Dialysis patients are operated to have AV Fistula which is a joint junction of an artery and vein in the arm, operated to increase the blood flow through the dialyzer machine. AV- fistula is a type of vascular access which is a path into the body to connect/disconnect devices, but in this case, it is mainly Dialyzer. To reduce the failure rate during maturation period of AV Fistula, doctors recommend squeezing ball exercise as a necessary precaution for AV Fistula failure. Doing Squeezable interaction for about 3-4 times a day is recommended based on patient’s health condition. Hence, the proposed architecture adopts this squeezable exercise by embedding with sensor and measuring the angle at which the sensor is bent. The framework also proposes a new care coordination system having the hardware layer which has key components such as raspberry Pi, sensor which help in recording the pressure values when user presses the ball and software layer which solely focuses on data sync among the applications used by the user. It has been recorded that 53 % of patients having AV-Fistula fail because of negligence and lack of care. The maturation period is so critical and important which made us to build a gamification platform to monitor the exercise and track the activity through android application to keep users motivated and disciplined. In further chapters of the study will focus on different clinical like procedure around AV-Fistula and technical information such as different technologies used and implemented in the proposed system along with sensor circuit. This project goal is to present a way of monitoring patients and to keep track of the compliance whether the patient is active doing exercise daily. This way we are trying to present a care monitoring system for patients to help prevent AV Fistula failure. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection

No description available.

Esta pesquisa utilizou a revisão sistemática com o objetivo de identificar os principais tratamentos da fístula faringocutânea após a laringectomia total e elaborar recomendações para as intervenções de enfermagem na assistência ao paciente submetido a laringectomia total, com a complicação fístula faringocutânea. Foram previamente localizados 1007 estudos, dos quais foram selecionados 37 estudos publicados em periódicos científicos indexados no Pubmed, Biomednet, Cinahl, Cochrane Library, MEDLINE e LILACS, desses 17 (46%) abordavam o tratamento da fístula faringocutânea, após laringectomia total, 10 (27%) discutiam os fatores de risco e os outros 10 (27%) as complicações após a laringectomia total. A análise desses artigos revelou que o delineamento da pesquisa predominante nos estudos foi o retrospectivo com 88,5%, e 11,5% prospectivos. A média de tempo de acompanhamento foi de 8,8 anos e a incidência de fístula faringocutânea, após a laringectomia total variou entre 8,7% e 27,0%, envolvendo um total de 635 pacientes. Os fatores de risco estudados pelos pesquisadores foram: radioterapia pré-operatória, técnica cirúrgica, traqueostomia pré-operatória, estadiamento do tumor, febre, doenças crônicas, vômito, nível de hemoglobina e reinício da alimentação oral, formando subgrupos com um número menor de pacientes e, conseqüentemente obtiveram percentuais individuais maiores de incidência da fístula faringocutânea, quando comparados com o índice geral de fístula proveniente da amostra inicial do estudo. O tratamento conservador e cirúrgico da fístula tem por finalidade preservar e restaurar a região lesada e envolve um processo complexo, dinâmico e sistêmico. Esta complicação aumentou o período de internação e de cicatrização, com médias de 28 e de 36 dias respectivamente. O tratamento predominante é ainda o conservador que implica cuidados higiênicos intensivos e o tratamento da ferida. O planejamento da assistência de enfermagem alicerçado em conhecimentos e habilidades técnico-científicas acerca do tratamento de feridas aliadas à dimensão psicossocial resultarão em intervenções de maior qualidade.A incorporação de conhecimentos oriundos da prática baseada em evidências na prática clínica, trará maior consistência à atuação do enfermeiro no cuidado do laringectomizado total e portador de fístula faringocutânea. / This research carried out a systematic review aimed at identifying the main treatments of pharyngocutaneous fistula after total laryngectomy and at elaborating recommendations for nursing interventions in care delivered to patients submitted to total laryngectomy, including the pharyngocutaneous fistula complication. In advance, 1007 studies were found, out of which we selected 37 studies published in scientific journals indexed in Pubmed, Biomednet, Cinahl, Cochrane Library, MEDLINE and LILACS. Among these, 17 (46%) dealt with the treatment of pharyngocutaneous fistula after total laryngectomy, 10 (27%) discussed the risk factors and the other 10 (27%) were about complications after total laryngectomy. The analysis of these articles revealed that the predominant research orientation was retrospective (88.5%) and 11.5% corresponded to prospective studies. Average follow-up time was 8.8 years and the occurrence of pharyngocutaneous fistula after total laryngectomy varied from 8.7% to 27.0%, involving 635 patients in total. Analyzed risk factors were: pre-operative radiotherapy, surgical technique, pre-operative tracheostomy, tumor stage, fever, chronic disease, vomiting, hemoglobin level and restarting oral feeding. These constitute subgroups with a lower number of patients which, consequently, obtained higher individual percentage values for the occurrence of pharyngocutaneous fistula in comparison with the general fistula rate from the initial study sample. The conservative and surgical treatment of fistula aims to preserve and restore the injured region and involves a complex, dynamic and systemic process. This complication increased the internment and healing periods, with an average duration of 28 and 36 days respectively. The conservative treatment still predominates and implies intensive hygienic care and wound treatment. The planning of nursing care, based on technical-scientific knowledge and abilities related to wound treatment, in association with the psychosocial dimension, will result in higher-quality interventions. Incorporating evidence-based knowledge into clinical practice will offer greater consistency to nursing actions in caring for patients after total laryngectomy who suffer from pharyngocutaneous fistula.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tendo em vista que o comportamento motor do trato gastrointestinal parece ter intima relaÃÃo com a atividade do sistema cardiovascular, decidimos verificar se a redistribuiÃÃo do volume sanguÃneo atravÃs de fistula aorto-caval com agulhas de calibres (21, 23 ou 26G) afeta a motilidade do trato gastrintestinal em ratos acordados. Ratos machos albinos (230 a 280g) foram divididos em grupos falso-operado (FO) ou com fÃstula designados (F), alÃm disso, tiveram grupos fÃstula+sangria (FS), fÃstula+vagotomia (FV) bem como fÃstula+esplancnotomia (FE), todos estudados com 24 horas apÃs a confecÃÃo da fistula com agulha (21G). Os parÃmetros hemodinÃmicos de pressÃo arterial mÃdia (PAM), freqÃÃncia cardÃaca (FC), e pressÃo venosa central (PVC) foram monitorados continuamente e o dÃbito cardÃaco (DC) determinado por termo-diluiÃÃo. ApÃs os procedimentos cirÃrgicos os ratos FO e os (F) tiveram os parÃmetros hemodinÃmicos e o esvaziamento gÃstrico (EG) estudados nos tempos pÃs-prandial (10, 20 ou 30min.). A PA dos ratos (F) tiveram valores inferiores (p < 0,05) quando comparados aos FO (116,3  3,5 vs 101,3  3,3mmHg). Por outro lado, nos ratos (F) houve aumento (p < 0,05) nos valores da PVC (1,9  0,4 vs 5,8  0,6cmH2O) da FC (365,0  7,0 vs 417,0  7,0bpm) e do DC (119,9  9,6 vs 172  5,3ml/min) quando comparados aos ratos FO. Em relaÃÃo ao FO ocorreu uma retenÃÃo gÃstrica nos ratos (F) nos tempos pÃs-prandial 10, 20 e 30min (45,6 Â3,6 vs 57,5  2,1%; 36,4  2,7 vs 50,5  3,3 % e 33,3  2,7 vs 44,7  3,0 %, respectivamente). Os ratos do grupo (FS), apresentaram valores de (EG) inferiores aos animais (F) (36,5  3,2 vs 50,5  3,3%, p<0,05), mas similares aos FO (36,4  2,7%). Em relaÃÃo à vagotomia (FV), a mesma reverteu o retarde no (EG) induzido pela FÃstula (F) (40,4  2,3 vs 50,5  3,3%), em contrapartida, os ratos submetidos a esplancnotomia (FE) nÃo apresentaram diferenÃas com os (F) (50,5  3,3 e 50,1  1,4%). AlÃm do mais, nÃo foi encontrada participaÃÃo da secreÃÃo Ãcida no retarde do (EG) apÃs fÃstula. Portanto, a sobrecarga cardÃaca advinda de fÃstula arteriovenosa com agulhas de calibre (21, 23 ou 26G) alÃm de promover alteraÃÃes nos parÃmetros hemodinÃmicos, induz retarde no (EG) e interfere no trÃnsito intestinal de lÃquidos em ratos acordados. Tal retarde no (EG) inclusive foi abolido apÃs sangria ou vagotomia subdiafragmÃtica prÃvias, mas nÃo havendo alteraÃÃo apÃs esplancnotomia. / In view that the behaviour of gastrointestinal tract seems to have intimate relationship with the activity of the cardiovascular system, we decided to verify whether the redistribution of blood volume through fistula aorto-caval with sizes of needles (21, 23 or 26G) affect the motility of the gastrointestinal tract in rats awaked. Male albino rats (230 to 280g) were divided into groups false-operated (FO) or designated with fistula (F), moreover, had groups fistula + bleeding (FS), fistula + vagotomy (FV) and fistula + esplancnotomy (FE), all with studied 24 hours after preparation of the fistula with needle (21G). Hemodynamic parameters of mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were monitored continuously and cardiac output (CO) determined by term-dilution. After the surgical procedures the rats FO and (F) had the hemodynamic parameters and gastric emptying (GE) studied in the time post-prandial (10, 20 or 30min.). The MAP of rats (F) had lower values (p <0.05) when compared to FO (116.3  3.5 vs. 101.3  3.3 mmHg). Moreover, in rats (F) increased (p <0.05) the values of CVP when compared to rats FO (1.9  0.4 vs 5.8  0.6 cmH2O), HR (365.0  7.0 vs 417.0  7.0 bpm) and the CO (119.9  9.6 vs 172  5.3 ml / min). In relation the rats the FO was a gastric retention increased in (F) in the time post-prandial 10, 20 and 30min (45.6  3.6 vs 57.5  2.1%; 36.4  2.7 vs 50.5  3.3% and 33.3  2.7 vs 44.7  3.0%, respectively). The rats of the group (FS), showed values of (GE) lower than the animals (F) (36.5  3.2 vs 50.5  3.3%, p <0.05) but similar to FO ( 36.4  2.7%). The vagotomy (FV), it reversed the delay in the (GE) induced by fistula (F) (40.4  2.3 vs 50.5  3.3%), in contrast, the rats undergoing esplancnotomy (FE) showed no differences in comparation with the (F) (50.5  3.3 and 50.1  1.4%). Moreover, was not found involvement of acid secretion in the delays of the (GE) after fistula. Therefore, the overload heart arisen from arteriovenous fistula with needles, size (21, 23 or 26G) to promote changes in hemodynamic parameters, leads decreases the (GE) and interfere in the intestinal transit of liquids in rats awaked. This delay in the (GE) was also abolished after bleeding or prior the subdiaphragmatic vagotomy, but no change after esplancnotomy.

Introdução: A correção cirúrgica primária do palato é de fundamental importância na reabilitação do indivíduo com fissura labiopalatina e visa tanto a restauração anatômica local, com o fechamento da comunicação existente entre a cavidade nasal e oral, como a restauração funcional do anel velofaríngeo por meio do reposicionamento dos músculos palatinos. Ao longo dos anos, as técnicas de fechamento de palato foram evoluindo progressivamente utilizando, cada vez mais, o procedimento de reposicionamento da musculatura responsável pelo fechamento do esfíncter velofaríngeo, denominado veloplastia intravelar. Tal procedimento favorece o funcionamento sinérgico da musculatura velar e faríngea evitando, assim, os sintomas decorrentes da insuficiência velofaríngea. No entanto, apesar de todos os esforços no sentido de conseguir o funcionamento velofaríngeo adequado, intercorrências intra-operatórias e complicações pós-operatórias imediatas e/ou tardias podem contribuir para o insucesso da palatoplastia primária e, consequentemente, levar ao aparecimento de hipernasalidade. Objetivos: Investigar o efeito da palatoplastia primária realizada com veloplastia intravelar sobre a ressonância da fala e o índice de intercorrências intra-operatórias e complicações pós-operatórias da cirurgia e, ainda, correlacionar as intercorrências e complicações pós-operatórias com os resultados de ressonância. Material e Métodos: Foram avaliados, prospectivamente, 60 pacientes com fissura labiopalatina, de ambos os sexos, submetidos à correção primária do palato aos 13 meses de idade, em média, por um único cirurgião plástico. Todos os pacientes foram submetidos à palatoplastia primária com veloplastia intravelar, utilizando amplo descolamento muscular da mucosa nasal e mínimo descolamento da mucosa oral e reposicionamento posterior do grupo muscular. Intercorrências intra-operatórias, tais como, sangramento excessivo, lasceração da mucosa, extubação e as complicações pós-operatórias imediatas e tardias, tais como febre, tosse, choro, vômito, infecção cirúrgica, infecção não cirúrgica e trauma local foram investigadas, por meio de anotações feitas no prontuário e pelo relato dos pais. A presença e localização de fístula ou deiscência do palato foi feita por meio de avaliação clínica realizada pelo mesmo cirurgião plástico, 14,8 meses, em média, após a cirurgia. Os pacientes foram submetidos, também, à gravação em áudio de amostra de fala, as quais foram analisadas por três fonoaudiólogas, que classificaram a hipernasalidade da fala em presente ou ausente. O escore final da hipernasalidade foi obtido pelo consenso entre as três avaliadoras. As intercorrências intra-operatórias e as complicações pós-operatórias foram analisadas de forma descritiva. A associação entre as intercorrências intra-operatórias e complicações imediatas e tardias com a formação de fístulas, bem como a associação entre a ocorrência de fístulas e deiscências com a presença e ausência de hipernasalidade foram analisadas por meio de Teste Exato de Fisher. Resultados: Verificou-se 5% de intercorrências intra-operatórias (sangramento excessivo e lasceração de mucosa), 20% de complicações imediatas (tosse, febre, choro, sangramento e vômito) e 13,3% de complicações tardias (tosse, sangramento e infecção não cirúrgica). O índice de ocorrência de fístulas foi de 16,67% e de deiscências foi de 5%. A proporção de hipernasalidade foi de 18,6%. Conclusão: A palatoplastia com veloplastia intravelar utilizada no presente estudo demonstrou ser uma técnica segura, de fácil execução, eficiente para a fala e com baixos índices de complicações. / Introduction: Primary surgical palate repair is fundamental for the rehabilitation of individuals with cleft lip and palate. This procedure aims at local anatomic restoration, closing the communication between nasal and oral cavities, but also at functional restoration of the velopharynx by repositioning of the palatal muscles. Along the years, the techniques for palate repair have been progressively improved, increasingly using the procedure for repositioning of velopharyngeal sphincter muscles, called intravelar veloplasty. This procedure favors the synergic functioning of the velar and pharyngeal musculature, thus avoiding the symptoms of velopharyngeal insufficiency. However, despite all efforts to achieve an adequate velopharyngeal closure, intraoperative events and immediate and/or late postoperative complications may contribute to the failure of primary palatoplasty, consequently leading to the occurrence of hypernasality. Objectives: To investigate the effect of primary palatoplasty with intravelar veloplasty on the speech resonance, the rate of intraoperative events and postoperative complications of surgery, as well as to correlate the events and postoperative complications with resonance outcomes. Material and Methods: A total of 60 individuals with cleft lip and palate were prospectively evaluated, of both genders, underwent primary palate repair at 13 months of age in the average, by a single plastic surgeon. All individuals were submitted to primary palatoplasty with intravelar veloplasty, with wide muscular dissection of the nasal mucosa, minimum dissection of the oral mucosa and posterior muscle repositioning. Intraoperative events, such as excessive bleeding, mucosal laceration and extubation; and immediate and late postoperative complications, including fever, cough, crying, vomiting, surgical infection, non-surgical infection and local trauma were assessed from the patients records and parents reports. The presence and location of palatal fistula or dehiscence were clinically analyzed by the same plastic surgeon, at 14.8 months after surgery in the average. The individuals were also submitted to audio recording of speech samples, which were analyzed by three speech-language pathologists who scored the speech hypernasality as present or absent. The final score of hypernasality was obtained by consensus among the three examiners. The intraoperative events and postoperative complications were descriptively analyzed. The Fishers exact test was applied to investigate the association between intraoperative events, immediate and late complications and the occurrence of fistulas, as well as between the occurrence of fistulas and dehiscences and the presence or absence of hypernasality. Results: The findings revealed 5% of intraoperative events (excessive bleeding and mucosal laceration), 20% of immediate complications (cough, fever, crying, bleeding and vomiting) and 13.3% of late complications (cough, bleeding and non-surgical infection). The occurrence of fistulas was 16.67%, and dehiscences were observed in 5%. The proportion of hypernasality was 18.6%. Conclusion: Palatoplasty with intravelar veloplasty used in the present study presented to be a safe technique, with easy accomplishment, effective for speech and with low rates of complications.

Vascular access (VA) is one of the most important determinants of outcomes in haemodialysis (HD). Poor VA outcomes have a significant adverse impact on patient experience, morbidity and mortality and also result in significant burden on the health economy. An arteriovenous fistula (AVF) is accepted as the best HD vascular access. However AVF prevalence is variable and AVFs are associated with a high early failure rate. A small but significant number of AVFs experience late failure further down the line. The purpose of this project, broadly, was to understand VA outcomes, focusing specifically on AVFs. This project involved a series of clinical studies that were specifically designed by the student researcher to investigate various time points in the life cycle of AVFs – from creation and maturation - to its use and subsequent failure. The MANVAS, OPEN and Coil embolisation studies focus on the early phase of AVF development and maturation, whilst, the VA in Home HD study investigates the impact of intensive self-use in a non-healthcare setting. It is followed by the prospective thrombosed vascular access study focusing on the late phase of VA failure. The MANVAS study, a prospective cohort study, was set up with an aim to follow up patients undergoing AVF formation with a view to defining the natural history and maturation process of AVFs, and determine factors which affect outcomes – demographic, clinical, and biological. The OPEN study was designed to investigate poor maturation due to anastomotic failure by the intervention of the OptiflowTM device. The results suggest high maturation rates that were significantly better than those reported in the literature. The coil embolisation study demonstrated that the intervention of coil embolisation is a safe and effective treatment option for failing AVFs with accessory draining veins. The Vascular Access in Home Haemodialysis (HHD) study demonstrated that VA outcomes are significantly better in HHD patients and unadjusted patient survival in the HHD cohort was associated with incident VA. The thrombosed access study is a prospective longitudinal study designed to assess the effectiveness of endovascular access salvage and investigation of factors that impact longer-term access survival. One of the major aims of the study was to analyse outcomes related to prompt restoration of flow for patients presenting with acute failure of fistulae and grafts. The study showed that timely endovascular salvage is highly effective in restoring immediate patency but long-term outcomes remain poor. It also confirms poor outcomes of grafts as compared to AVFs and demonstrates that progression to thrombosis in AVFs portends poorer prognosis. The endovascular technique of balloon maceration, compared to outcomes reported in the literature, appears to be equally safe and effective with no increased risk of clinically significant pulmonary embolism. The clinical studies in this thesis provide a unique insight into the different aspects of the lifecycle of an AVF, and pave the way for an improvement in our fundamental understanding of the natural history and biology of AVFs.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22304号 / 医博第4545号 / 新制||医||1040(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川口 義弥, 教授 坂井 義治, 教授 羽賀 博典 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Fine-leaved Festuca valesiaca possesses abiotic stress tolerances. However, their agronomic performances in the western United States and its genetic relationship to species of the Festuca ovina complex have not been investigated. Also, natural hybridization due to open pollination presents difficulties in distinguishing them for closely related taxa using morphological analysis. Given the species’ agronomic potentials, a project was designed to identify Festuca valesiaca accessions possessing high biomass production and seed yield for possible low-maintenance applications and to examine their relatedness to taxa of the Festuca ovina complex by multi-locus AFLP genotyping and chloroplast DNA sequence analysis using primer combinations designed from three intergenic spacers. Plant vigor, height and width, total biomass, and seed weight and seed number of Festuca valesiaca accessions were evaluated from 2009 to 2011 at Blue Creek, Utah in a random complete block design with six replications. The Festuca valesiaca accessions examined produced abundance of small seeds. Seed production was significantly (P = 0.001) correlated (r2 = 0.84) with the total biomass, plant height, and plant vigor rating. The Festuca valesiaca accessions examined possessed lower height than the control ‘Cascade’ but higher biomass, spring green-up, and seed production. Given their morphological attributes, Festuca valesiaca accessions PI 659923, W6 30575, and W6 30588 should be considered for low-maintenance applications and use in plant improvement. The AFLP-based neighbor-joining analysis indicated that Festuca valesiaca is a closely related subcluster of Festuca ovina and should be considered as one species. Festuca trachyphylla is a subcluster under Festuca ovina and Festuca valesiaca. Festuca idahoensis has a close relationship with Festuca roemeri but not with Festuca ovina. Low admixture was detected between the Festuca rubra and Festuca trachyphylla accessions examined, while a comparative high admixture was detected among the commercial cultivars examined. Chloroplast sequences data reconfirmed that the Festuca ovina complex genetically differed from Festuca rubra and the other reference taxa examined. Festuca valesiaca and Festuca ovina possessed the same maternal lineage based on chloroplast DNA sequence analysis. One Festuca valesiaca accession, W6 30537, was genetically similar to the Festuca rubra examined and should be putatively reclassified as Festuca rubra pending further taxonomic analysis.

No description available.

Gastroduodenal fistula (GDF) or double pylorus is a rare, often asymptomatic condition with a prevalence of approximately 0.02-0.08%. The reported cases have been mainly in Asian countries and more prevalent in males than females. Although the etiology is unclear, and nonsteroidal anti-inflammatory drug use have been associated with the formation of GDF. We present the case of a 65-year-old female with alcoholic cirrhosis and recurrent vomiting who was found to have an antral ulcer. The case includes the serial endoscopic examinations over the period of 7 years and shows the antral ulcer which fistulized into the duodenal bulb creating double pylorus.