OBJETIVO: Avaliar se as trombofilias pioram os desfechos maternos e fetais entre pacientes com formas graves de pré-eclâmpsia (PE). MÉTODO: De outubro/2009 a outubro/2014, foi realizada uma coorte retrospectiva de gestantes com PE grave diagnosticada antes de 34 semanas e seus recém-nascidos (RNs), internados no Hospital das Clínicas da FMUSP. Foram incluídas pacientes que tinham ausência de cardiopatias, nefropatias, diabetes pré-gestacional, moléstia trofoblástica gestacional, malformação fetal, gemelidade e que realizaram pesquisa de trombofilias no período pós-natal. Foram excluídas gestações subsequentes de uma mesma paciente no período de estudo, confirmação de alteração morfológica, genética ou cromossômica fetal, após o nascimento, e ainda as que realizaram uso de heparina ou ácido acetil salicílico durante a gestação. Foram pesquisados: fator V de Leiden, a mutação G20210A da protrombina, antitrombina, proteína C, proteína S, homocisteína, anticoagulante lúpico e anticorpos anticardiolipina IgG e IgM. Compararam-se os grupos com e sem trombofilia em relação a parâmetros clínicos e laboratoriais maternos e desfechos perinatais. Esta pesquisa foi aprovada pela Comissão de Ética para Análise de Projetos de Pesquisa da FMUSP. RESULTADOS: Entre as 127 pacientes selecionadas, 30 (23,6%) apresentaram diagnóstico de pelo menos uma trombofilia, hereditária ou adquirida. Entre as pacientes com trombofilia, tivemos mais pacientes da raça branca (p= 0,036). A análise de parâmetros maternos mostrou uma tendência das trombofílicas terem mais plaquetopenia (p=0,056) e evidenciou piora de parâmetros laboratoriais quando analisados em conjunto (aspartato aminotransferase >= 70 mg/dL, alanina aminotransferase>=70 mg/dL, plaquetas < 100.000/mm3, creatinina sérica >= 1,1 mg/dL); p=0,017. Não houve diferença quanto aos achados perinatais fetais. CONCLUSÃO: A presença de trombofilia associa-se à piora em parâmetros laboratoriais maternos, em pacientes com formas graves de PE, sem, contudo, piorar os desfechos perinatais, ao menos na amostra estudada / OBJECTIVE: To evaluate whether thrombophilia worsens maternal and foetal outcomes among patients with severe preeclampsia (PE). METHOD: From October 2009 to October 2014, a retrospective cohort study was performed on pregnant women with severe PE diagnosed before 34 weeks of gestation and their newborns hospitalized at the Clinics Hospital, FMUSP. Patients who had no heart disease, nephropathies, pre-gestational diabetes, gestational trophoblastic disease, foetal malformation, or twin pregnancy and who underwent thrombophilia screening during the postnatal period were included. Subsequent pregnancies of the same patient during the study period; cases of foetal morphological, genetic, or chromosomal abnormalities after birth; and women who used heparin or acetylsalicylic acid during pregnancy were excluded. Factor V Leiden, G20210A prothrombin mutation, antithrombin, protein C, protein S, homocysteine, lupus anticoagulant, and anticardiolipin IgG and IgM antibodies were analysed. The groups with and without thrombophilia were compared regarding their maternal clinical and laboratory parameters and perinatal outcomes. This research was approved by the Ethics Committee for the Analysis of Research Projects of FMUSP. RESULTS: Of the 127 patients selected, 30 (23.6%) had a diagnosis of at least one thrombophilia, either hereditary or acquired. Among the patients with thrombophilia, we observed more white patients (p = 0.036). Analysis of maternal parameters showed a tendency of thrombophilic women to have more thrombocytopenia (p = 0.056) and showed worsening of laboratory parameters when analysed jointly (aspartate aminotransferase >= 70 mg/dL, alanine aminotransferase >= 70 mg/dL, platelets < 100,000/mm3, serum creatinine >= 1.1 mg/dL; p = 0.017). There were no differences in foetal perinatal findings. CONCLUSION: The presence of thrombophilia is associated with worsening of maternal laboratory parameters in patients with severe forms of PE but not with the worsening of perinatal outcomes, at least in the sample studied

Cardiac remodeling after acute myocardial infarction (MI) is an important process that leads to progressive ventricular enlargement and heart failure. Several variables have been identified to predict an increase in left ventricular (LV) volume and a decrease of LV ejection fraction (LVEF) after an acute MI including infarct size, anterior location, cardiac enzyme level, transmurality of the infarct, patency of the infarct-related artery, end systolic volume (ESV) and mitral deceleration time, etc. / Regional disturbances of LV wall motion have long been recognized to occur in patients with cardiac diseases, such as hypertrophic cardiomyopathy, unstable angina, acute ischemia, and MI. Tissue Doppler imaging (TDI) is recently established for detecting regional contractile abnormalities and asynchrony, and can predict reverse remodeling and improved synchronicity after biventricular pacing therapy in heart failure patients. However, it is unclear whether LV asynchrony plays an important role in the evolutionary changes of LV remodeling after an acute infarction and whether it can predict the changes independently. / The identification of transmural extent of myocardial necrosis and degree of non-viability after acute MI is clinically important. TDI-derived strain rate imaging (SRI) quantifies local rate of myocardial deformation and has the potential to differentiate viable from infarcted myocardium. / Therefore, in this study we aimed to investigate: (1) Whether SRI may differentiate transmural from non-transmural MI as assessed by ce-MRI in routine patients post acute infarction, and establish practical cutoff values for identifying transmural scar tissue from non-transmural or subendocardial infarction with viable myocardium. (2) Whether LV systolic and diastolic asynchrony measured by TDI occurs early after acute MI even in the absence of widening of QRS complexes, and determine if this is explained by the site and extent of the infarction measured by ce-MRI. (3) The relationships between serial measurements of infarct size on ce-MRI and LV remodeling process after an acute infarction, and determine whether early assessment of infarct size predicts progressive ventricular enlargement and cardiac dysfunction, and whether it differs with infarct location. (4) The relationships between LV asynchrony, infarct size and LV remodeling, and determine whether early assessment of LV asynchrony by TDI compared with standard clinical correlates of LV remodeling and infarct size predicts progressive ventricular enlargement and cardiac dysfunction. (Abstract shortened by UMI.) / Zhang Yan. / "April 2005." / Adviser: John E. Sanderson. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0175. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 161-192). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Background. Diabetes mellitus is a complex metabolic disorder characterized by clustering of multiple cardiovascular risk factors. Diabetic albuminuria is associated with increased prevalence of both micro-vascular and macro-vascular complications. This thesis examined vascular function (Flow-mediated dilatation, FMD) in type 2 diabetic patients with particular emphasis on its relationships with nephropathy. Independent predictors for FMD in Chinese population using data from both diabetic and non-diabetic subjects as well as the predictive value of FMD on clinical endpoints and death in type 2 diabetic patients with nephropathy were examined. / Conclusions. In Chinese subjects with or without type 2 diabetes, hyperglycaemia, hypertriglyceridemia, smoking and albuminuria were independent predictors for FMD. Type 2 diabetic subjects with overt nephropathy had impaired endothelium-dependent and endothelium-independent dilatation, suggesting vascular dysfunction beyond the endothelium. In agreement with studies from Caucasians, smoking was the most important determinant for vascular dysfunction in Chinese type 2 diabetic patients with overt nephropathy. Furthermore, FMD was predictive of new onset of cardiovascular events and related death in Chinese type 2 diabetic patients with overt nephropathy. / In diabetic patients with overt nephropathy, smoking (current and ex-smokers), waist hip ratio (WHR) and serum creatinine were independent predictors for impaired FMD. The latter was predictive of advancement of IMT and was an independent predictor for new onset of combined cardiovascular diseases and related death after a follow up period of 42 months (log rank test=6.04, p=0.014 using Cox regression analysis) after controlling for all confounding factors. In addition, fasting total cholesterol and plasma glucose were predictive for all-cause mortality while serum creatinine predicted new onset of renal endpoint. In a subgroup analysis in diabetic patients with overt nephropathy, smokers who developed CVD or ESRD had greater diminution of FMD than those who did not develop clinical endpoints. / Methods and results. FMD was assessed using high-resolution ultrasound scan. In the cross-sectional study, the sample population was divided into four groups according to the presence or absence of type 2 diabetes and level of albuminuria. They included the non-diabetic group (N=52), diabetic group with normoalbuminuria (N=18), diabetic group with microalbuminuria (N=18) and diabetic group with overt nephropathy defined as macroalbuminuria and renal insufficiency (N=22). Compared to non-diabetic subjects, type 2 diabetic subjects with nephropathy had impaired FMD (4.54% +/- 2.25 vs. 2.50% +/- 2.31, p&lt;0.05) and impaired GTN-dependent dilatation (GTND) (14.30% +/- 3.77 vs. 12.70% +/- 4.70, p&lt;0.05). They also had reduced endothelium-dependent dilatation to endothelium-independent dilatation ratio when compared to non-diabetic subjects (0.19 +/- 0.17 vs. 0.32 +/- 0.15, p&lt;0.05). These findings suggest that the impaired vascular dilatation was due to dysfunction of both endothelium and vascular smooth muscle cells. In the entire cohort, fasting plasma glucose, fasting triglyceride, smoking and albuminuria were independent predictors for FMD. / Lai Wai Keung Christopher. / "February 2006." / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6298. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 202-252). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Diabetic pregnancy is associated with increased risk of congenital malformations. Previous studies have shown that maternal diabetes can interact with the vitamin A metabolite, all-trans retinoic acid (RA), in increasing embryonic susceptibility to caudal regression and neural tube defects. The aim of this thesis is to investigate the cellular and molecular mechanisms that underlie this interaction. / First hypothesis. RA concentration in the embryo is tightly regulated by the synthesizing enzyme retinaldehyde dehydrogenase type II (RALDH2), and the degrading enzyme CYP26. Alteration in expression levels of these enzymes under maternal diabetes may affect the availability of RA and thus its teratogenicity. / In conclusion, results of this thesis provide insight into the mechanism of how maternal diabetes interacts with RA in enhancing embryonic susceptibility to congenital malformations. This is also the first report to show that maternal diabetes alters RA homeostasis. (Abstract shortened by UMI.) / Second hypothesis. The transfer of RA to the nucleus for molecular action is regulated by cytoplasmic cellular retinoic acid binding proteins CRABP-I and CRABP-II. Alteration in expression levels of these binding proteins under maternal diabetes may affect the amount of RA reaching the nucleus and thus its teratogenicity. / Third hypothesis. The action of RA is mediated via different nuclear retinoic acid receptors (RAR) and retinoid X receptors (RXR). Alteration in expression levels of these receptors under maternal diabetes may affect the efficacy of RA signal transduction and thus its teratogenicity. / Three hypotheses are proposed to explain the underlying mechanism of increased embryonic susceptibility to RA teratogenicity under maternal diabetes: / To investigate these hypotheses, expression levels of various genes in different groups were compared. Result show that there are no significant differences in mRNA expression levels of CRABP-I, CRABP-II, RARgamma, RARgamma and RXRalpha between embryos of diabetic and non-diabetic mice with or without RA treatment. In contrast, expression levels of Raldh2 and CYP26 are significantly reduced in embryos of diabetic mothers, and in embryos of non-diabetic mice cultured in vitro in hyperglycemic conditions. Moreover, embryos of diabetic mice show significantly reduced response to RA-induced up-regulation of CYP26. These findings suggest that the rate of degradation of RA is slower in embryos of diabetic mice and thus the teratogenic effect of RA is enhanced. / Leung Bo Wah. / "July 2005." / Adviser: Alisa S. W. Shum. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3779. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 158-198). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Conclusion. The equations developed in this study provide a more accurate estimate of GFR, ranging from normal to renal impairment, in both Chinese diabetic and non-diabetic patients, compared to currently available GFR formulae. / Hypothesis/objectives. Type 2 diabetes mellitus is a major health burden associated with increased morbidity and mortality as well as socio-economic impact. A rapid increase in disease prevalence has been reported and predicted in China and other Asian countries. Patients with low and declining GFR and microalbuminuria are at high CVD risk. A simple and precise predictive equation of GFR for Chinese diabetic patients is essential in the light of the growing epidemic of diabetes and CKD in Chinese population both for monitoring and treatment purposes. In this pilot study, a set of accurate, simple and clinically practical equations to predict GFR in Chinese type 2 diabetic patients was established. Their performance was validated using separate samples of diabetic and non-diabetic subjects and compared with other widely used GFR formulae. / Methods. 202 type 2 diabetic patient and 46 non-diabetic patients were enrolled in the study. Of these 135 were randomly selected as the training sample; the remaining 67 diabetic patients and 46 non-diabetic patients constituted 2 validation groups. The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equation including MDRD and CG equations in the validation samples. / Results. Independent factors associated with GFR included age, serum creatinine concentration, serum urea nitrogen level and serum albumin levels (P &lt; 0.005 for all factors). Two predictive formulae, sRFCD and RFCD, were established. Simplified Renal formula in Chinese Diabetes (sRFCD) Study (ml/min/1.73 m2) is: GFR (for men) = 90400 x (Age)-0.495 (yr) x [ SCr]-1.097 (mumol/l) GFR (for women) = 58983 x (Age)-0.542 (yr) x [SCr]-1.012 (mumol/l) and Renal formula in Chinese Diabetes (RFCD) Study (ml/min/1.73 m2) is: GFR (for men) = 11825 x (Age)-0.494 x [SCr]-1.059 (mumol/l) x [Alb]+0.485 (g/l) GFR (for women) = 34166 x ( Age)-0.489 x [SCr] -0.877 (mumol/l) x [SUN] -0.150 (mmol/l) The multiple regression model explained 89.9% and 89.4% respectively of the variance in the logarithm of GFR. Compared to other GFR formulae, the sRFCD and RFCD formulae showed less bias and were more precise and accurate in estimating GFR in diabetic patients whereas the sRFCD and MDRD formulae showed better performance in non-diabetic patients. / Leung Tak Kei. / "July 2006." / Adviser: Juliana C. N. Chan. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5117. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 161-180). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

OBJETIVO: Analisar a associação entre o estado nutricional materno em gestações de alto risco e complicações do parto, do puerpério e análise do consumo dietético dessas gestantes. MÉTODOS: Estudo prospectivo e observacional realizado no período de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o quinto dia; idade acima de 18 anos; gestação de alto risco; feto único e vivo no início do trabalho de parto; parto na Instituição; peso materno aferido no dia do parto. O estado nutricional no final da gestação foi avaliado pelo índice de massa corporal (IMC), aplicando-se a curva de Atalah. As pacientes foram classificadas em: baixo peso, adequado, sobrepeso e obesidade. O consumo dietético foi avaliado por aplicação do questionário de frequência do consumo alimentar. As complicações do parto e do puerpério, investigadas durante o período de internação e 30 dias após a alta, foram: tipo de parto, infecção e/ou secreção em ferida cirúrgica, infecção urinária, infecção puerperal, febre, hospitalização, uso de antibióticos e morbidade composta (pelo menos uma das complicações puerperais citadas). RESULTADOS: Foram incluídas 374 puérperas classificadas pelo IMC final em: baixo peso (n=54, 14,4%); adequado (n=126, 33,7%); sobrepeso (n=105, 28,1%) e obesidade (n=89, 23,8%). Não houve diferença significativa na proporção de cesáreas quando comparados os seguintes grupos: baixo peso e adequado (68,3%), sobrepeso (76,2%) e obesidade (78,6%, P=0,201). A obesidade materna apresentou associação significativa com as seguintes complicações do puerpério: infecção de ferida cirúrgica (16,7%, P=0,042), infecção urinária (9,0%, P=0,004), uso de antibiótico (12,3%, P<0,001) e morbidade composta (25,6%, P=0,016). Aplicando-se o modelo de regressão logística, verificou-se que a obesidade no final da gestação é variável independente na predição da morbidade composta (OR: 2,09; IC95%: 1,15 - 3,80, P=0,015). A análise do consumo dietético demonstrou média de consumo energético semelhante nos grupos: baixo peso e adequado (2344 cal/dia), sobrepeso (2433 cal/dia) e obesidade (2450 cal/dia, P=0,640). Não se constatou diferença significativa no consumo médio diário de macro e micronutrientes entre os grupos estudados. CONCLUSÃO: A obesidade materna no final da gravidez, em pacientes de alto risco, está associada, de forma independente, com a ocorrência de complicações infecciosas no puerpério, demonstrando a necessidade de acompanhamento mais eficiente em relação ao ganho de peso materno nessas gestações / OBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies

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Tong, Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 66-78). / Abstracts in English and Chinese; includes Chinese. / Acknowledgements --- p.i / Conferences & Academic Awards --- p.ii / Table of contents --- p.iii / List of figures --- p.vii / List of tables --- p.viii / List of abbreviations --- p.ix / Abstract --- p.x / Abstract (Chinese) / Chapter Chapter I --- Background of diabetes mellitus and DM complicating pregnancy …… --- p.1 / Chapter 1.1 --- Definitions and clinical manifestations of Diabetes Mellitus --- p.1 / Chapter 1.2 --- Diagnostic criteria of DM --- p.1 / Chapter 1.3 --- Classification of DM --- p.1 / Chapter 1.4 --- Prevalence of DM --- p.2 / Chapter 1.5 --- Aetiology and Pathogenesis of DM --- p.3 / Chapter 1.6 --- Treatment of DM --- p.3 / Chapter 1.7 --- Complications of DM --- p.4 / Chapter 1.8 --- DM complicating pregnancy --- p.4 / Chapter 1.8.1 --- Implications of DM complicating pregnancy --- p.4 / Chapter 1.8.2 --- Diabetic Embryopathy --- p.5 / Chapter 1.8.3 --- Incidences of the major congenital anomalies --- p.5 / Chapter 1.8.4 --- Possible pathogenesis of congenital anomalies in DM complicating pregnancy --- p.6 / Chapter 1.8.4.1 --- Apoptosis --- p.6 / Chapter 1.8.4.2 --- Oxidative stress --- p.7 / Chapter 1.8.4.3 --- Arachidonic acid and PGE2 --- p.7 / Chapter 1.8.5 --- Clinical management of DM complicating pregnancy --- p.8 / Chapter 1.8.5.1 --- Pre-pregnancy care --- p.8 / Chapter 1.8.5.2 --- Antenatal management of DM complicating pregnancy --- p.9 / Chapter Chapter II --- Background of Traditional Chinese Medicine in treatment of DM --- p.10 / Chapter 2.1 --- Definition and manifestations of DM in TCM theory --- p.10 / Chapter 2.2 --- Historical context of DM in TCM --- p.10 / Chapter 2.2.1 --- "Spring and Autumn Period and Warring States Period (770 B.C.一8 A.D.): The first nomenclature of ""Wasting Thirst""" --- p.10 / Chapter 2.2.2 --- "Han Dynasty (9 A.D.-280 A.D.)： monograph on ""Wasting Thirst""" --- p.11 / Chapter 2.2.3 --- "Sui and Tang Dynasty (581 A.D.-960 A.D.)： the diagnosing marker of ""Wasting Thirst""" --- p.11 / Chapter 2.2.4 --- Song Dynasty (960 A.D.-1270 A.D.): the Golden Time of developing the treatment on DM --- p.12 / Chapter 2.2.5 --- Ming and Qing Dynasty (1270 A.D. - 1911 A.D.): the integration period of TCM theory on DM --- p.15 / Chapter 2.3 --- Aetiology of DM in TCM theory --- p.15 / Chapter 2.3.1 --- Congenital weakness --- p.16 / Chapter 2.3.2 --- Improper diet --- p.16 / Chapter 2.3.3 --- Emotional disorders and overstrain --- p.17 / Chapter 2.3.4 --- Excessive sexual activities --- p.17 / Chapter 2.4 --- Pathogenesis of DM in TCM theory --- p.17 / Chapter 2.5 --- Prognosis of DM in TCM theory --- p.19 / Chapter 2.5.1 --- """Dual Qi-Yin Deficiency"" and ""Dual Yin-Yang Deficiency""" --- p.19 / Chapter 2.5.2 --- "Multi-systemic malfunction of ""Zang Fu""" --- p.19 / Chapter 2.6 --- Principle of treatment --- p.20 / Chapter 2.7 --- Commonly used herbal remedies and recent experimental studies --- p.20 / Chapter 2.8 --- TCM on relieving DM complications --- p.21 / Chapter 2.9 --- "Dwarf Lilyturf Tuber (Ophiopogonis Radix, Mai Dong,麥冬）" --- p.21 / Chapter 2.10 --- Objectives and hypothesis --- p.22 / Chapter 2.10.1 --- Objectives --- p.22 / Chapter 2.10.2 --- Hypotheses --- p.23 / Chapter Chapter III --- Methodology and Results --- p.24 / Chapter 3.1 --- Set up of mouse embryos --- p.24 / Chapter 3.1.1 --- Mouse strain --- p.24 / Chapter 3.1.2 --- Research animal ethnics and care guidelines --- p.24 / Chapter 3.1.3 --- Mouse sacrifice and embryo dissection --- p.24 / Chapter 3.1.4 --- Grouping of embryos --- p.25 / Chapter 3.2 --- Preparations of D-glucose --- p.25 / Chapter 3.3 --- Chinese medicine quality controls and preparations --- p.25 / Chapter 3.4 --- Whole mouse embryo culture --- p.26 / Chapter 3.5 --- Morphological scoring on mouse embryos and statistical analysis --- p.27 / Chapter 3.6 --- Establishment of cranial NTD by D-glucose --- p.28 / Chapter 3.6.1 --- Dosage of D-glucose to induce cranial NTD --- p.29 / Chapter 3.6.2 --- Result --- p.30 / Chapter 3.7 --- Experimental designs --- p.31 / Chapter 3.8 --- Part I: Efficacy and dose-response effects of Maidong extract --- p.32 / Chapter 3.8.1 --- Safety dose of Maidong extract on non-diabetic mouse embryos --- p.32 / Chapter 3.8.1.1 --- Dosage --- p.32 / Chapter 3.8.1.2 --- Result --- p.35 / Chapter 3.8.2 --- Efficacy and dose-effect response of Maidong extract on non-diabetic mouse embryos --- p.36 / Chapter 3.8.2.1 --- Dosage and grouping --- p.37 / Chapter 3.8.2.2 --- Result --- p.38 / Chapter 3.9 --- Part II: Efficacy and dose-response effects of serum from Maidong extract-treated rat serum --- p.40 / Chapter 3.9.1 --- Preparation of Maidong treated non-diabetic full rat serum --- p.41 / Chapter 3.9.1.1 --- Rats --- p.41 / Chapter 3.9.1.2 --- Dosage for feeding --- p.41 / Chapter 3.9.1.3 --- Administration --- p.42 / Chapter 3.9.1.4 --- Termination of rats and preparation of rat serum --- p.42 / Chapter 3.9.2 --- Safety dose of Maidong treated non-diabetic full rat serum non-diabetic mouse embryos --- p.43 / Chapter 3.9.2.1 --- Dosage --- p.43 / Chapter 3.9.2.2 --- Result --- p.44 / Chapter 3.9.3 --- Protective Effect of Maidong extract-treated full rat serum --- p.46 / Chapter 3.9.3.1 --- Dosage and grouping --- p.46 / Chapter 3.9.3.2 --- Result --- p.47 / Chapter 3.10 --- "Part III: Efficacy and dose-response effects of Ophiopogonin D, a major chemical component of Maidong in preventing hyperglycemia-induced cranial neural tube defect" --- p.49 / Chapter 3.10.1 --- Safety dose of Ophiopogonin D --- p.50 / Chapter 3.10.1.1 --- Preparation of Ophiopogonin D --- p.50 / Chapter 3.10.1.2 --- Dosage --- p.50 / Chapter 3.10.1.3 --- Results --- p.52 / Chapter 3.10.2 --- Efficacy and dose-response effects of Ophiopogonin D --- p.53 / Chapter 3.10.2.1 --- Dosage and grouping --- p.53 / Chapter 3.10.2.2 --- Results --- p.55 / Chapter Chapter IV --- Discussion --- p.58 / Chapter 4.1 --- Whole embryo culture system --- p.58 / Chapter 4.2 --- Quality control of Maidong extract --- p.58 / Chapter 4.3 --- "Therapeutic effect of single herb, formula and chemical components" --- p.59 / Chapter 4.4 --- Dosage of D-glucose to induce cranial NTD --- p.60 / Chapter 4.5 --- Dosage and efficacy of Maidong extract and Ophiopogonin D --- p.60 / Chapter 4.6 --- Administration of Maidong extract to non-diabetic female rats --- p.61 / Chapter Chapter V --- Conclusions --- p.63 / Chapter Chapter VI --- Future Study --- p.64 / References --- p.66

I NTRODUÇÃO: Apesar da importância do tabagismo no processo de doença cardiovascular da sociedade moderna, os estudos de avaliação de risco cardíaco pré-operatório não têm demonstrado a associação entre o hábito de fumar (como variável independente) e os eventos cardíacos pós-operatórios. Nestas pesquisas, as variáveis independentes continuam sendo infarto do miocárdio prévio, insuficiência renal crônica, diabetes, angina, idade, dentre outras. OBJETIVO: Avaliar o papel do tabagismo nas complicações cardíacas pós-operatórias de operações não cardíacas. MÉTODOS: Trata-se de uma coorte retrospectiva de um Hospital Geral, onde foram incluídos 1072 pacientes. Estes foram estratificados em Tabagistas Atuais (n=265), Ex- Tabagistas (n=335) e Não Tabagistas (n=472). Os três grupos foram analisados para os desfechos cardiovasculares combinados no pós-operatório (infarto, edema pulmonar, arritmia com instabilidade hemodinâmica, angina instável; morte cardíaca) e mortalidade em 30 dias. Foram usados o teste quiquadrado e Regressão logística, considerando-se p<0,05 como significante. RESULTADOS: Os desfechos cardiovasculares combinados no pós-operatório e a mortalidade em 30 dias foram 71 (6,6%) e 34 (3,2%), respectivamente. Os Tabagistas Atuais e Pregressos apresentaram 53 (8,8%) eventos cardíacos combinados enquanto que os Não Tabagistas 18 (3,8%), p=0,002. Em relação à mortalidade, Tabagistas Atuais e Pregressos apresentaram 26 (4,3%) enquanto que os Não Tabagistas 8 (1,7%), p=0,024. Na análise multivariada, faixa etária, cirurgia de emergência, insuficiência cardíaca, sobrecarga ventricular esquerda, revascularização do miocárdio e extra-sístole ventricular associaram-se independentemente aos eventos cardiovasculares perioperatórios enquanto que faixa etária, cirurgia de emergência, insuficiência cardíaca, alterações laboratoriais, história de hepatopatia, operações por neoplasia e tabagismo se associaram a mortalidade em 30 dias após a operação de alto risco. CONCLUSÃO: Os Tabagistas atuais e pregressos apresentaram mais eventos cardíacos e mortalidade do que os Não tabagistas. Entre as variáveis independentes associadas a eventos cardíacos e mortalidade em 30 dias, o tabagismo Atual foi á única variável modificável detectada. / I NTRODUCTION: Despite the importance of smoking in the process cardiovascular disease in modern society, the assessments of cardiac risk preoperative haven´t demonstrated an association between smoking (as independent variable) and postoperative cardiac events. Generally, in the researches, indicate as independent variables : myocardial infarction, chronic renal failure, diabetes, angina, age, etc. OBJECTIVE: To assess the impact of smoking in postoperative cardiac complications of non-cardiac surgery. METHODS: A retrospective cohort study designed at General Hospital with 1072 patients. The patients were divided into Current Smokers (n = 265), Past Smokers (n = 335) and Nonsmokers (n = 462). The three groups were analyzed for combined cardiovascular outcomes in postoperative (infarction, pulmonary edema; arrhythmia with hemodynamic instability, unstable angina, cardiac death) and 30-days mortality. The chi-square test and logistic regression were used, considering p<0.05 as significant. RESULTS: The combined cardiovascular outcomes in postoperative and 30-days mortality were 71 (6.6%) and 34 (3.2%), respectively. The Current and Past Smokers presented 53 (8.8%) combined cardiac events than Nonsmokers which showed 18 (3.8%), p = 0002. The 30-days mortality, Current and Past Smokers presented 26 (4.3%) while Nonsmokers 8 (1.7%), p= 0024. At multivariate analysis, age, emergency operation, cardiac failure, left ventricular hypertrophy, coronary-artery revascularization and ventricular premature contractions were independent variables associated with postoperative cardiac events. Another hand, age, emergency operation, cardiac failure, left ventricular hypertrophy, operation of cancer, liver failure, and abnormality laboratories tests were independent variables associated with 30-days mortality after surgery. CONCLUSION: There are more cardiac events and high mortality with Current and Past smokers when compared to nonsmokers. Many independent variables were associated with cardiac postoperative cardiac events and 30-days mortality. However, Current Smoking was unique modifiable variable find out.

[Truncated abstract] Approximately 35% of women worldwide have stress incontinence, which is defined as involuntary leakage of urine on effort, exertion, or on sneezing and coughing. There are various surgical techniques for stress incontinence; however, minimally invasive operations are increasingly being chosen by surgeons and their patients. Of these procedures, tension-free vaginal tape (TVT) has a cure rate of approximately 90% and is now perceived as the standard technique for stress incontinence. Reported complications of TVT include arterial laceration, bladder perforation, bowel perforation, de novo urgency, dyspareunia, excessive blood loss, haematoma, nerve injuries, urethral erosion, urge incontinence, urinary tract infection, vascular injury, vaginal mesh erosion, voiding dysfunction and death. Suprapubic urethral support sling (SPARC) is a very similar minimally invasive operation and early indications suggested that the success rate for treating stress incontinence was expected to be identical or better than those obtained with the earlier TVT approach, with possibly fewer adverse perioperative events. Our trial sought to establish equivalence between TVT and SPARC in relation to short-term complications and efficacy. OBJECTIVES The primary outcome was bladder perforation. Secondary outcomes were blood loss, voiding difficulty, urgency, and cure of stress incontinence symptoms. METHOD A randomised controlled one-sided equivalence trial (RCT) was conducted in Perth, Western Australia during 2003 and 2004 by researchers in the School of Population Health, University of Western Australia (UWA) and King Edward Memorial Hospital (KEMH). Patients were recruited from the public Urology/Urogynaecology Clinic at the primary women's hospital and the consultant surgeons' private practices. ... However, acute urinary retention requiring a return to theatre to loosen the tape (TVT 0%, SPARC 6.5%; OR: [infinity], 95% CL: 2.2, [infinity]; p=0.002) and subjective short-term cure (TVT 87.1%, SPARC 76.5%; OR: 2.07, 95% CL: 1.13, 3.81; p=0.03) were statistically significantly different. CONCLUSIONS The results are consistent with clinical equivalence between TVT and SPARC in relation to the incidence of bladder perforation. No statistically significant difference was found between TVT and SPARC in blood loss, urgency or short-term objective cure of stress incontinence at the six week post-discharge visit to the surgeon. However, the tapes were more difficult to adjust correctly in SPARC procedures and a statistically significant number of patients required a return to theatre for loosening of the tape (TVT 0/147, 0% and SPARC 10/154, 6.5%, p=0.002). Compared with SPARC, TVT was statistically significantly higher for subjective short-term cure. In ii relation to vaginal mesh erosion, TVT was lower than SPARC, though not statistically significantly. Overall, voiding difficulty (loosening of the tape), urgency and vaginal mesh erosion were the most important clinical problems. This randomised controlled trial demonstrates the importance of testing new devices which appear to be similar, but which may have clinically relevant differences. A follow up study to assess the long-term efficacy of tension-free vaginal tape and suprapubic urethral support sling and associated complications is planned.