Dissertation (Ph.D.)--Auburn University, 2009. / Abstract. Vita. Includes bibliographic references (p.94-115).

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Supervisor: Kenneth A. Lawson. Vita. Includes bibliographical references.

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin-Madison, 2002. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (p. 240-252).

Thesis (Ph. D.)--University of Texas at Austin, 2005. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Indiana University, 2007. / Title from screen (viewed on September 21, 2007). School of Nursing, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Tamilyn Bakas, Sharon Sims, Mary L. Fisher, Janet Welch. Includes vitae. Includes bibliographical references (leaves 228-244).

Thesis (Ph.D.)--University of Western Sydney, 2008. / A thesis submitted to the University of Western Sydney, College of Health and Science, School of Nursing in fulfilment of the requirements for the degree of Doctor of Philosophy. Includes bibliographical references.

Orientador: Maeli Dal Pai Silva / Banca: Jesus Carlos Andreo / Banca: Walter Luis Garrido Cavalcante / Resumo: A insuficiência cardíaca (IC) está associada à miopatia dos músculos esqueléticos dos membros, com perda da massa muscular, diminuição na proporção da cadeia pesada das miosinas do tipo I (MHCI), aumento na proporção da cadeia pesada das miosinas do tipo II (MHCII), decréscimo do metabolismo oxidativo e alterações nos fatores de regulação miogênica (MRFs). Na IC também ocorre aumento do estresse oxidativo na musculatura esquelética, o qual está relacionado às mudanças estruturais, morfológicas e funcionais. Nesse estudo, nós investigamos e comparamos as características morfofuncionais dos músculos Sóleo (SOL), lento e com predomínio de fibras oxidativas e Extensor Digitorum Longus (EDL), rápido e com predomínio de fibras glicolíticas em ratos com IC induzida pela monocrotalina. Foram utilizados ratos Wistar, machos (90 a 100 g), divididos em 2 grupos: controle (CT) e insuficiência cardíaca (IC), induzida pela injeção de dose única de monocrotalina (MCT, 30mg/Kg i.p.). Após 22 dias da injeção da MCT, quando os animais apresentaram sinais de IC, todos os animais foram sacrificados e pesados. Os músculos SOL e EDL foram retirados, pesados e processados para as análises morfológicas, moleculares, bioquímicas e funcionais. A expressão gênica da MyoD e miogenina foram determinadas usando qRT-PCR, as isoformas de MHC foram determinadas por eletroforese em gel de poliacrilamida, a freqüência e área de secção transversal dos tipos de fibra foram analisadas pela reação histoquímica de ATPase miofibrilar (mATPase). Foram realizados estudos bioquímicos para a determinação do hydroperóxido de lipídeo (HL), da glutationa peroxidase (GSH-Px) e da superóxido dismutase (SOD) e catalase (CAT); o estudo miográfico foi realizado para determinar a força máxima de contração, o tempo de contração e de relaxamento e a resistência à fadiga... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Heart failure (HF) is characterized by a limited exercise tolerance, skeletal muscle myopathy with atrophy, shift toward fast muscle fiber and myogenic regulatory factors (MRFs) changes. Reactive oxygen species (ROS) also contribute to target organ damage in the heart failure syndrome. In this study, we investigated and compared the morphofunctional characteristics in SOL, a slow oxidative muscle and EDL, a fast glycolytic muscle in a monocrotaline-induced heart failure. Two groups of rats were studied: control (CT) and Heart Failure (HF), induced by a single intraperitoneal injection of monocrotaline (MCT, 30mg/Kg). MyoD and myogenin expression were determined by using qRT-PCR, MHC isoforms were studied by using polyacrylamide gel electrophoresis, muscle fiber-type frequency and cross sectional area (CSA) were analyzed by myofibrillar adenosine triphosphatase (mATPase). Biochemical study were performed to determine: lipid hydroperoxide (LH), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD); myographic study was performed to analyze: amplitude, rise time, fall time and fatigue resistance in SOL and EDL muscles. All monocrotaline treated rats showed signs of HF (atrium and right ventricular hypertrophies, pleural and pericardial effusions, and congested liver). HF group showed SOL and EDL muscles atrophy, confirmed by CSA decreased in muscle fiber types (types I, IC, IIC and IIA in SOL and I, IIC, IIA, IIA/D and IIDB in EDL muscles); the frequency of IIC fiber type and the fall time of muscle contraction increased only in SOL muscle; he myogenin mRNA expression was lower only in the SOL muscle and the MyoD mRNA expression decreased only in EDL muscle. HF group also presented the concentration of lipid hydroperoxide increased, superoxide-dismutase and glutathione peroxidase activity reduced only in SOL muscle; EDL muscle showed the contractile properties, concentration... (Complete abstract click electronic access below) / Mestre

At an annual cost of over thirty billion dollars annually, the diagnosis and management of heart failure is one of the most significant public health concerns of the twenty first century, as nearly twenty percent of Americans will develop some form of heart failure in their lifetime. The incidence of newly diagnosed heart failure has remained stable over the last several years at approximately 650,000 diagnoses per year; however, due to several contributing factors the prevalence has continued to rise despite substantial advancements in interventional therapies. The three most significant contributing factors to the rising heart failure prevalence have been identified as 1) significant advancements in technology and medical intervention have dramatically improved the survival rate of those experiencing acute coronary events. This has resulted in a greater number of patients who then progress to chronic heart failure. 2) The management of those with chronic heart failure has been dramatically improved which has allowed those with the disease to live longer and 3) heart failure is in large part a disease associated with advancing age. As the population in the United States and other developed countries continue to grow, such a strong association will inevitably result in a rapidly increasing prevalence. Current clinically therapies for managing heart failure can be categorized into three major groups: pharmaceutical therapy, mechanical circulatory support, or cell-based therapy. Pharmaceutical therapies are used in the earlier stages of disease progression or to manage symptoms and comorbidities of later stage heart failure. Mechanical circulatory support is often implemented when the disease progresses to a more severe state, where volume and / or pressure overload of the ventricles is present. Many modalities of mechanical circulatory support serve as a bridge to transplant, as the only long-term treatment of advanced decompensated heart failure is cardiac transplantation. The third category of treatments for HF is cell-based or stem cell therapies. These therapies are still in their infancies but hold significant potential of cardiac regeneration and reversal of the pathologic remodeling associated with heart failure. While the management of the early stages of heart failure have improves, addressing end-stage failure remains a significant obstacle in resolving the U.S. of the heart failure epidemic. The use of ventricular assist devices (VADs) has improved the management of end-stage failure over the last few decades, but VADs serve mostly as a bridge to transplant, so eventually a donor organ and cardiac transplantation is required. As the population continues to grow, the number of patients in need of a donor heart will increase, leading to an even larger discrepancy between the number of donor organs available and those in severe need. While advancements in VAD technology have reduced potential complications and increased the duration and effectiveness of the mechanical circulatory support, a long-term permanent treatment is still very much in need. Cell-based cardiac therapy or cardiac stem cell therapy holds the greatest potential to solving this age-old problem. The ability to not only regenerate dead or damaged tissue in the heart but also reverse pathologic remodeling due to heart failure could cure millions of patients of heart failure, returning them to a healthy, fully functioning state. The last decade has shed much light on the potential of stem cell therapies, but also has illuminated significant barriers to creating a clinically acceptable treatment. While these barriers seem tall, it is crucial that much time and resources be invested into stem cell therapies for cardiac applications as they hold the greatest potential to being able to effectively treat, rather than manage, those with heart failure. In addition to regenerating dead of damaged myocardium, stem cell technology has the potential to grow an entire organ that is patient specific in its origin, and would fully alleviate having to wait for an available donor organ. The ability to grow an entire organ in the lab, which can later be transplanted, would forever change the way medicine is practiced, while saving millions if not billions of lives worldwide.

Background The number of people in Sub-Saharan Africa dying of heart failure is increasing. However, little is known about their experiences and needs. In Kenya, palliative care services are available for some people with cancer and HIV/AIDS, but these services may not be configured to meet the needs of patients dying with heart failure. Aims and objectives This study aimed to explore the experiences of patients living and dying with heart failure in Kenya. Specifically, it sought to understand how patients describe their illness experience, their experience of receiving treatment and care, and their perspectives on how their care could be improved. Methods Twenty patients admitted and diagnosed with advanced heart failure were purposively recruited from a rural district hospital. Serial in-depth interviews were conducted with patients at 0, 3 and 6 months after recruitment. Bereavement interviews were carried out with carers. All interviews were conducted and recorded in the local language of Kiswahili, transcribed into English and analysed thematically with the assistance of Nvivo software. Results Forty-four interviews were conducted. Three significant phases were identified in patients’ experience (i) coming to a diagnosis, (ii) living with heart failure and (iii) dying with heart failure. Before receiving the diagnosis of heart failure, many patients were mistakenly misdiagnosed with common serious infectious conditions such as pneumonia, tuberculosis, and malaria. Once treatment commenced and physical symptoms abated, many patients were hopeful of a full recovery, unaware that there would be a progressive deterioration in their health. Social relationships were a source of encouragement but were strained by the accumulating cost of care. Patients particularly those who were younger, felt anxious or depressed when symptoms failed to improve with treatment. Uncertainty was prevalent and underlay patients’ experiences from the time of diagnosis to the end of life. Very few patients spoke about the possibility of death believing that life and death are in the hand of God. Majority of patients had poor understanding of their illness and expressed a need for more information and better communication with health professionals. Conclusion Patients with advanced heart failure in Kenya have significant unmet physical, psychological, social, spiritual, financial, and information needs. Patients’ narratives pointed to how they could benefit from a holistic approach aimed at catering for their multidimensional wellbeing. There is need to improve patients access to information and support better communication with health professionals. Chronic disease management aimed at (i) early identification of patients (ii) improving treatment and care guidelines and (iii) promoting primary and secondary prevention to identify, treat and control common risk factors for heart failure is needed.