizacije i torakalne mobilizacije u zatvorenom kinetičkom lancu su imali bolji funkcionalni oporavak i značajniju redukciju intenziteta bola u odnosu na ispitanike koji su radili program vežbi lumbalne stabilizacije u zatvorenom i otvorenom kinetičkom lancu.</p> / <p>Introduction: An individual program of lumbar stabilization exercises could contribute to a better recovery of patients with chronic lower back pain. The exercise program in the treatment of chronic lumbar pain is quite diverse, but it has been proven that stabilization exercises are most effective, especially in a closed kinetic chain. Objective: was to compare the program of lumbar stabilization exercises in the open and closed kinetic chain, in relation to the program of lumbar stabilization exercises and thoracic mobilization in a closed kinetic chain, and to evaluate the clinical efficacy of both exercise programs. Methods: The study was conducted as a prospective, experimental study of 80 subjects of both sexes (35 men, 45 women), average life expectancy (48.45 +/- 10.22 years) with chronic lumbar pain. The research was conducted at the Rehabilitation Clinic &quot;Dr. Miroslav Zotović&quot; in Belgrade in the period from June 2017 to March 2018. Respondents were divided into two groups of 40 patients. The first group of respondents carried out a lumbar stabilization and thoracic mobilization program in a closed kinetic chain (LSTMZ) and the second, program of lumbar stabilization exercises in closed and open kinetic chain (LSZO). In addition to general demographic, anthropometric data on respondents, the following questionnaires and tests were used: for assessing the intensity of back pain and lower extremities - visual analogue scale (VAS), for assessing the neuropathic pain component DN4 (Douleur Neuropathique en 4 Questions),&nbsp; for functional status assessment was used Oswestry disability index (ODI), for assessment of sagittal mobility of the lumbosacral spine- Schober test, muscular strength assessment - manual muscle test; Sensitivity testing at key sensory points for dermatomas was performed according to the ASIA (American Spinal Injury Association) scale, stretching test of the ishiadic (Lazarević) and femoral nerves was udes for detection of nerve root irritation, and the Prone Instability test was used to assess the stability of the lumbosacral spine. Respondents were ergonomically educated, transcutaneous electrical-nerve stimulation (TENS) and low-power laser therapy were performed. Patients were given an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after 4 and 8 weeks. Results: In both groups of subjects, high statistically significant (p &lt;0.001) reduction of pain intensity to VAS scale for lumbar spine and for the leg, functional disability (Oswestry) sagital mobility of lumbar spine (Schober) improvement were found at all measurement intervals. The statistically significant (p &lt;0.05) recovery of group 1 subjects compared to group 2 was achieved at all measurement intervals in the parameters: Pain intensity (VAS LS and VAS for the leg), degree of disability (ODI), motor score value for the trunk measured by the ASIA scale and the value of the neuropathic pain component (DN4). Statistically significant (p &lt;0.05) recovery of group 2 subjects compared to group 2 was achieved after 8 weeks with the parameter for assessing the sensory touch score value to the ASIA scale. It has been found that higher initial pain intensity values to VAS ls and VAS for leg and degree of disability to ODI, negatively affect the final outcome of these parameters in patients with chronic low back pain in both groups of subject (p&lt;0,05). Patients with a positive neuropathic pain component have a lower outcome of chronic low back pain treatment with lumbar stabilization and thoracic mobilization exercises (p&lt;0,05). Conclusions: Patients who performed lumbar stabilization and thoracic mobilization exercises program in a closed kinetic chain had better functional recovery and a significant reduction in pain intensity compared to respondents who performed a lumbar stabilization program in a closed and open kinetic chain.</p>

L’appréciation du pain par le consommateur est largement impactée par ses propriétés sensorielles, notamment les perceptions d’arômes et de texture en bouche. Ces perceptions ne peuvent pas être uniquement expliquées par la composition aromatique du pain ou par sa structure. Elles dépendent également de phénomènes dynamiques, résultant de la déstructuration du pain en bouche, très dépendante de chaque individu. L’objectif de ce projet de thèse est donc de mieux comprendre les déterminants liés au produit et à l’individu à l’origine des dynamiques de perceptions d’arômes et de texture du pain. Une stratégie multidisciplinaire, basée sur l’étude du processus oral en conditions réelles de mastication, a été mise en place pour répondre à cet objectif. Les résultats de cette étude montrent d’une part que la capacité d’hydratation et la rigidité de la mie jouent un rôle majeur dans l’évolution des propriétés des bols et des perceptions de texture et d’arômes au cours de la consommation. Ainsi, plus un pain a une capacité d’hydratation élevée, plus il sera facilement déstructuré et hydraté. De plus, un pain avec une mie rigide provoquerait une plus grande libération des composés d’arômes susceptibles d’interagir avec les récepteurs olfactifs sensoriels. D’autre part, deux types de comportements masticatoires, basés sur la durée de mastication, ont été identifiés entre les individus participant à l’étude. Ces comportements conduisent à des bols aux propriétés différentes au moment de la déglutition et à des dynamiques différentes de perception de texture et d’arôme. / The liking of the bread by the consumers is largely impacted by its sensory properties, and notably the aroma and texture perceived during inmouth consumption. These perceptions cannot be only explained by the volatile composition of the bread or by its structure. In fact, they also depend on dynamic phenomena, resulting from the breakdown of the bread in mouth, which depends on each individual. This PhD project aims thus to better understand the determinants linked to the product and to the individual at the origin of the dynamics of aroma and texture perceptions of bread. A multidisciplinary strategy, based on the study of the oral processing in real conditions of mastication was set up to fulfill this objective. The results show firstly that the hydration capacity and the rigidity of the crumb have a main impact on the evolution of bolus properties and texture and aroma perceptions during consumption. In this way, the higher the hydration capacity of the bread is, the more easily broken and hydrated it will be. Moreover, a bread with a rigid crumb could cause a higher release of volatile compounds susceptible to interact with the sensory olfactive receptors. In addition, two types of masticatory behavior, based on masticatory duration, were highlighted between the individuals of the study. These behaviors lead to bolus with different properties at swallowing time and at different dynamics of aroma and texture perceptions.

<p>UVOD: Ingvinalna hernioplastika predstavlja najučestaliju operaciju u abdominalnoj hirurgiji. U istorijatu herniologije su se razvijale različite ideje, te iz njih nastale operativne metode, koje su imale za cilj formiranje kvalitetnog vezivnog tkiva na mestu kilnog defekta. Danas postoje brojne hirur&scaron;ke tehnike, bazirane na tenzionim ili beztenzionim principima, uz primenu hirur&scaron;kih mrežica, otvorenim pristupom, kao i laparoskopskim tehnikama. Zajednički cilj navedenih metoda je kreiranja idealne hernioplastike ingvinalnih kila. I pored postojanja ogromnog broja hirur&scaron;kih procedura i tehnika, jo&scaron; uvek ne postoji tzv. &raquo;prava hernioplastika&laquo; koja bi zadovoljila sve potrebne zahteve vezane za problem ingvinalnih hernija. CILJ I HIPOTEZA: Cilj rada je bio da se napravi uporedna analiza između dve različite hirur&scaron;ke tehnike otvorenim pristupom, konvencionalne tenzione suturne hernioplastike, te beztenzione tehnike, uz kori&scaron;ćenje hirur&scaron;kih mrežica ( mesh ). Kori&scaron;ćeni su sledeći parametri tokom istraživanja: određivanje nivoa postoperativnog bola prema numeričkoj skali, vizuelno-analognoj te kategorijskoj skali bola; određivanje samostalne fizičke aktivnosti; (savijanje nogu, naprezanje trbu&scaron;nih mi&scaron;ića, ustajanje) u neposrednom postoperativnom periodu; gradacija nivoa mi&scaron;ićne snage, određivanje vremenskog perioda kada se pacijenti uspevaju vratiti svojim svakodnevnim aktivnostima i radnim obavezama; određivanje stope postoperativnog morbiditeta i mortaliteta te određivanje stope ranog recidiva bolesti. RADNA HIPOTEZA: Beztenzionu ingvinalnu hernioplastiku karakteri&scaron;e znatno manja operativna trauma, &scaron;to ima za posledicu manji lokalni i generalizovani odgovor organizma na stres. Kod bolesnika operisanih beztenzionom metodom očekuje se manji intenzitet bola, kraće zadržavanje u hospitalnim uslovima, manji procenat postoperativnih komplikacija, brži povratak uobičajenim fizičkim i radnim aktivnostima i znatno manji stepen recidiva bolesti. Pretpostavlja se da beztenziona ingvinalna hernioplastika u poređenju sa konvencionalnom uzrokuje manju nelagodnost za pacijente, znatno manji postoperativni bol i bolju mi&scaron;ićnu aktivnost. Pobolj&scaron;anje mi&scaron;ićne aktivnosti ogleda se u lak&scaron;oj vertikalizaciji, kvalitetnijem kretanju uz manje bolan hod, bez povijanja tela na stranu operativne rane. MATERIJAL I METODE: Istraživanje je prospektivna, kliničko- statistička studija sa praćenjem parametara (preoperativnih, intraoperativnih i postoperativnih) kod svakog operisanog bolesnika. Studija je obuhvatila seriju od 200 pacijenata hospitalizovanih na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine, od decembra 2002. do avgusta 2007.godine, svrstanih u dve jednake grupe po 100 pacijenata, odabranih metodom slučajnog izbora. Prva, ispitivana grupa obuhvatila je pacijente operisane beztenzionim procedurama, druga, kontrolna grupa je obuhvatila pacijente operisane konvencionalnim, tenzionim tehnikama. Kori&scaron;ćeni metod rada je kliničko statistički sa praćenjem svih potrebnih fiziolo&scaron;kih parametara, a dobijeni rezultati su analizirani i međusobno upoređivani statističkim metodama multifaktorijalne analize. Pronađene vrednosti su međusobno upoređene parametrijskim i neparametrijskim testovima značajnosti na nivou p&lt;0.05. REZULTATI: komparacija između dve ispitivane grupe je vr&scaron;ena tokom preoperativnog, intraoperativnog i postoperativnog perioda, različitim statističkim parametrima. Konstatovana je, statističkom analizom, homogenost grupa u smislu starosne dobi i polne distribucije, kao i lokalnog preoperativnog nalaza vezanog za tip, veličinu i lokalizaciju kila, kao i spram klasifikacije hernija. U sledećim parametrima je ustanovljena statistički signifikantna razlika: postoperativni bol, gradacija mi&scaron;ićne snage, rana fizička aktivnost, količina utro&scaron;enih analgetika, dužina hospitalizacije, prisutnost obostranih kila, povratak radnim aktivnostima i obavezama, postoperativne komplikacije i recidiv bolesti. Dobijeni podaci su prikazani tabelarno, te delom u vidu grafikona i dijagrama. ZAKLJUČCI: 1. Kod pacijenata operisanih beztenzionom metodom evidentan je znatno manji postoperativni bol i brži oporavak i povratak uobičajnim dnevnim i radnim aktivnostima 2. Proceduru treba izvoditi u svim slučajevima sa prisutnim velikim defektima i razorenim zadnjim zidom ingvinalnog kanala 3 Beztenzionu hernioplastiku karakteri&scaron;e manji broj recidiva u poređenju sa otvorenim tenzionim hernioplastikama. 4. Pacijenti sa bilateralnim ingvinalnim i recidivnim hernijama imaju punu indikaciju za izvođenje beztenzione herioplastike sa ugradnjom mesh-a. 5. Preduslov za uspe&scaron;no obavljenu beztenzionu hernioplastiku je primena dovoljno velike proteze, odnosno mesh-a, dimenzija 15 x 10 cm.</p> / <p>INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure in abdominal surgery. In the history of herniology have developed different ideas, and from them emerged operational methods, which are aimed at educating quality of connective tissue at the site of the hernia defect. Nowadays, there are numerous surgical techniques, based on the tensioned or tension-free principles, with the use of surgical mesh for open access as well as laparoscopic techniques. Common goal of these methods is creating ideal inguinal hernioplasty despite the existence of a huge number of surgical procedures and techniques, there is still no so-called &raquo;Proper hernioplasty &quot; that would satisfy all the necessary requirements related to the problem of inguinal hernia. AIM AND HYPOTHESIS: The aim of this study was to make a comparative analysis between two different open access surgical techniques conventional tension hernioplasty and tension-free techniques, with the use of surgical mesh .The following parameters were used during the research: determining the level of postoperative pain according to a numerical scale, visual analogue scale and categorical scale of pain; determining the initial independent physical activities: (bending the legs, straining abdominal muscles, getting up) in the immediate postoperative period; gradation levels of muscular strength, determination period when patients can return to their usual daily activities and work duties; determining the rate of postoperative morbidity and mortality and to determine rates of early recurrence of the disease. WORKING HYPOTHESIS: Tension-free inguinal hernioplasty characterized by significantly less operative trauma, which results in smaller local and generalized body&#39;s response to stress. In patients operated by the tension. free method is expected to lower the intensity of pain, a shorter stay in the hospital setting, a smaller percentage of postoperative complications, faster return to normal physical and occupational activities and much lower degree of disease recurrence. It is assumed that the tensional. free inguinal hernioplasty compared with conventional causes less discomfort for patients, significantly less postoperative pain and better muscle activity. Better muscle activity is reflected in a facilitated mobilization, quality of movement and less painful gait, without bending the body at the side of the surgical wound. MATHERIAL AND METHODS: The research was a prospective, clinical-statistical study of the monitoring parameters (preoperative, intraoperative and postoperative) in each of the operated patients. The study involved a series of 200 patients hospitalized at the Clinic for Abdominal, Endocrine and Transplantation Surgery, Clinical Center Vojvodine, from December 2002 to August 2007, divided into two groups of 100 patients, randomly chosen. First, the test group consisted of patients operated by the tension-free procedures, the other, the control group consisted of patients operated on conventional techniques. The method used is the work of clinical statistical tracking of all necessary physiological parameters, and the results were analyzed and compared with each other with multivariate statistical methods of analysis. Found values are compared with each other parametric and non-parametric tests of significance at p &lt;0.05. RESULTS: The comparison between the two study groups was performed during the preoperative, intraoperative and postoperative period, using various statistical parameters. It was noted using the statistical analysis, the homogenity of the groups in terms of age and sex distribution, as well as local preoperative findings related to the type, size and location pounds as well as towards the classification of hernias. In the following parameters is statistically significant difference: postoperative pain, graduations of muscle strength, healing of physical activity, the quantity of analgesics, length of hospitalization, the presence of bilateral hernias, the return of work activities and responsibilities, postoperative complications and recurrence. The data are presented in tables, and partly in the form of graphs and charts. CONCLUSIONS: 1. In patients operated by the tension-free obvious method is significantly less postoperative pain and faster recovery and return to usual daily and work activities 2. The procedure should be performed in all cases with the presence of large defects and lacerated back wall of the inguinal canal 3. Tension-free hernioplasty is characterized by a smaller number of recurrence compared with conventional hernioplasty 4. Patients with bilateral inguinal hernias and recurrent have a full indication of the performance of the tension-free hernioplasty with the installation of mesh. 5. A prerequisite for the successful work carried out tension-free hernioplasty application is large enough prosthesis ( mesh ), measuring 15 x 10 cm.</p>

L'enjeu des travaux contenus dans cette thèse est la caractérisation rhéologique de suspensions concentrées d'objets viscoplastiques suspendus dans une matrice viscoplastique. Trois contraintes physiques se présentent : l'hétérogénéité des objets, la taille des objets au regard de la taille du système étudié, et la proximité entre la consistance de la phase suspendante et celle des objets. Dans notre contexte alimentaire, il faut ajouter des contraintes d'ordre biologique : les faibles durées de vie des produits, les prélèvements in vivo et la conservation des conditions de températures et d'humidité. L'ensemble de ces contraintes aboutit à une rhéométrie spécifique, aux frontières de la mécanique des milieux continues, avec pour objectif de mesurer des propriétés rhéologiques pertinentes. Pour cela, deux instrumentations originales ont été construites pour effectuer la caractérisation rhéologique le plus vite et au plus près de la génération des échantillons.Appliquée aux bols alimentaires issus de fromage, leur rhéologie vient gouverner les écoulements en bouche et induire la création de surface d'échange en bouche, au travers de la mastication. Au travers de ces interfaces, les arômes et les sapides sont libérés et transportés vers les récepteurs sensoriels. Les résultats montrent le lien entre le seuil de contrainte à l'écoulement du bol et la libération d'arômes de différents hydrophobicités, fonction de la fermeté et du taux de matières grasses du fromage. Plus particulièrement, la phase suspendante fluide, semble jouer un rôle majeur dans la création et la persistance des surfaces d'échanges. Appliquée aux jus gastriques issus de pain, l'enjeu est de savoir si des modifications des contenus en glucides pouvaient impacter la rhéologie des jus gastriques, modifier les cinétiques de vidange en sortie d'estomac, et diminuer l'excursion glycémique. Les résultats montrent l'effet d'un ajout d'amylose sur l'augmentation de la viscosité aux temps de digestion longs, lorsque la rhéologie n'est plus gouvernée par l'encombrement des particules de pain gonflées d'eau. Cependant, l'amylose ne semble pas avoir d'impact sur les cinétiques de vidange, ce qui vient conforter que le débit en sortie d'estomac est régulé par la charge énergétique contenue dans le repas. / The challenge of this work is to carry out the rheological characterization of concentrated suspensions of viscoplastic objects suspended in a viscoelastic matrix. Three structural constraints are faced: the heterogeneity of the particles, the size of particle in relation to the size of the whole system studied, and the proximity between the consistency of the suspending phase and that the consistency of the particles. In the food context, some biological constraints are added: small lifetimes of bolus, in vivo sampling and test conditions of temperature and humidity. All these constraints lead to a compromise in rheometry, at the edge of continuum mechanics, aiming to measure useful rheological properties. To carry out the rheological characterizations quickly and efficiently, two original devices has been designed trough this work. Applied to food bolus from cheese, rheology comes to govern flows in the mouth and induce the creation of exchange area in the mouth, during the chewing process. Through these interfaces, the savors and flavors are released and transported to the sensory receptors. The results show the relationship between the yield stress of the bolus and flavors release of different hydrophobic aromas, depending on the firmness and fat content of the cheeses. Specifically, fluid suspending matrix appears to play a major role in the creation and persistence of exchange area.Applied to gastric juice from bread, the issue is whether changes in carbohydrate content could impact the rheology of gastric juice, modify the kinetics of stomach flow rate, and decrease the glycemic excursion. The results show the effect of amylose addition on increasing the viscosity for long digestion time, when the rheology is no longer governed by the jamming effect of the particles made of water-swollen bread. However, amylose does not seem to have any impact on the kinetics of emptying, which reinforces that the stomach flow rate is regulated by the caloric charge contained in the meal.

<p>Sve veća potreba za izvođenjem kolonoskopije u dijagnostičke ili terapijske svrhe nameće potrebu za usavr&scaron;avanjem ove endoskopske procedure. Izvođenje kolonoskopije u op&scaron;toj, intravenskoj anesteziji, moglo bi u značajnoj meri olak&scaron;ati njeno izvođenje, pobolj&scaron;ati podno&scaron;enje ove procedure od strane ispitanika i omogućiti otkrivanje većeg broja pacijenata sa potencijalno malignim bolestima debelog creva. Cilj ispitivanja je bio utvrditi da li primena op&scaron;te intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i skraćuje vreme intubacije cekuma, povećava broj viđenih patolo&scaron;kih procesa i smanjuje osećaj bola i učestalost neželjenih reakcija. Primena op&scaron;te intravenske anestezije značajno je povećala broj totalnih kolonoskopija u 94.3% ispitanika u odnosu na 78.7% totalnih kolonoskopija kontrolne grupe i skratila vreme intubacije cekuma, značajno je povećala broj viđenih patolo&scaron;kih promena u 46.7% ispitanika u odnosu na broj viđenih patolo&scaron;kih promena u 28.8% ispitanika kontrolne grupe i značajno je smanjila intenzitet bola i učestalost neželjenih reakcija. U kontrolnoj grupi ispitanika skalom bola nakon kolonoskopije ustanovljen je značajno veći intenzitet bola u poređenju sa ispitanicima ekperimentalne grupe. Na Likertovoj skali zadovoljstva ustanovljena je značajno bolja kontrola bola i lični stav lekara u ekperimentalnoj grupi, dok su poseta ustanovi i procedura, razumevanje procedure, tehnička ve&scaron;tina lekara, lični stav medicinskih sestara i drugog tehničkog osoblja značajno bolje ocenjeni u kontrolnoj grupi. Od svih ispitivanih faktora na zadovoljstvo obe grupe pacijenata značajno su uticali: način izvođenja procedure, bol, uočene patolo&scaron;ke promene i intubacija cekuma. U kontrolnoj grupi ispitanika između skale zadovoljstva i skale bola ustanovljena je značajna negativna korelacija. U kontrolnoj grupi se 80,1% pacijenata izjasnilo da bi ponovnu kolonoskopiju uradili u op&scaron;toj intravenskoj anesteziji u poređenju sa svim pacijentima eksperimentalne grupe koji ne bi menjali način izvođenja ponovne procedure. Primena op&scaron;te intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i uočenih patolo&scaron;kih promena, smanjuje učestalost i intenzitet neželjenih reakcija povećavajući zadovoljstvo pacijenata, &scaron;to bi prevashodno moglo imati značaja u skriningu karcinoma debelog creva. Potrebno je pro&scaron;iriti ispitivanje primene op&scaron;te intravenske anestezije u drugim endoskopskim procedurama kako bi bila uvedena u svakodnevnoj kliničkoj praksi.</p> / <p>An increasing need to perform colonoscopy for diagnostic or therapeutic purposes imposed the need for mastering this endoscopic procedure. Performing colonoscopy in general intravenous anesthesia could greatly ease the procedure, make it more comfortable for patients and it could enable detecting a higher number of patients with occult malignant diseases of the colon. The aim of this paper was to determine if the implementation of general intravenous anesthesia during colonoscopy increases the number of total colonoscopies and shortens the time of cecum intubation, increases the number of familiar pathological processes and decreases the sensation of pain as well as the frequency of side reactions. The implementation of general intravenous anesthesia has significantly increased the number of total colonoscopies in 94.3% of examined patients in relation to 78.7% of total colonoscopies of the control group and shortened the time of cecum intubation. It has significantly increased the number of familiar pathological changes in 46.7% of the patients in relation to the number of familiar pathological changes in 28.8% patients of the control group and significantly decreased pain intensity and the frequency of side reactions. A statistically greater pain intensity after colonoscopy was determined by the pain scale in the control group in comparison to the examinees of the experimental group. Likert satisfaction scale has shown that the experiment group assessed pain control and doctors&rsquo; opinion as significantly better, while the institution visits and the procedure, understanding the procedure, doctors&rsquo; technical skills, nurses&rsquo; and technical personnel&rsquo;s personal opinions were assessed as significantly better in the control group. Out of all the examined factors on the satisfaction of both groups, the following ones had a significant inluence: the way the procedure was done, the level of pain, detected pathological changes and cecum intubation. A significanlty negative correlation was determined between the scale of satisfaction and the scale of pain in the control group. 80.1% of the control group patients stated that they would undergo a general anesthesia colonoscopy again in comparison to all the patients of the experimental group who would not change the way the procedure was previously done. The implementation of general intravenous anesthesia in the course of colonoscopy increases the number of total colonoscopies and detected pathological changes, decreases the frequency and intensity of side-effects therefore it enhances patients&#39; sastisfaction, which could play a major role in colon cancer screening. It is necessary to extend the implementation of general intravenous anesthesia in other endoscopic procedures in order to introduce it in everyday clinical practice.</p>

Made available in DSpace on 2014-12-17T14:20:06Z (GMT). No. of bitstreams: 1 JorissaDNA_DISSERT.pdf: 748501 bytes, checksum: d9c39c04628903b39f6b496588542d7a (MD5) Previous issue date: 2012-04-11 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This work aims to analyze the interpretations about Evo Morales' government in Bolivia. For such, it proposes a theoretical reclaim of Marxism in Latin America, as well as of Bolivian political history since the 1952 Revolution, going through the crisis in Pacted Democracy intensified in the five-year conjuncture of struggles started in 2000 up to the election and reelection of Morales. It departs from an empirical prior conjecture taken from a qualitative analysis and a broad literature review to analyze the different interpretations of the Bolivian political process from Marxist theoretical matrices. After this historical recovery and this reading of contemporary Bolivia, it concludes with a consideration about the formation of a possible new block of power in the country, with the retaking of nationalism and Indianism as revolutionary reasons / Este trabalho tem como foco a an?lise das interpreta??es do governo de Evo Morales, na Bol?via. Para tanto, prop?e uma retomada te?rica do marxismo na Am?rica Latina, bem como da hist?ria pol?tica boliviana desde a revolu??o de 1952, passando pela crise da democracia pactuada intensificada no quinqu?nio de lutas iniciado no ano 2000 at? a elei??o e reelei??o de Morales. Partimos, ent?o, de um pressuposto emp?rico a partir de um exame qualitativo e de uma ampla revis?o bibliogr?fica para analisar as diferentes interpreta??es do processo pol?tico boliviano por matrizes te?ricas de origem marxista. Feito esse resgate hist?rico e esta leitura da Bol?via contempor?nea, conclu?mos problematizando sobre a poss?vel forma??o de um novo bloco no poder no pa?s, com a retomada do nacionalismo e do indigenismo como raz?es revolucion?rias

The story of "El Libertador", Simon Bolivar, greatest figure of South American history, may be pursued through seemingly endless sources of extant written material. The Bibliography of Simon Bolivar compiled by the library of the Pan-American Union is, in itself, an extensive volume; hundreds of his letters and documents have been preserved, and his biographers are numbered by scores. Throughout the nineteenth century he remained one of the most popularized of new world figures, and although he has lost considerable identity in the United States during the twentieth century, he continues to be written about. Man Of Glory by D. J. Clinton (Marrow Co., New York, 1939) is the most recent comprehensive biography. Yet, in so far as can be ascertained at this writing, the work herein contained is the first full length treatment in the dramatic form, in any language, of this amazing personality. Liberator of five countries, and father of the Pan-American idea, Bolivar's influence is an active tradition still shaping destiny for Latin America. With increasing contact between North and South America, and the popularlizing of the Pan-American program, Simon Bolivar will be revived in the interest of the people of the United States to the extent that he should be a "success" in a popular an art medium as the theatre, like Queen Victoria, Jaurez, Zola, Disraeli, Lincoln, Edison any many others who have won glory behind the foodlights as well as in the theatre of world events.

La question de recherche à la base de cette étude soulève le point de la nature paradoxale du canon de représentation égyptien qui démontre, simultanément, une certaine rigidité dans l’application de règles stylistiques et iconographiques établies, particulièrement dans l’art non commandité par l’État, et des preuves de transformation et d’intégration de motifs nouveaux. Partant de cette problématique, l’étude vise à identifier les mécanismes par lesquels ce canon permet, à la fois, l’innovation et le maintien d’une certaine tradition. L’approche est de nature double et consiste tout d’abord à identifier de grandes tendances et discontinuités stylistiques et iconographiques sur les bols de faïence du Moyen au Nouvel Empire. De plus, elle tente de déterminer si les transformations d’ordre sociopolitique et idéologique, survenant à ces périodes, peuvent être lues dans les variations stylistiques et iconographiques trouvées sur les bols de faïence. Après une description du champ conceptuel de la « représentation » en contexte égyptien, l’auteur effectue l’analyse iconographique exhaustive de ce qui constitue l’apport majeur de son étude, un corpus de 500 bols et fragments de faïence provenant de divers sites égyptiens du Moyen au Nouvel Empire. Les données ont été traitées par le biais de la méthode d’analyse iconologique proposée par Panofsky, qui lui permet de dévoiler un grand nombre de continuités et de transformations d’ordre stylistique et iconographique pour les différentes périodes. Plusieurs facteurs semblent avoir été à l’origine de ces transformations, dont la fluctuation entre un contexte de centralisation et de décentralisation politique de l’État, ainsi que l’intégration de motifs étrangers (proche-orientaux et égéens) résultant d’un contact accru entre l’Égypte et les régions voisines. De plus, les transformations idéologiques apportées par le règne d’Akhénaton et par la « contre-réforme » idéologique à la période ramesside, semblent avoir également contribué à des innovations au sein du canon, même si ce dernier maintient une certaine continuité légitimée par le pouvoir étatique. Le canon de représentation, devient ainsi une forme de langage dont l’État se sert et qui, parfois malgré lui, se transforme et fluctue selon les réalités des différentes périodes. / This study’s research question raises the issue of the paradoxical nature of the Egyptian canon of representation which shows, simultaneously, a certain rigidity in the application of established stylistic and iconographic rules, especially in non-state commissioned art, and evidence for the transformation and integration of new iconographical motifs. The study aims to identify the mechanisms by which the canon permits, at the same time, transformative processes and the maintenance of tradition. The approach is twofold and consists primarily in identifying trends and stylistic/iconographical discontinuities in the iconography found on the faience bowls from the Middle to the New Kingdoms. Furthermore, it aims to determine if the socio-political and ideological transformations taking place in these periods can be discerned in the stylistic and iconographical variations found on the bowls of the Middle to the New Kingdoms. The author discusses the theoretical model of “representation” in Egyptian context, followed by an analysis of what constitutes the major contribution of this study: an exhaustive iconographical analysis of 500 faience bowls and fragments originating from various Egyptian sites dating to the New Kingdom. The data was evaluated by means of the method of iconological analysis proposed by Panofsky, which permits the identification of a number of stylistic and iconographic continuities and changes for all periods. These transformations seem to be the result of a variety of factors, including fluctuations in the centralization and decentralization of the state, as well as the integration of foreign motifs (Near-Eastern and Aegean), which results from increased contacts between Egypt and its neighbouring regions. Furthermore, the ideological transformations taking place under Akhenaton’s reign and the ones resulting from the ideological “counter-reformation” occurring during the Ramessid period, equally seem to contribute to the changes in the representational canon, even though the latter maintained a certain continuity that was legitimized by the state. The canon thus emerges as a form of language used by the state, and sometimes despite it, which can fluctuate and be altered depending on the realities of the different periods.