INTRODUÇÃO: A orbitopatia de Graves é uma doença autoimune cujas manifestações clínicas ocorrem por infiltração tecidual inflamatória. Apresenta estágio ativo inicial e estágio sequelar posteriormente, podendo se manifestar nas formas clínicas miogênica ou lipogênica. A inflamação da órbita pode gerar importante congestão, agravando manifestações clínicas e comprometendo o sucesso da terapia específica em alguns pacientes. O objetivo deste trabalho é a avaliação da congestão orbitária feita pelo estudo das características do fluxo sanguíneo na veia oftálmica superior, por meio do Doppler colorido de órbitas, nos grupos de pacientes com orbitopatia de graves em fase ativa, em fase sequelar miogênica e em fase sequelar lipogênica, além do grupo controle. MÉTODOS: Estudo transversal prospectivo realizado entre maio de 2006 e abril de 2008 no Serviço de Órbita do HCFMUSP. Noventa órbitas de 46 pacientes com orbitopatia de Graves foram incluídas, assim como 38 órbitas de 20 pacientes do grupo controle. Foi feito exame oftalmológico completo e avaliação pelo DCO em todos os pacientes. Pacientes com orbitopatia de Graves foram divididos em grupos com doença em atividade e doença em estágio sequelar nas apresentações miogênicas ou lipogênicas. O sentido, as velocidades máxima e mínima do fluxo sanguíneo na veia oftálmica superior, e o intervalo entre as mesmas, foram aferidos. Os achados foram comparados entre os diferentes grupos e analisados também em relação à restrição muscular, exoftalmometria, escore de atividade clínica, idade, sexo, lado estudado, comorbidades e tabagismo. RESULTADOS: Foi encontrada diferença no sentido do fluxo sanguíneo da veia oftálmica superior (p<0,001), na velocidade máxima (p=0,001), na velocidade mínima (p=0,002) e no intervalo entre a velocidade máxima e a mínima do mesmo (p<0,001) entre os grupos de estudo. A velocidade máxima do fluxo sanguíneo apresentou correlação com a restrição muscular (p=0,003), o escore de atividade clínica (p<0,001) e a exoftalmometria (p=0,015), enquanto a velocidade mínima correlacionou-se com restrição muscular (p<0,001) e escore de atividade clínica (p=0,006). CONCLUSÕES: Há diferença mensurável na velocidade e no sentido do fluxo sanguíneo da veia oftálmica superior entre pacientes dos diferentes grupos de estudo / INTRODUCTION: Graves orbitopathy is an autoimmune disease whose clinical manifestations are secondary to inflammatory tissue infiltration. It presents an initial active stage and a later latent stage, and can manifest myogenic or lipogenic clinical forms. Inflammation of the orbit can generate significant congestion, worsening clinical manifestations and limiting the success of specific therapy in some patients. The objective of this study is to evaluate orbital congestion studying the characteristics of blood flow in the superior ophthalmic vein with the color Doppler in groups of patients with Graves Orbitopathy in active stage, lipogenic latent stage and myogenic latent stage, and patients from the control group. METHODS: Transversal study made between May 2006 and April 2008 in the Orbit Department of University of São Paulo Medical School. Ninety orbits from 46 patients with Graves orbitopathy and 38 orbits from 20 patients of the control group were included. All patients underwent complete ophthalmological exams including color Doppler of the orbits. Patients with Graves orbitopathy were divided in active stage, latent lipogenic stage and latent myogenic stage groups. The direction of venous blood flow in the superior ophthalmic vein and its maximum and minimum velocities - including the interval between them - were measured. The results were compared among the groups and analyzed also in relation to muscular restriction, exophthalmometry, clinical activity score, age, sex, studied orbit side, comorbidities and use of tobacco. RESULTS: There was difference in blood flow direction of the superior ophthalmic vein (p<0,001), blood flow maximum speed (p=0,001), blood flow minimum speed (p=0,002) and blood flow speed interval (p<0,001) among the groups of this study. Blood flow maximum speed presented correlation with muscle restriction (p=0,003), clinical activity score (p<0,001) and exophthalmometry (p=0,015). Blood flow minimum speed presented correlation with muscle restriction (p<0,001) and clinical activity score (p=0,006). CONCLUSIONS: There are measurable difference in speed and direction of blood flow in the superior ophthalmic vein among patients of the different groups of this study

Os circuladores tradicionais são amplamente utilizados em telecomunicações e defesa militar para o simultâneo envio e recepção de sinais por um único meio. Esses circuitos passivos, fabricados a partir de materiais ferromagnéticos, possuem a desvantagem do aumento de dimensões, peso e custos de fabricação com a diminuição da frequência de operação definida no projeto destes dispositivos, inviabilizando sua aplicação em frequências abaixo de 500 MHz. O circulador ativo surgiu como uma alternativa aos tradicionais, tendo aplicações em frequências desde o nível DC até a ordem de dezenas de gigahertz. As suas maiores aplicações ocorrem quando são necessários dispositivos compactos, de baixo custo e de baixa potência. Os primeiros circuitos propostos possuíam uma grande limitação em termos de frequência de operação e de potência entregue à carga. Entretanto, com os avanços tecnológicos na eletrônica, tais problemas podem ser amenizados atualmente. Neste trabalho é apresentado o desenvolvimento de um circuito circulador ativo para a utilização em instrumentação eletrônica, em particular para a operação em frequências na ordem das utilizadas em equipamentos de ultrassom Doppler de ondas contínuas, na faixa de 2 MHz a 10 MHz. As possíveis vantagens da implementação de circuladores em sistemas de ultrassom estão relacionadas ao incremento da relação sinal-ruído, aumento da área de recepção do transdutor, simplificação da construção do transdutor, simplificação do circuito de demodulação/ processamento, e maior isolação entre os circuitos de transmissão e recepção de sinais. Na fase inicial, o circulador ativo proposto é modelado por equacionamento, utilizando-se tanto o modelo ideal dos amplificadores operacionais como o seu modelo de resposta em frequência. Simulações computacionais foram executadas para confirmar a validade do equacionamento. Um circuito montado em placa de prototipagem rápida foi apresentado, e testes de prova de conceito em baixas frequências foram realizados, mostrando uma grande semelhança entre o teórico, o simulado e o experimental. A segunda parte contou com o projeto do circuito circulador para a operação em maiores frequências. O circuito proposto é composto por três amplificadores operacionais de realimentação por corrente e vários componentes passivos. Uma análise de sensibilidade utilizando os métodos de Monte-Carlo e análise do pior caso foi aplicada, resultando em um perfil de comportamento frente às variações dos componentes do circuito e às variações da impedância de carga. Uma placa de circuito impressa foi projetada, utilizando-se de boas práticas de leiaute para a operação em altas frequências. Neste circuito montado, foram realizados os seguintes testes e medições: comportamento no domínio do tempo, faixa dinâmica, nível de isolação em relação à amplitude do sinal, largura de banda, levantamento dos parâmetros de espalhamento, e envio e recepção de sinais por transdutor de ultrassom Doppler de ondas contínuas. Os resultados dos testes de desempenho foram satisfatórios, apresentando uma banda de transmissão de sinais para frequências de 100 MHz, isolação entre portas não consecutivas de 39 dB na frequência de interesse para ultrassom Doppler e isolação maior que 20 dB para frequências de até 35 MHz. A faixa dinâmica excedeu a tensão de 5 Vpp, e o circuito teve bom comportamento no envio e na recepção simultânea de sinais pelo transdutor de ultrassom. / Traditional circulators are widely used in both telecommunications and military defense for sending and receiving signals simultaneously through a single medium. These passive circuits which are manufactured from ferromagnetic materials, have the disadvantages of having suffered an increase in dimensions, weight, and manufacturing costs along with the decrease in the operation frequency established in the designs of such devices, thus preventing their useful employment in frequencies below 500 MHz. The active circulator emerged as an alternative to the traditional ones, and has applications on frequencies ranging from a DC level to levels involving dozens of gigahertz. It is applicable when compact devices are made necessary, at a low cost, and for low frequencies. The first circuits to be introduced had a major limitation in terms of operating frequency and power delivered to the load. However, due to technological advances in electronics, problems such as the aforementioned can now be minimized. This research work presents the development of an active circulator circuit to be used in electronic instrumentation, particularly for operation at frequencies such as those used in continuous wave Doppler ultrasound equipment, ranging from 2 MHz to 10 MHz. The advantages made possible by implementing ultrasound systems with circulators are related to an increase in the signal-to-noise ratio, an increase in the transducers reception area, a simplified construction of the transducer, simplification of the demodulation/processing circuit, and a greater isolation between the transmission circuits and signal reception. In the initial phase, the proposed active circulator was modeled by means of an equating method, using both the ideal model of operational amplifiers and the model of frequency response. Computer simulations were carried out in order to confirm the validity of the equating method. A circuit mounted upon a breadboard was introduced and proof of concept assessments were performed at low frequencies, showing a great similarity among the theoretical, simulated and experimented data. The second phase is when the circulator circuits design was developed in order make its operation at higher frequencies possible. The proposed circuit is comprised of three currentfeedback operational amplifiers and several passive components. A sensitivity analysis was carried out using Monte-Carlo methods and worst-case analyses, resulting in a certain behavioral profile influenced by variations in circuit components and variations in load impedance. A printed circuit board was designed, employing good practice layout standards so that operation at high frequencies would be achieved. The following evaluations and measurements were performed on the circuit that was assembled: time domain behavior, dynamic range, isolation level relative to signal amplitude, bandwidth, survey of the scattering parameters, and transmission and reception of signals by a continuous wave Doppler ultrasound transducer. The results of the performance tests were satisfactory, presenting a 100 MHz signal transmission band, isolation between non-consecutive ports of 39 dB at the frequency of interest to the Doppler ultrasound, and an isolation greater than 20 dB for frequencies of up to 35 MHz. The dynamic range exceeded the 5Vpp and the circuit performed satisfactorily in the simultaneous transmission and reception of signals through the ultrasound\'s transducer.

Stroke is an enormous global burden, six and a half-million people die fromstroke annually [1]. Effectively monitoring blood hemodynamic parameters suchas blood velocity and volume flow permits to help and cure people. This projectaimed to calibrate a custom-made wearable system for measuring cerebral bloodflow (CBF) using a photoplethysmography (PPG) sensor. The measurementswere validated using Doppler ultrasound as a reference method. Five (N=5)subjects (age = 24±1.41 years) were selected for the project. The PPG and Dopplerultrasound probe were placed above the left and right common carotid arteries(CCA), respectively. Measurements were taken simultaneously for 12 secondseach, with six consecutive measurements per subject and 2 time-synchronizedECG recordings. Subsequently, using an extraction algorithm the velocityenvelope (TAMEAN) was extracted from the Doppler image to obtain the bloodvolume flow (ml/min). After synchronization, the PPG signal output expressedin volts was calibrated to the corresponding volume, and a calibration curve wascreated.The extraction algorithm achieved remarkable results, with almost perfectcorrelation with the Doppler image reference, rT AM EAN =0.951 and rvolume=0.975demonstrating its reliability. Challenges encountered during postprocessingand synchronization highlighted the need for careful refinement in the projectframework. Despite successful signal processing and alignment techniques,calibration results were suboptimal due to synchronization difficulties andmotion artifacts. Limitations included impractical measurement locations andsusceptibility to movement artifacts. The calibration process did not yield theexpected outcomes and the project aim was not achieved. All the linear regressionmodels for each subject failed to accurately predict the volume flow based on themeasured voltages. Future work could focus on refining calibration procedures,improving synchronization methods, and expanding studies to include largercohorts. Although the wearable device was tested, the project’s goal was onlypartially achieved, underscoring the complexity of accurately measuring cerebralblood flow using PPG sensors. / Stroke är en enorm global börda, sex och en halv miljon människor dör av strokeårligen [1]. Effektiv övervakning av hemodynamiska blodparametrar såsomblodflödeshastighet och volymflöde gör det möjligt att hjälpa och bota människor.Detta projekt syftade till att kalibrera ett specialtillverkat bärbart system föratt mäta cerebralt blodflöde (CBF) med hjälp av en fotopletysmografisensor(PPG). Mätningarna validerades med Doppler-ultraljud som referensmetod. Fem(N=5) försökspersoner (ålder = 24±1.41 år) valdes ut för projektet. PPG- ochDoppler-ultraljudssonden placerades över vänster respektive höger gemensamhalsartär (CCA). Mätningar togs samtidigt i 12 sekunder vardera, med sexpå varandra följande mätningar per försöksperson och 2 tids-synkroniseradeEKG-inspelningar. Därefter användes en extraktionsalgoritm för att extraherahastighetskuvertet (TAMEAN) från Doppler-bilden för att få blodvolymflödet(ml/min). Efter synkronisering kalibrerades PPG-signalens utgång uttryckt i volttill motsvarande volym, och en kalibreringskurva skapades.Extraktionsalgoritmen uppnådde anmärkningsvärda resultat, med nästan perfektkorrelation med Doppler-bildreferensen, rT AM EAN =0.951 och rvolume=0.975,vilket visar dess tillförlitlighet. Utmaningar som uppstod under efterbearbetningoch synkronisering betonade behovet av noggrann förfining av projektetsramverk. Trots framgångsrik signalbehandling och justeringstekniker varkalibreringsresultaten suboptimala på grund av synkroniseringssvårigheteroch rörelseartefakter. Begränsningar inkluderade opraktiska mätplatser ochkänslighet för rörelseartefakter. Kalibreringsprocessen gav inte de förväntaderesultaten och projektmålet uppnåddes inte. Alla linjära regressionsmodellerför varje försöksperson misslyckades med att noggrant förutsäga volymflödetbaserat på de uppmätta spänningarna. Framtida arbete kan fokusera på att förfinakalibreringsprocedurer, förbättra synkroniseringsmetoder och utöka studier tillatt omfatta större kohorter. Även om den bärbara enheten testades, uppnåddesprojektets mål endast delvis, vilket understryker komplexiteten i att noggrantmäta cerebralt blodflöde med hjälp av PPG-sensorer.

Current bio-robotic assistive devices have developed into intelligent and dexterous machines. However, the sophistication of these wearable devices still remains limited by the inherent difficulty in controlling them by sensing user-intention. Even the most commonly used sensing method, which detects the electrical activity of skeletal muscles, offer limited information for multi-function control. An alternative bio-sensing strategy is needed to allow for the assistive device to bear more complex functionalities. In this thesis, a different sensing approach is introduced using Pulsed-Wave Doppler ultrasound in order to non-invasively detect small tendon displacements in the hand. The returning Doppler shifted signals from the moving tendon are obtained with a new processing technique. This processing technique involves a unique way to acquire raw data access from a commercial clinical ultrasound machine and to process the signal with Fourier analysis in order to determine the tendon displacements. The feasibility of the proposed sensing method and processing technique is tested with three experiments involving a moving string, a moving biological beef tendon and a moving human hand tendon. Although the proposed signal processing technique will be useful in many clinical applications involving displacement monitoring of biological tendons, its uses are demonstrated in this thesis for ultrasound-based user intention analysis for the ultimate goal of controlling assistive exoskeletal robotic hands.

Peripheral vascular grafts are used for the treatment of peripheral arterial disease and arteriovenous grafts for vascular access in end stage renal disease. The development of neo-intimal hyperplasia and thrombosis in the distal anastomosis remains the main reason for occlusion in that region. The local haemodynamics produced by a graft in the host vessel is believed to significantly affect endothelial function. Single spiral flow is a normal feature in medium and large sized vessels and it is induced by the anatomical structure and physiological function of the cardiovascular system. Grafts designed to generate a single spiral flow in the distal anastomosis have been introduced in clinical practice and are known as spiral grafts. In this work, spiral peripheral vascular and arteriovenous grafts were compared with conventional grafts using ultrasound and computational methods to identify their haemodynamic differences. Vascular-graft flow phantoms were developed to house the grafts in different surgical configurations. Mimicking components, with appropriate acoustic properties, were chosen to minimise ultrasound beam refraction and distortion. A dual-beam two-dimensional vector Doppler technique was developed to visualise and quantify vortical structures downstream of each graft outflow in the cross-flow direction. Vorticity mapping and measurements of circulation were acquired based on the vector Doppler data. The flow within the vascular-graft models was simulated with computed tomography based image-guided modelling for further understanding of secondary flow motions and comparison with the experimental results. The computational assessments provided a three-dimensional velocity field in the lumen of the models allowing a range of fluid dynamic parameters to be predicted. Single- or double-spiral flow patterns consisting of a dominant and a smaller vortex were detected in the outflow of the spiral grafts. A double- triple- or tetra-spiral flow pattern was found in the outflow of the conventional graft, depending on model configuration and Reynolds number. These multiple-spiral patterns were associated with increased flow stagnation, separation and instability, which are known to be detrimental for endothelial behaviour. Increased in-plane mixing and wall shear stress, which are considered atheroprotective in normal vessels, were found in the outflow of the spiral devices. The results from the experimental approach were in agreement with those from the computational approach. This study applied ultrasound and computational methods to vascular-graft phantoms in order to characterise the flow field induced by spiral and conventional peripheral vascular and arteriovenous grafts. The results suggest that spiral grafts are associated with advanced local haemodynamics that may protect endothelial function and thereby may prevent their outflow anastomosis from neo-intimal hyperplasia and thrombosis. Consequently this work supports the hypothesis that spiral grafts may decrease outflow stenosis and hence improve patency rates in patients.

This Mater's thesis deals with the evaluation of pulse wave velocity using multi-channel whole-body impedance cardiography. Data were taken from the group of healthy volunteers whose impedance changes were measured during rest, respiratory maneuvers, tilt and stress exercise. The result of this measurement are values of peaks of pulse wave time shifts towards R-wave. The velocity values towards the thorax electrodes were recalculated on the basis of knowledge about the pulse wave time shifts and the distances from the heart to the scanned locations, which were measured using the arterial segment's lengths.

L'analyse de séries temporelles biomédicales chaotiques tirées de systèmes dynamiques non-linéaires est toujours un challenge difficile à relever puisque dans certains cas bien spécifiques les techniques existantes basées sur les multi-fractales, les entropies et les graphes de récurrence échouent. Pour contourner les limitations des invariants précédents, de nouveaux descripteurs peuvent être proposés. Dans ce travail de recherche nos contributions ont porté à la fois sur l’amélioration d’indicateurs multifractaux (basés sur une fonction de structure) et entropiques (approchées) mais aussi sur des indicateurs de récurrences (non biaisés). Ces différents indicateurs ont été développés avec pour objectif majeur d’améliorer la discrimination entre des signaux de complexité différente ou d’améliorer la détection de transitions ou de changements de régime du système étudié. Ces changements agissant directement sur l’irrégularité du signal, des mouvements browniens fractionnaires et des signaux tirés du système du Lorenz ont été testés. Ces nouveaux descripteurs ont aussi été validés pour discriminer des fœtus en souffrance de fœtus sains durant le troisième trimestre de grossesse. Des mesures statistiques telles que l’erreur relative, l’écart type, la spécificité, la sensibilité ou la précision ont été utilisées pour évaluer les performances de la détection ou de la classification. Le fort potentiel de ces nouveaux invariants nous laisse penser qu’ils pourraient constituer une forte valeur ajoutée dans l’aide au diagnostic s’ils étaient implémentés dans des logiciels de post-traitement ou dans des dispositifs biomédicaux. Enfin, bien que ces différentes méthodes aient été validées exclusivement sur des signaux fœtaux, une future étude incluant des signaux tirés d’autres systèmes dynamiques nonlinéaires sera réalisée pour confirmer leurs bonnes performances. / The analysis of biomedical time series derived from nonlinear dynamic systems is challenging due to the chaotic nature of these time series. Only few classical parameters can be detected by clinicians to opt the state of patients and fetuses. Though there exist valuable complexity invariants such as multi-fractal parameters, entropies and recurrence plot, they were unsatisfactory in certain cases. To overcome this limitation, we propose in this dissertation new entropy invariants, we contributed to multi-fractal analysis and we developed signal-based (unbiased) recurrence plots based on the dynamic transitions of time series. Principally, we aim to improve the discrimination between healthy and distressed biomedical systems, particularly fetuses by processing the time series using our techniques. These techniques were either validated on Lorenz system, logistic maps or fractional Brownian motions modeling chaotic and random time series. Then the techniques were applied to real fetus heart rate signals recorded in the third trimester of pregnancy. Statistical measures comprising the relative errors, standard deviation, sensitivity, specificity, precision or accuracy were employed to evaluate the performance of detection. Elevated discernment outcomes were realized by the high-order entropy invariants. Multi-fractal analysis using a structure function enhances the detection of medical fetal states. Unbiased cross-determinism invariant amended the discrimination process. The significance of our techniques lies behind their post-processing codes which could build up cutting-edge portable machines offering advanced discrimination and detection of Intrauterine Growth Restriction prior to fetal death. This work was devoted to Fetal Heart Rates but time series generated by alternative nonlinear dynamic systems should be further considered.