Determina la experiencia institucional del Hospital Nacional Guillermo Almenara Irigoyen con la terapia de Ibuprofeno oral en el cierre del ductus arterioso persistente en recién nacidos prematuros < 1500g. Se encontró 40 Recién nacidos prematuros con indicación de terapia con Ibuprofeno Oral para el cierre del ductus arterioso persistente. Se revisaron las historias clínicas respectivas y los resultados de 36 prematuros que cumplieron los criterios de selección del período en estudio se muestran mediante estadística descriptiva. Los Recién nacidos prematuros estudiados tenían una media del Peso al Nacer de 989.25 gramos ± 223.62 DE y la Edad Gestacional media de 28.72 semanas ± 2.28 DE. La Tasa global de cierre del ductus fue de 75%. El cierre total del ductus se dio en el 58.33% y el cierre parcial en el 16.67%. La tasa de cierre del ductus al primer y segundo curso de Ibuprofeno oral fue de 69.45% y 50% respectivamente.En el 25% (9/36) de los prematuros se realizó la ligadura del ductus. La reapertura del ductus se dio en 2 pacientes.En cuanto a los efectos adversos la Disfunción Renal Transitoria se presentó en el 3.45%, hemorragia gastrointestinal en el 16.67% y NEC en el 5.56%. La perforación intestinal no se registró en ningún caso. En 1 prematuro se registró variación de la hemorragia intraventricular de Grado 1 a 2 después de la terapia con Ibuprofeno oral. Se concluye que la suspensión de Ibuprofeno oral es una opción eficaz, barata y segura que debe considerarse para el cierre del ductus arterioso persistente del recién nacido prematuro. Hay un buen porcentaje de cierre del ductus con el segundo curso de Ibuprofeno por lo cual es una buena opción intentar cursos repetidos de Ibuprofeno antes que decidir por el cierre quirúrgico. Son precisos más estudios en nuestro medio sobre tasas de cierre a cursos incompletos, así como factores predictores de falla al tratamiento. / Trabajo de investigación

The ductus arteriosi (DA) are two blood vessels connecting the pulmonary arteries to the descending aorta in the avian embryo. Following hatching, the DA closes, separation of the systemic and pulmonary circulation. I present the morphological changes that occur in the chicken DA during prepipping, internal pipping, external pipping, and hatching. The avian DA consists of two distinct tissue types, a proximal and a distal portion. Histological examination shows developmental differences between the proximal and distal portions of the DA with regard to lumen occlusion, endothelial cells, smooth muscle and elastin. Endothelial cell proliferation begins to occur as early as external pipping, with the lumen almost completely occluded by the 3rd day of post-hatching life. Expression of vascular endothelial growth factor (VEGF) increases in avian endothelial cells during hatching. I provide a morphological timeline of changes in the DA as the chicken develops from embryo to hatchling.

Developing chicken embryos have two ductus arteriosus (DA) that shunt blood away from the lungs and to the chorioallantoic membrane, the embryonic gas exchanger. In mammals, DA closure is stimulated by an increase in blood gas O2 that occurs as the animal begins to breathe with its lungs. The goal of this study was to determine the influence of O2 levels during incubation on the vascular reactivity and morphology of the O2-sensitive DA and to examine the effects of changing O2 levels during late incubation on the morphology of the DA from chicken embryos. In comparison to normoxia, hypoxia (15%) reduced venous O2 levels in day 16 and day 18 embryos and reduced aircell O2 values in day 16, day 18, and internally pipped (IP) embryos, whereas hyperoxia (30%) increased venous O2 levels and aircell O2 level in day 16, day 18, and IP embryos. In comparison to normoxia, hypoxia delayed closure of the DA, whereas hyperoxia accelerated DA closure. In comparison to the left DA from externally pipped (EP) normoxic embryos, the left DA from EP hypoxic embryos exhibited a significantly weaker contractile response to O2. The DA from day 18 hypoxic embryos exhibited a significantly weaker contractile response to norepinephrine and phenylephrine when compared with the DA from day 18 normoxic and hyperoxic embryos. The effect of incubation in hypoxia / hyperoxia during different developmental windows on the DA O2-induced contractile response was observed only in IP embryos that were incubated in normoxia for 16 days and were then moved to hyperoxia. Incubation in hypoxia / hyperoxia resulted in differences in embryo mass, yolk mass, and heart mass. There is an association between the decreased contractile response to O2 and delayed closure in the proximal portion of the DA from hypoxic embryos; as well as an increased contractile response to O2 and accelerated closure in the proximal portion of the DA from hyperoxic embryos.

No description available.

OBJECTIVES: The objective of this thesis is to explore the effectiveness and safety of common pharmacotherapeutic options used for the management of patent ductus arteriosus (PDA) in preterm infants. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance, article 1 develops the protocol to conduct the systematic review and network meta-analysis to answer the research question. Article 2 details the actual methods implemented to conduct the network meta-analysis and presents the results in the form of network plots, league tables, rank heat maps, rankograms and forest plots. RESULTS: Article 1 suggests the need to conduct a Bayesian random-effects network meta-analysis of randomized controlled trials (RCTs) as the analysis would involve multiple treatments with potentially both direct and indirect comparisons. Article 1 also a priori defines potential effect modifiers and statistical strategies to control for the same. In article 2, the results of the meta-analysis show that in 68 RCTs that included 4802 infants, 14 different variations of indomethacin, ibuprofen or acetaminophen were used. Oral high-dose ibuprofen was associated with a significantly higher odds of PDA closure compared with standard-dose intravenous ibuprofen (Odds Ratio [OR], 3.59; 95% Credible Interval [CrI],1.64-8.17) and intravenous indomethacin (OR, 2.35; 95% CrI,1.08-5.31). Oral high-dose ibuprofen ranked the best option for PDA closure (SUCRA [surface under the cumulative ranking curve],0.89 [SD, 0.12]) and to prevent surgical PDA ligation (SUCRA,0.98 [SD, 0.08]). There was no significant difference in the odds of mortality, necrotizing enterocolitis or intra-ventricular hemorrhage with use of placebo or no treatment compared with any of the other treatment modalities. CONCLUSION: This thesis suggests that oral high-dose ibuprofen could be the best treatment option for closure of a hemodynamically significant PDA. Placebo or no treatment for a hemodynamically significant PDA may not increase morbidity and mortality. / Thesis / Master of Science (MSc) / The following thesis explores the effectiveness and safety of commonly used drugs for the treatment of a heart condition in premature infants called the patent ductus arteriosus (PDA). Article 1 outlines the protocol for the systematic review and network meta-analysis designed to evaluate the effectiveness and safety of indomethacin, ibuprofen and acetaminophen for the treatment of PDA in preterm infants. Article 2 provides in detail the results of the network meta-analysis that examined all eligible randomized controlled trials that compared intravenous or oral formulations of indomethacin, ibuprofen or acetaminophen compared against to other or placebo for the treatment of a PDA that may be harmful for a premature infant based on certain clinical and echocardiographic criteria set by the clinicians and researchers. Overall, this body of work suggests that a higher dose of oral ibuprofen is the best treatment for PDA in premature infants.

Nossa pesquisa de mestrado tem por objeto a Arte Retórica de Consulto Fortunaciano, manual de retórica latino composto por volta do século IV d. C.. A pesquisa divide-se em três partes: a primeira compreende um estudo sobre a autoria, datação e partição da obra; a segunda, um estudo sobre a doutrina exposta nesta e, em particular, sobre quatro pontos que chamam a atenção da crítica especializada por serem, de algum modo, particulares da obra, a saber, a doutrina das conduções da causa (ductus), a sistematização dos estados de causa (status), a divisão dos caracteres da elocução (characteres elocutionis), a divisão das figuras (figurae); a terceira parte compreende a tradução anotada da obra. / Our Master research focuses on the Art of rhetoric by Consultus Fortunatianus, a Latin handbook on rhetoric composed about the fourth century A. D.. The research is divided into three parts: the first comprises a study of the authorship, dating and partition of the work; the second part carries out a study of the doctrine set forth in the work and in particular of four points which attract the attention of specialized critics for being somehow particular to the work, namely the doctrine of the way to approach a case (ductus), the systematization of the issues (status), the 7 classification of the kinds of style (characteres elocutionis), the classification of the figures (figurae); the third part includes the annotated Portuguese translation of the work.

Nossa pesquisa de mestrado tem por objeto a Arte Retórica de Consulto Fortunaciano, manual de retórica latino composto por volta do século IV d. C.. A pesquisa divide-se em três partes: a primeira compreende um estudo sobre a autoria, datação e partição da obra; a segunda, um estudo sobre a doutrina exposta nesta e, em particular, sobre quatro pontos que chamam a atenção da crítica especializada por serem, de algum modo, particulares da obra, a saber, a doutrina das conduções da causa (ductus), a sistematização dos estados de causa (status), a divisão dos caracteres da elocução (characteres elocutionis), a divisão das figuras (figurae); a terceira parte compreende a tradução anotada da obra. / Our Master research focuses on the Art of rhetoric by Consultus Fortunatianus, a Latin handbook on rhetoric composed about the fourth century A. D.. The research is divided into three parts: the first comprises a study of the authorship, dating and partition of the work; the second part carries out a study of the doctrine set forth in the work and in particular of four points which attract the attention of specialized critics for being somehow particular to the work, namely the doctrine of the way to approach a case (ductus), the systematization of the issues (status), the 7 classification of the kinds of style (characteres elocutionis), the classification of the figures (figurae); the third part includes the annotated Portuguese translation of the work.

The chicken ductus arteriosi (DA) are two embryonic blood vessels that shunt blood away from the non-ventilated lungs and towards the body and chorioallantoic membrane. I show that prostaglandins have a diminished role in maintaining chicken DA patency and nitric oxide inhibits oxygen induced contraction of the day 19 proximal DA in a time dependent manner. The pathways governing oxygen induced contraction in the chicken DA are similar to those found in mammals and include contributions from ROS, Kv channels, L-type Ca2+ channels, and the Rho kinase pathway. Longer exposure to high oxygen generates increased oxygen induced constriction of the day 19 DA that may be mediated through the Rho kinase pathway.

Conceituação do objeto pesquisado: a definição de fontes digitais de simulação caligráfica, origem e evolução tecnológica. A identificação das categorias de compreensão da forma caligráfica: as características visuais associadas ao universo instrumental da caligrafia; ao processo de construção da escrita; à perícia ferramental e à caligrafia como ocorrência espaço-temporal. O processo de construção das fontes digitais de simulação caligráfica. As etapas de construção das fontes de simulação baseadas em referências concretas: análise do original, digitalização, vetorização, métrica e fechamento do arquivo. As estratégias de construção das fontes baseadas em referências conceituais. Articulação de características estruturais e expressivas associadas ao instrumental caligráfico. A sugestão do ductus caligráfico em fontes digitais de simulação: construção contínua e interrompida. As estratégias associadas à representação visual da habilidade ferramental: ornamentação, integração e imperícia. O conceito de variância aplicado à tipografia digital: variância manual, aleatória e planejada. Apresentação dos projetos Zapfino, Bickham e Champion Script. Comentários a respeito da relevância das fontes digitais de simulação caligráfica: conservação, interação, compartilhamento e valorização da prática caligráfica. / Conceptualization of the studys object: the definition of digital typefaces simulating calligraphy, their origin and technological evolution. Identification of categories for understading calligraphic shapes: visual characteristics associated with the instrumental universe of calligaphy; the process of writing; craft skills and calligraphy as a temporal-spatial event. The process of manufacturing digital typefaces simulating calligraphy.The steps of development of digital typefaces simulating calligraphy based on concrete references: source analysis, digitalization, translation to outlines, spacing and font generation. Strategies for designing typefaces simulating calligraphy based on conceptual references. Articulation of structural and expressive features associated with the calligraphic craft. Suggestion of calligraphic ductus in digital typefaces simulating calligraphy: continuous and interrupted construction. Strategies associated with the visual representation of instrumental skills: ornamentation, integration and lack of skills. The concept of variation applied to digital type: manual, random and planned variation. Presentation of the typefaces Zapfino, Bickham and Champion Script. Comments related to the relevance of digital typefaces simulating calligraphy: conservation, interaction, sharing and increasing appreciation for the calligraphic practice

Conceituação do objeto pesquisado: a definição de fontes digitais de simulação caligráfica, origem e evolução tecnológica. A identificação das categorias de compreensão da forma caligráfica: as características visuais associadas ao universo instrumental da caligrafia; ao processo de construção da escrita; à perícia ferramental e à caligrafia como ocorrência espaço-temporal. O processo de construção das fontes digitais de simulação caligráfica. As etapas de construção das fontes de simulação baseadas em referências concretas: análise do original, digitalização, vetorização, métrica e fechamento do arquivo. As estratégias de construção das fontes baseadas em referências conceituais. Articulação de características estruturais e expressivas associadas ao instrumental caligráfico. A sugestão do ductus caligráfico em fontes digitais de simulação: construção contínua e interrompida. As estratégias associadas à representação visual da habilidade ferramental: ornamentação, integração e imperícia. O conceito de variância aplicado à tipografia digital: variância manual, aleatória e planejada. Apresentação dos projetos Zapfino, Bickham e Champion Script. Comentários a respeito da relevância das fontes digitais de simulação caligráfica: conservação, interação, compartilhamento e valorização da prática caligráfica. / Conceptualization of the studys object: the definition of digital typefaces simulating calligraphy, their origin and technological evolution. Identification of categories for understading calligraphic shapes: visual characteristics associated with the instrumental universe of calligaphy; the process of writing; craft skills and calligraphy as a temporal-spatial event. The process of manufacturing digital typefaces simulating calligraphy.The steps of development of digital typefaces simulating calligraphy based on concrete references: source analysis, digitalization, translation to outlines, spacing and font generation. Strategies for designing typefaces simulating calligraphy based on conceptual references. Articulation of structural and expressive features associated with the calligraphic craft. Suggestion of calligraphic ductus in digital typefaces simulating calligraphy: continuous and interrupted construction. Strategies associated with the visual representation of instrumental skills: ornamentation, integration and lack of skills. The concept of variation applied to digital type: manual, random and planned variation. Presentation of the typefaces Zapfino, Bickham and Champion Script. Comments related to the relevance of digital typefaces simulating calligraphy: conservation, interaction, sharing and increasing appreciation for the calligraphic practice