A interpretação dos achados laboratoriais no estabelecimento da causa mortis consiste na integração dos conhecimentos sobre a toxicocinética e toxicodinâmica do agente, conhecimentos de sua redistribuição post mortem (RPM) e achados necroscópicos que possibilitem o nexo causal entre o toxicante e o efeito letal. Neste sentido, é importante considerar que somente as concentrações de cocaína (COC) e seus metabólitos podem não ser determinantes na interpretação da causa de morte, podendo ser útil o cotejamento com outros parâmetros, como os níveis de neurotrasmissores que representem o mecanismo de ação do fármaco. Assim, este trabalho teve por objetivo investigar a RPM da COC e seu metabólito benzoilecgonina (BE) em três segmentos do tecido encefálico (TE), no humor vítreo (HV) e sangue (SG), bem como determinar as concentrações de catecolaminas e indolaminas no encéfalo para avaliar a aplicação da neuroquímica post mortem (NPM) na toxicologia forense. No estudo de RPM foram quantificados os níveis de COC e BE em três segmentos do TE (córtex frontal, núcleos da base e cerebelo), no HV e no SG através de método por cromatografia líquida de alta eficiência (HPLC) acoplada ao detector de arranjo de diodos. Os estudos de neuroquímica foram realizados empregando-se HPLC acoplada ao detector eletroquímico. Os resultados indicaram que as concentrações médias de COC foram maiores no TE, seguido por SG e HV (3,09, 2,92 e 1,71 µg/mL, respectivamente), enquanto para BE foram maiores em SG, seguido por HV e TE (6,12, 1,39 e 0,87 µg/mL, respectivamente). As concentrações de COC se apresentaram distribuídas uniformemente nos três segmentos de TE e apresentaram alta correlação com o HV. Adicionalmente, a média de concentrações de dopamina total foi maior no grupo de indivíduos com amostras positivas para COC, sendo verificado diferença significativa entre este grupo e o de indivíduos com amostras negativas para o fármaco de interesse. Os resultados demostraram que o estudo de RPM e da NPM constituem ferramentas aplicáveis na interpretação da causa e maneira de morte. / In case of intoxication, the interpretation of analytical results to assess the cause and process of death requires knowledge about toxicokinetics, toxicodynamic, postmortem redistribution, and autopsy elements. Cocaine-related deaths occur mainly after prolonged drugs use and the presence of cocaine (COC) in fluids or tissues does not prove that death was due to COC consumption, and the interpretation of postmortem concentrations is even more complicated than attempts at making such correlations in the living. The objectives of this study were to investigate the post mortem redistribution (PMR) of COC and its metabolite benzoylecgonine (BE) in three segments of brain (frontal cortex, base nucleous, and cerebellum), vitreous humor, and blood. In additional, catecholamines and indolamines were quantified in brain in order to evaluate the usefulness of post mortem neurochemistry (PMN) in forensic toxicology. In PMR studies were quantified the COC and BE levels in three brain (BR) segments, in vitreous humor (VH), and blood (BL) by High Performance Liquid Chromatography (HPLC) with diode array detection, and for neurochemistry studies the neurotransmitters were quantified by HPLC with electrochemical detection. A homogenous distribution of COC and BE within frontal cortex, base nucleous, and cerebellum was found. The COC media concentrations were 3.09, 2.92 e 1.71µg/mL in BR, BL and VH, respectively, and the BE media concentrations were 6.12, 1.39 e 0.87 µg/mL in BL, VH, and BR, respectively. The COC concentrations in VH show high correlation with brain. The media total dopamine concentration was significant higher in COC positive group. These findings suggest that the studies of PMR and PMN by neurotransmitters levels may be useful to assess the cause and process of death.

The thesis is bent on systematic analysis of Czech legislation de lege lata in organs taking for transplantation then on the part of received legal regulations. Subsequently equate to law those problems with other countries around the world and serves a comprehensive view of different solution of law. The way out of the theoretic parts is to incorporate problems among basic human rights, the right to live and the right of protection of personality, according to international convention and Czech laws. Theoretic part leads to the characteristics internationally recognized law principles for transplantation which is above all legal protection of organ donors warranted formulation of agreement or dissent from organs taking and pertinent grant the same possibilities for families. Further then certainty to define deaths brain and anonymity for deceased donors but also protection for the organs recipients and data confidentiality preservation with the possibility to antedate the donors and last but not least to ban pecuniary benefit and dealing with organs. The thesis comments on how these principles are projected in their legislation in particular countries in the world. The research was aimed to find out the relation between knowledgeable agreement or if you like knowledgeable dissent from fulfilment of organs taking and measurable transplantation records in particular countries. It used data, which were for the first time published on a world-wide scale by the world's health organization. As measurable result for transplantation was selected a number of deceased organs donors to one million inhabitants. The hypothesis confirmed that a country with legislation knowledgeable agreement, which means the country where the right requires knowledgeable agreement individually with organs taking, has worse measurable record than the country where's by law is to agreed to take organs expectedly unless it is used the right to deny it during the life of the organ donor. The other research investigated also the right that families can express their opinion on taking organs from deceased relative with a hypothetical presumption that the family decision can implicate to disrespect the universal personal law if it denies the will of the deceased person done during its life. At last the situation of absence of the right on family decision-making was surveyed. Such cases of other access to universal personal law did not notice better results in transplantations than there, where this right thoroughly applied in laws. This research brought a lot of interesting information on access of organs taking for transplantations in different parts of the world. This fact contributed to recognition on how important is the influence of morale and ways on legislation of appropriate country and how legislation influences results of transplantation in creditable life-saving process.

Submitted by (edna.saturno@ufrpe.br) on 2016-10-11T13:34:12Z No. of bitstreams: 1 Geraldo Martins.pdf: 2758105 bytes, checksum: 4e586fcda70973bcd0b330ad69b0e52c (MD5) / Made available in DSpace on 2016-10-11T13:34:12Z (GMT). No. of bitstreams: 1 Geraldo Martins.pdf: 2758105 bytes, checksum: 4e586fcda70973bcd0b330ad69b0e52c (MD5) Previous issue date: 2013-02-21 / The objective of this study was to identify and analyze the abundance of dipteran family Calliphoridae present along the decomposing carcass of pigs in the Cariri, Paraiba State, Brazil, in two periods: rainy and dry. The study was conducted in Reserva Particular do Patrimônio Natural (RPPN) Fazenda Almas, in São José dos Cordeiros-PB. We used two pig carcasses (Sus scrofa) by period, protected from scavengers by a metal cage inside trap like "Shannon". Samples were collected daily, twice a day, for eleven days in both periods. The meteorological data of precipitation were obtained at the Centro de Previsão e Estudos Climáticos do INMET and temperature and relative humidity were obtained in situ using a digital hygrometer. The insects collected were placed in the laboratory of entomology of UFPB and identified as well. We collected 8.811 individuals of the family Calliphoridae, belonging to six species (Chrysomya albiceps (Wiedemann, 1819), Cochliomyia macellaria (Fabricius, 1775), Chrysomya putoria (Wiedemann, 1818), Chloroprocta idioidea (Robineau-Devoidy, 1830), Chrysomya megacephala (Fabricius, 1794) e Lucilia eximia (Wiedemann, 1818)), which were presented the in both the periods, although a relative abundance of species was higher in the rainy period (4.706). We measured the abundance of species per period, where C. albiceps was the most abundant in the dry period (3.244/36, 81%) and C. idioidea in the rainy period (2.860/32, 45%). There were five stages of decomposition: fresh, chromatic, emphysematous, coliquative and skeletonization stage. The emphysematous was the stage where we most collected Calliphoridae (3.923/44, 52%), followed by skeletonization (3.458/39, 25%), chromatic (726 / 8.24%), coliquative (627/7, 12%) and fresh (77/0, 87%). It was also found that the highest abundance of C. idioidea occurred on the highest elevation of relative humidity and rainfall. This study is the first survey of the region of Caatinga in Paraiba state using active collecting, these results will serve to enrich the data to local forensic entomology and will contribute to the understanding the fauna of the region carrion flies. / Objetivou-se com este estudo inventariar e analisar a abundancia de dípteros da família Calliphoridae presentes ao longo da decomposição da carcaça de suínos na região do Cariri, estado da Paraíba, Brasil, em dois períodos: chuvoso e seco. O estudo foi desenvolvido na Reserva Particular do Patrimônio Natural (RPPN) na Fazenda Almas, no município de São José dos Cordeiros-PB. Foram utilizadas duas carcaças de suíno (Sus scrofa) por período, protegidas de animais carniceiros por uma gaiola metálica no interior de armadilha do tipo “Shannon”. As coletas foram realizadas diariamente, duas vezes ao dia, durante onze dias em ambos os períodos. Os dados meteorológicos de precipitação foram obtidos no Centro de Previsão de Tempo e de Estudos Climáticos do INMET e a temperatura e umidade relativa do ar foram obtidas in loco utilizando-se um termohigrômetro digital. Os insetos coletados foram encaminhados mediante autorização ao laboratório de entomologia da UFPB e posteriormente identificados e parte deles depositada na coleção de referencia. Foram coletados 8.811 indivíduos da família Calliphoridae, pertencentes a seis espécies: Chrysomya albiceps (Wiedemann, 1819), Cochliomyia macellaria (Fabricius, 1775), Chrysomya putoria (Wiedemann, 1818), Chloroprocta idioidea (Robineau-Devoidy, 1830), Chrysomya megacephala (Fabricius, 1794) e Lucilia eximia (Wiedemann, 1818), as quais estiveram presentes em ambos os períodos, porém a abundância relativa de espécies foi maior no período chuvoso (4.706/53,4%). Verificou-se a abundância de algumas espécies por período, onde a C. albiceps foi a espécie mais abundante no período seco (3.244/36,81%) e C. idioidea no período chuvoso (2.860/32,45%). Observaram-se cinco fases de decomposição: fresca, cromática, enfisematosa, coliquativa e esqueletização. A enfisematosa foi a fase onde mais se coletou Calliphoridae (3.923/44,52%), seguida pela esqueletização (3.458/39,25%), cromática (726/8,24%), coliquativa (627/7,12%) e fresca (77/0,87%). Constatou-se também que a maior abundancia de C. idioidea ocorreu no dia de maior elevação da umidade relativa e precipitação. Este é o primeiro estudo de levantamento realizado com coleta ativa em região de Caatinga paraibana, cujos resultados permitirão enriquecer os dados da entomologia forense local e contribuirão para o entendimento da fauna de dípteros necrófagos da região.

No description available.

Rigid body modeling has historically been used to study various features of the elbow joint including both physical and computational models. Computational modeling provides an inexpensive, easily customizable, and effective method by which to predict and investigate the response of a physiological system to in vivo stresses and applied perturbations. Utilizing computer topography scans of a cadaveric elbow, a virtual representation of the joint was created using the commercially available MIMICS(TM) and SolidWorks(TM) software packages. Accurate 3D articular surfaces, ligamentous constraints, and joint contact parameters dictated motion. The model was validated against two cadaveric studies performed by Chanlalit et al. (2011, 2012) considering monopolar and bipolar circular radial head replacements in their effects on radiocapitellar stability and respective reliance upon lateral soft tissues, as well as a comparison of these with a novel anatomic radial head replacement system in an elbow afflicted with the “terrible triad” injury. Rigid body simulations indicated that the computational model was able to accurately recreate the translation of forces in the joint and demonstrate results similar to those presented in the cadaveric data in both the intact elbow and in unstable injury states. Trends in the resulting data were reflective of the average behavior of the cadaveric specimens while percent changes between states correlated closely with the experimental data. Information on the transposition of forces within the joint and ligament tensions gleaned from the computational model provided further insight into the stability of the elbow with a compromised radial head.

The use of computational modeling is an effective and inexpensive way to predict the response of complex systems to various perturbations. However, not until the early 1990s had this technology been used to predict the behavior of physiological systems, specifically the human skeletal system. To that end, a computational model of the human elbow joint was developed using computed topography (CT) scans of cadaveric donor tissue, as well as the commercially available software package SolidWorks™. The kinematic function of the joint model was then defined through 3D reconstructions of the osteoarticular surfaces and various soft-tissue constraints. The model was validated against cadaveric experiments performed by Hull et al and Fern et al that measured the significance of coronoid process fractures, lateral ulnar collateral ligament ruptures, and radial head resection in elbow joint resistance to varus displacement of the forearm. Kinematic simulations showed that the computational model was able to mimic the physiological movements of the joint throughout various ranges of motion including flexion/extension and pronation/supination. Quantitatively, the model was able to accurately reproduce the trends, as well as the magnitudes, of varus resistance observed in the cadaveric specimens. Additionally, magnitudes of ligament tension and joint contact force predicted by the model were able to further elucidate the complex soft-tissue and osseous contributions to varus elbow stability.

Cette présente thèse poursuit l’objectif central de mieux comprendre l’expérience vécue par des adolescents ayant reçu une transplantation rénale et celle des parents donneurs et non donneurs. Elle s’inspire d’une perspective développementale, où la construction identitaire des adolescents est évaluée qualitativement ainsi que l’expérience des parents, ceux-ci jouant un rôle important dans le développement de l’adolescent. Les adolescents vivant avec une maladie chronique rénale doivent relever les défis développementaux normaux ainsi que ceux associés à la maladie et aux traitements associés. Dans un contexte de transplantation d’organe, des défis additionnels, tels que le lien qui unit le receveur au donneur et les atteintes à l’image de soi rendent cette période charnière encore plus complexe. L’adolescence pose des défis importants pour la relation parent-enfant, tels que l’indépendance grandissante de l’adolescent, son désir d’autonomie, les changements au niveau de l’investissement et la nécessité du lien avec les figures d’attachement. Les jeunes greffés dénoncent leur impression d’être surprotégé et les parents de ces adolescents, eux aussi, se disent surprotecteurs. Pour certains parents, un deuxième rôle est incarné ; celui de donneur d’organe. Les influences que peut avoir le don sur le développement de l’adolescent sont toutefois inconnues. L’un des éléments centraux de cette thèse est également l’évaluation de la résolution du diagnostic pour les parents, ce processus ayant été défini comme un important précurseur de l’acceptation de la maladie à travers d’autres populations de parents d’enfants malades. Il est donc significatif de tenter de comprendre si ces parents sont arrivés à résoudre ou non le diagnostic de leur enfant et les pratiques parentales qui découlent du statut de résolution. Des parents étant encore habités par des questions et des émotions liées au moment du diagnostic sont susceptibles d’être envahis par celles-ci lorsque l’adolescent se montre peu adhérent ou par exemple, lorsqu’il s’engage dans des comportements à risque pour la survie du rein. Un devis qualitatif a été choisi, utilisant une entrevue semi-structurée réalisée auprès de chaque membre de la dyade. L’étude a été réalisée auprès de 10 adolescents et de 9 parents. Les analyses ont été guidées par la méthode de l’analyse phénoménologique interprétative (IPA). Au niveau de l’expérience parentale, les premières réactions au diagnostic indiquent la présence de trauma chez les parents au statut non résolu. Le statut de donneur aide la résolution des aspects négatifs de l’expérience, mais n’explique pas complètement le statut de résolution du diagnostic. Les préoccupations quant à l’adhérence sont centrales dans la relation que les parents ont avec leur adolescent. Les résultats appellent à un regard sur les besoins de soutien de ces parents et encore plus pour ceux dont la résolution est incomplète. Au niveau de l’évaluation du développement identitaire des adolescents, les résultats suggèrent que le développement est influencé par des préoccupations similaires chez les adolescents et ce peu importe le statut de donneur : l’image du corps, les relations sociales et l’anxiété par rapport au futur. Pour ceux ayant reçu d’un parent, des émotions uniques face au parent peuvent être un obstacle au développement d’une identité unique. L’évaluation des représentations d’attachement a permis de constater la prévalence élevée de types d’attachement insécurisant chez cet échantillon ainsi que la présence d’éléments traumatiques dans la relation d’attachement pour certains. / The central objective of this thesis is to better understand the experience of adolescents with a kidney transplant and the experience of their donor and non-donor parents. Inspired by a developmental perspective, and using a qualitative design, the thesis evaluates the identity development and the relationships between adolescents and their parents. It is in fact during adolescence that identity development becomes significant and youth living with a chronic kidney disease have to take up challenges related to their condition and its treatment as well as those of normal development. In context of a kidney transplant, additional challenges like the relationship to the donor and the impacts on body image makes the adolescence a more complex period. Adolescence brings significant challenges for the parent-child relationship, like growing needs of becoming more autonomous and independent and the investment and necessity of the proximity with attachment figures. Adolescents with a kidney transplant express their impression of being overprotected from their parents, and parents also consider themselves overprotective. Unique to the field of organ transplants, parents can be the donor for their child, but it is unclear whether this ability to give life for a second time has an impact the adolescent’s development and the experience of parents. One of the central elements of this thesis is the evaluation of diagnosis resolution for parents of adolescents with a kidney transplant, a process that has been recognized as a precursor of accepting the disease and is associated with proactive parental attitudes in other populations of parents with sick children. It is necessary to understand how parents of adolescent kidney recipients resolved the diagnosis and their parental practices according to the type of resolution they portray. Parents who still deal with unresolved emotions may feel overwhelmed when their adolescent is not compliant with the medical regiment or when he engages in risky behaviours for the survival of the graft. A qualitative design was chosen, using semi-structured interviews with each member of the dyads. Participants were 10 adolescents and 9 parents. Analyses were conducted according to the interpretative phenomenological analysis method (IPA). For the article with parents, results show that early reactions to the diagnosis suggest parents experienced trauma. Donor status seems to help resolve the negative aspects of the experience but does not fully explain diagnostic resolution status. For all parents, concerns over adherence are central to their relationship with their youth. Results call for attention to the support needs of all parents and particularly those with an unresolved status. For the article on identity development, results suggest identity development is influenced by similar concerns for all adolescents whether they received from a donor parent or not: body image, social relationships and anxiety for the future. For those who received from a parent donor, feelings toward the parent can be a challenge when building a unique identity. The evaluation of attachment representations informed us on the high presence of insecure attachments types among this specific sample of adolescents and on the presence of traumatic symptoms in the attachment relationship for some.

No description available.

No description available.

Das zunehmende Durschnittsalter unserer Gesellschaft und der Mangel an Spenderorganen stellen bedeutende Herausforderungen für die Organtransplantation dar. Organe, die früher als "marginal" galten, werden heute routinemässig transplantiert. Gleichzeitig mit der Zunahme älterer Patienten auf der Warteliste steigt das Interesse an der Entwicklung von speziellen Allokations-Strategien. Basierend auf dem Konzept der Abstimmung des metabolischen Bedarfs des älteren Empfängers und der Kapazität der älteren Spenderniere entwickelte Eurotransplant daher das Eurotransplant Senior Program (ESP), welches im Januar 1999 gestartet wurde. Im Rahmen dieses Programms werden Nieren von über 65 Jahre alten Spendern lokal auf eine selektierte Gruppe über 65 Jahre alter, nicht immunisierter Empfänger übertragen. Das Ziel dieser 5-Jahres Analyse war es herauszufinden, ob das ESP erfolgreich seine Ziele erreicht hat, Organe von älteren Spendern optimal zu nutzen und die Zeit auf der Warteliste für ältere Empfänger zu verkürzen. Als Basis dienten Daten des Eurotransplant Information Systems (ENIS). Zusätzliche Informationen wurden für die ESP Patienten und zwei Kontrollgruppen mit entweder annähernd vergleichbarem Alter des Spenders (Kontrolle 1) oder des Empfängers (Kontrolle 2) erfasst. Insgesamt zeigt diese Auswertung, dass die Ziele des ESP erreicht wurden. Die Verfügbarkeit von älteren Spenderorganen wurde von 162 (10%) im Jahre 1998 auf 239 (fast 15%) im Jahre 2004 gesteigert. Die Wartezeit für ältere Empfänger verkürzte sich signifikant im Vergleich zu vor der Einführung des ESP und weiter im Verlauf der ersten 5 Jahre auf deutlich unter 4 Jahre, während sich die Wartezeit für Patienten in den Kontrollen die über ETKAS transplantiert wurden um bis zu einem Jahr verlängerte. Die kalte Ischämiezeit für ESP Patienten war signifikant kürzer mit etwa 12 im Vergleich zu ca. 17 Stunden für beide Kontrollen.Das Patienten- und Transplantatüberleben der Empfänger von Organen von über 65-jähriger Spendern wurde durch die ESP-Allokation, trotz 5-10% höherer Abstossungraten, nich negativ beeinflusst. Die Analyse der unabhängigen Risikofaktoren für akute Abstoßungsreaktionen weist darauf hin, dass ein verbessertes HLA matching unter Beibehaltung kurzer Ischämiezeiten möglicherweise von Vorteil wäre. / The aging society and the shortage of organs impose significant challenges to organ transplantation. As a result, organs previously considered marginal are now routinely used. At the same time, an increase in the number of elderly patients on renal transplant waiting lists has heightened interest in the development of special allocation strategies for these patients. As a result, Eurotransplant started the Eurotransplant Senior Program (ESP) in January 1999, an allocation scheme based on the concept of matching the metabolic demand of the recipient and the excretory capacity of the donor. The program obtaines kidneys from donors over 65 years and locally allocates them to a selected group of non-immunized patients in the same age group. The main objective of this evaluation was to find out if the allocation scheme is effective in using kidneys from elderly donors and if it shortens the waiting time for elderly patients. The Eurotransplant database was used as a starting point, and data added to the database by collecting additional information on the ESP patients, and on two control groups. The controls were observed over the same time period as the ESP patients, and matched them for either donor age (Control 1) or recipient age (Control 2). Overall, this 5-year analysis of the ESP shows that the objectives of the program have been met. The availability of elderly donors increased from 169 (10%) in 1998 to 239 (almost 15%) in 2004. The waiting time for elderly recipients transplanted within the ESP was successfully reduced compared to the waiting time before introduction of ESP and is now below 4 years, while waiting time in both control groups has increased by up to one year. The cold ischemia time for ESP patients was significantly shorter, with a mean of approximately 12 hours compared with over 17 hours in both control groups. Graft and patient survival in recipients of organs from donors age over 65 were not negatively impacted by the ESP allocation despite 5-10% higher acute rejection rates.Based on an analysis of independent risk factors the use of HLA matching instead of waiting time should be considered as an allocation criterion while maintaining a short cold ischemia time.