Aus vielen experimentellen und klinischen Studien geht hervor, dass ein Kapnoperitoneum zu charakteristischen Kreislaufveränderungen führt. Danach kommt es durch die Insufflation eines Gases in die Peritonealhöhle zu einer Erhöhung des intraperitonealen Druckes und zu einer Zunahme sowohl des peripheren venösen Druckes als auch des intrathorakalen Druckes. Insgesamt nimmt der Druckgradient zwischen diesen beiden Drücken ab. Als Folge wird der venöse Rückstrom zum Herzen reduziert, wodurch wiederum das Blutangebot für das Herz, welches die kardiale Vorlast wesentlich bestimmt, vermindert wird. Konsekutiv führt das letztlich zu einer Abnahme des Herzschlag- und des Herzminutenvolumens. Das verminderte Herzschlagvolumen wird von den arteriellen Barorezeptoren registriert, wodurch eine Stimulation des Sympathikus ausgelöst wird. Als Kompensationsmechanismus steigen die Herzfrequenz, in vielen Studien der mittlere arterielle Druck und der systemische Gefäßwiderstand. Als hormonelle Regulation wird Vasopressin ausgeschüttet. Der Anstieg dieser Drücke bedeutet eine Zunahme der kardialen Nachlast, was die kardiale Belastung weiter erhöht. Am gesunden Herzen wird die myokardiale Kontraktilität durch das Kapnoperitoneum nicht beeinflusst. An einem komplexen Tiermodell an 43 Läuferschweinen sollte überprüft werden, ob eine gezielte Erhöhung der kardialen Vorlast durch kolloidale Volumenersatzmittel, eine partielle Blockade der sympathikotonen Reaktionen durch den selektiven ß-Blocker Esmolol oder eine gezielte Senkung der kardialen Nachlast durch den Vasodilatator Nitroprussidnatrium geeignet sind, die negativen Auswirkungen des Kapnoperitoneums zu vermindern und die Herz-Kreislauffunktion bei laparoskopischen Operationen zu verbessern. Weil bekannt ist, dass die Körperposition eine wichtige Rolle bei der Ausprägung der physiologischen Veränderungen spielt, sollten die Tiere in Gruppen entweder in Horizontal-, Kopfhoch- oder Kopftieflage untersucht werden. Das ist von besonderer Bedeutung, weil viele laparoskopische Operationen zur Optimierung der Übersicht im Operationsgebiet eine Modifikation der Körperposition erfordern. Oberbaucheingriffe wie die Cholecystektomie werden vornehmlich in Kopfhochlage durchgeführt, während gynäkologische Laparoskopien in Kopftieflage stattfinden. Zur Vermeidung einer Hypovolämie erhielten die Tiere vor Beginn der Messungen 1l kristalloide Infusion. Die Untersuchungen ergaben, dass unter diesen Bedingungen ein Kapnoperitoneum von 14 mm Hg in Horizontallage ohne wesentliche Veränderungen der Herz- Kreislaufparameter toleriert wurde. Lediglich in Kopftief- und in Kopfhochlage war mit dem Intrathorakalen Blutvolumen ein wesentlicher Parameter der kardialen Vorlast vermindert und die Herzauswurfleistung mit dem Herzschlag- und Herzminutenvolumen reduziert, während die kardiale Nachlast mit dem peripheren systemischen Gefäßwiederstand erhöht war und die myokardiale Kontraktilität unverändert blieb. Damit kommt dem intrathorakalen Blutvolumen eine entscheidende Bedeutung zu. Eine Erhöhung des intrathorakalen Blutvolumens und damit der kardialen Vorlast verbesserte die Herzkreislauffunktion während des Kapnoperitoneums in allen Körperpositionen deutlich. Das äußerte sich in einer Steigerung des mittleren arteriellen Druckes, der im Normbereich blieb, einer Abnahme des systemischen Gefäßwiderstandes und einem Anstieg der Herzauswurfleistung. Die Esmolomedikation beeinträchtigte die Herzkreislauffunktion während des Kapnoperitoneums, indem sie die myokardiale Kontraktilität verschlechterte und die Herzfrequenz senkte mit der Folge, dass das Herzminutenvolumen abnahm. Die Senkung des mittleren arteriellen Druckes durch Nitroprussidnatrium verschlechterte ebenfalls in einigen Körperpositionen die myokardiale Kontraktilität und das Herzschlag- sowie das Herzminutenvolumen. Die beiden letztgenannten Konzepte können somit nicht generell zur Therapie hämodynamischer Effekte eines Kapnoperitoneums empfohlen werden. Entscheidende Bedeutung kommt einer Optimierung des intravasalen Volumens zu. Die Pfortader- und Nierendurchblutung wurden in diesem Modell durch das Kapnoperitoneum in keiner Körperposition relevant beeinträchtigt. Auch in der Literatur findet sich kein Hinweis auf eine durch ein Kapnoperitoneum induzierte dauerhafte Funktionsstörung von Leber oder Niere. / A capnoperitoneum increases peripheral venous resistance as well as intrathoracic pressure thus compromising venous blood return to the heart which is determinded by the pressure gradient between peripheral and central venous pressure. With a decreased cardiac preload cardiac stroke volume and cardiac output are reduced. The reduction in stroke volume induces changes in the carotidal sinus activity followed by an increased sympathetic nerve activity. These effects were often expressed by an increased heart rate, mean arterial pressure, or peripheral systemic resistance. As a hormonal reaction to theses changes vasopressin release increases further elevating cardiac afterload. Changes of cardiac contractility were not described during capnoperitoneum. In a procine trial using 43 piglets the questions should be answered if an increase of cardiac preload by infusion of colloidal fluids, a partial blockade of sympathetic receptors by esmolol, or a reduction of the cardiac afterload by infusion of the vasodilatator nitroprussidnatrium can minimize hemodynamic changes during capnoperitoneum. Because the body position is known to influence hemodynamic parameters and has to be varied during laparoscopic procedures pigs were divided into three groups representing head-up, head-down, and supine position. To avoid hypovolemia before the measurements the animals received 1L cristal solutions intravenously before the beginning of the experiment. In supine position the animals tolerated a capnoperitoneum of 14 mm Hg without changes of hemodynamic parameters. In head-up as well as in head-down position the intrathoracic blood volume decraesed followed by a reduction of stroke volume and cardiac output and an increase of peripheral systemic resistance. Cardiac contractility remained unchanged during all positions. The increase of intrathoracic blood volume by colloidal infusion improved hemodynamic parameters during all body positions. Mean arterial pressure increasesd to normal ranges while the peripheral systemic resistance decreased and the cardiac output increased. The medication of esmolol had negative effects on hemodynamic function during capnoperitoneum because heart rate and myocardial contractility as well as cardiac output decreased. Medication of Nitroprussidnatrium during capnoperitoneum was also shown to partly compromise myocardial contractility and stroke volume as well as cardiac output so that both therapeutical concepts, medication of esmolol and nitroprussidnatrium failed to improve hemodynamic function during capnoperitoneum. Optimizing intravascular volume and cardiac preload is of major importance to avoid hemodynamic side effects of capnoperitoneum. The perfusion of the portal vein as well as the renal artery were not influenced in none position during a capnoperitoneum of 14 mm Hg in this trial. However, the review of the literature did not indicate any prolonged influences on hepatic or renal function induced by capnoperitoneum of pressures around 14 mm Hg.

Introdução: Os anestésicos inalatórios empregados atualmente na prática clinica (isoflurano, sevoflurano e desflurano) possuem propriedades farmacocinéticas que favorecem rápida recuperação da anestesia, porém seu uso pode causar instabilidade hemodinâmica dose-dependente, relacionado à depressão direta da contratilidade miocárdica ou à hipovolemia relativa, derivado de um sequestro de sangue devido à vasodilatação do leito vascular periférico. Este estudo visa avaliar o comportamento da VPP durante a anestesia inalatória. Para tanto se utilizou três diferentes agentes inalatórios (isoflurano, sevoflurano e desflurano) em diferentes concentrações inaladas. Métodos: Foram utilizados 25 suínos divididos aleatoriamente em três grupos. Os animais foram submetidos à anestesia com o anestésico do respectivo grupo. Imediatamente após a determinação da CAM individual do agente inalatório em cada animal, ocorreu a primeira coleta de dados. O animal foi, então, exposto a diferentes níveis de CAM (1,0 CAM; 1,25 CAM) seguido por uma exposição decrescente de CAM (1,0 CAM); provocou-se então uma hemorragia correspondente a 30% da volemia e exposição a dois níveis de CAM (1,0 e 1,25), com 20 minutos em cada exposição. Ao final de cada período os valores ecocardiográficos e do VPP foram mensurados. A análise estatística foi realizada através de provas paramétricas empregando-se o método de comparações múltiplas para análise de variância com medidas repetidas (ANOVA). O grau de significância foi de 5% (p < 0,05). Resultados: Há aumento na variação de pressão de pulso com incremento de 25% na CAM dos anestésicos inalatórios (de 8±1 para 11±3% no grupo DESF, de 7±2 para 9±2 no grupo SEVO e de 9±4 para 10±3% no grupo ISO) sem diferença estatística entre os anestésicos. Apesar deste aumento na CAM e significativa hipotensão e queda no débito cardíaco, o aumento na VPP não torna o paciente responsivo a infusão de fluidos (o VPP permaneceu abaixo de 13%). Há pequena queda na PAM quando se eleva a CAM dos anestésicos em 25%, porém só há queda estatisticamente significativa no grupo DESF (de 84±7 para 68±12 mmHg). Não foram observadas alterações importantes em relação à contratilidade miocárdica. Conclusão: Observou-se que a VPP não é influenciada como o uso dos diferentes anestésicos inalatórios e apesar dos efeitos cardiovasculares esperados destes agentes, mantem-se a capacidade de demonstrar alterações de pré-carga mesmo em concentrações correspondentes a 1,25 CAM / Background: Inhalant anesthetics, such as isoflurane, sevoflurane and desflurane are widely used in daily clinical practice due to its pharmacological properties allowing a rapid recovery from anesthesia. Nevertheless, its use can lead to dose-dependent hemodynamic instability related to direct depression in myocardial contractility or to a relative hypovolemia caused by vasodilation of peripheral capillary bed. This study aims to evaluate the behavior of PPV during inhalant anesthesia. For this, three different anesthetics were used (isoflurane, sevoflurane and desflurane) with different inhaled concentrations. Methods: 25 young pigs were randomly assigned into three groups. Animals were anesthetized with its correspondent agent according to its group. After individual determination of minimal alveolar concentration (MAC), first data collection occurred. Pigs were then exposed to different MAC (1MAC and 1,25 MAC) followed by a decrease in MAC (1 MAC). At this point a 30% of estimated volemia hemorrhage was caused and pigs were exposed to a period of 1 MAC and after that 1,25 MAC. Each period lasted 20 minutes. At the end of each period, hemodynamic parameters and echocardiography were collected. Data were submitted to analysis of variance for repeated measures (ANOVA). P<0,05 was considered statistically significant. Results: There was an increase in PPV when with 1,25 MAC of all anesthetics. (from 8±1 to 11±3% in group DESF, from 7±2 to 9±2 in group SEVO and from 9±4 to 10±3% in group ISO), but without statistical difference among groups. Although there was an increase in PPV, followed by hypotension and drop in cardiac index, patients werent fluid responsive with a 25% increase in MAC, since PPV was lower than 13%. The decrease in blood pressure followed by 1,25MAC was only significant in DESF group (from 84±7 to 68±12 mmHg). No important alterations related to myocardial contractility were observed. Conclusion: PPV is not influenced by the use of different inhalant anesthetics and although there are cardiovascular effects of these agents which are expected, and were able to demonstrate alterations in preload even in concentration of 1,25 MAC

O treinamento de caminhada (TC) é recomendado para o tratamento de indivíduos com claudicação intermitente (CI) porque melhora a capacidade de caminhada. Além disso, seria interessante que o TC também promovesse modificações benéficas no sistema cardiovascular, pois os eventos cardiovasculares são a principal causa de morte nestes indivíduos. No entanto, os efeitos cardiovasculares do TC em indivíduos com CI foi pouco estudado. Assim, o objetivo deste estudo foi verificar o efeito do TC sobre o risco, a função e a regulação cardiovasculares em indivíduos com CI. Quarenta e dois indivíduos com CI foram divididos de forma aleatória em 2 grupos: controle (GC, n=20, sessões de 30 min de alongamento) e treinamento de caminhada (GT, n=22, 15 séries de 2 min de caminhada em intensidade correspondente à frequência cardíaca (FC) do limiar de dor intercalados por 2 min de repouso passivo). Nos dois grupos, a intervenção foi realizada 2 vezes/semana durante 12 semanas consecutivas. No início e ao final do estudo, os indivíduos realizaram as seguintes avaliações: glicemia e perfil lipídico de jejum; índice de massa corporal; capacidade de caminhada; consumo de oxigênio no 1º estágio e no pico do teste de esforço; índice tornozelo-braço (ITB) de repouso; janela isquêmica após teste ergoespirométrico; pressão arterial (PA) em repouso (auscultatória) e de 24 horas (oscilométrica); débito cardíaco (DC - reinalação de CO2); FC (ECG); volume sistólico (VS); resistência vascular (RV) sistêmica, do antebraço e da perna (plestismografia); componentes de alta (AF) e baixa (BF) frequência da variabilidade da FC; e sensibilidade barorreflexa espontânea (SBR). Mudanças significantes (P<0,05) ao longo do tempo e entre os grupos foram verificadas pela análise de variância ANOVA de dois fatores para medidas repetidas. O TC aumentou significantemente a capacidade de caminhada (&Delta;=+302±85m) e a SBR (&Delta;=+2.13±1.07 ms/mmHg), e diminuiu o VO2) no 1º estágio do teste (&Delta;=-1,8±0,4ml.kg-1.min-1), a janela isquêmica (&Delta;=- 0,40±0,38mmHg.min.m-1), a PA média (&Delta;=-5±2mmHg), a variabilidade da PA média de 24h (&Delta;=-0,8±0,2mmHg), o DC (&Delta;=-0.37±0.24L/min), a FC (&Delta;=- 4±2bpm), a RV do antebraço (&Delta;=-8.5±2.8 U) e a razão BF/AF (&Delta;=-1.24±0.99). A glicemia, o perfil lipídico, o índice de massa corporal, o VO2) pico, o ITB de repouso e a RV sistêmica e da perna não foram modificadas pelo TC. Não houve mudança em nenhuma variável no GC. Em conclusão, o TC melhorou a capacidade de caminhada, a economia de caminhada e a janela isquêmica. Além disso, o TC melhorou a função (PA, DC, FC e RV antebraço) e a regulação (BF/AF e SBR) cardiovasculares em indivíduos com CI. Estas alterações fornecem suporte adicional para a utilização do TC no tratamento de indivíduos com CI / Walking training (WT) is recommended for the treatment of patients with intermittent claudication (IC) because it improves walking capacity. Moreover, it would be interesting that WT also promotes beneficial changes on cardiovascular system, since cardiovascular events are the main causes of death in these patients. Nevertheless, the effects of WT on cardiovascular system in patients with IC have been poorly studied. Thus, the objective of this study was to investigate the effects of WT on cardiovascular risk, function and regulation in patients with IC. Forty-two IC patients were randomly divided into 2 groups: Control (CG, n=20, 30 min of stretching exercises) and walking training (TG, n=22, 15 sets of 2:2-min walk:rest at the heart rate (HR) of pain threshold). In both groups, the intervention was performed twice/week for 12 consecutive weeks. At the beginning and end of the study, the following measured were done: fasting glycemia and lipid profile; body mass index; walking capacity; VO2 at the first stage and the peak of a treadmill test; ankle brachial index (ABI); ischemic window after maximal test; resting (auscultatory) and 24-hour (oscillometric) blood pressure (BP); cardiac output (CO - CO2 rebreathing); heart rate (HR - ECG); stroke volume (SV); systemic, forearm and leg vascular resistance (VR - plethysmography); low- (LF) and high-frequency (HF) components of HR variability; and spontaneous baroreflex sensitivity (SBS). Significant changes (P<0.05) over time and between groups were assessed by 2-way ANOVA for repeated measures. WT significantly increased walking capacity (&Delta;=+302±85m) and SBS (&Delta;=+2.13±1.07 ms/mmHg), and decreased VO2 at the first stage of treadmill test (&Delta;=-1.8±0.4ml.kg-1.min-1), ischemic window (&Delta;=-0.40±0.38mmHg.min.m-1), mean BP (&Delta;=-5±2mmHg), ambulatory mean BP variability (&Delta;=-0,8±0,2 mmHg), CO (&Delta;=-0.37±0.24 L/min), HR (&Delta;=- 4±2bpm), forearm VR (&Delta;=-8.5±2.8 U) and LF/HF (&Delta;=-1.24±0.99). Glycemia, lipid profile, body mass index, VO2 peak, ABI, systemic and leg VR were unchanged following WT. There was no significant change for any variable in CG. In conclusion, WT enhanced walking capacity, walking economy and ischemic window. In addition, WT improved cardiovascular function (BP, CO, HR and forearm VR) and autonomic regulation (LF/HF, SBS) in patients with IC. These changes provide further support for the use of regular WT in treating patients with IC

O presente estudo tem por objetivo analisar Colocações Lexicais Especializadas (CLEs) da Hemodinâmica que apresentam bases nominais, por meio da Teoria Sentido-Texto. CLEs são colocações (agrupamentos lexicais) típicas de linguagem especializada que contém em sua constituição uma unidade terminológica, que pode ou não ser a base, além de elementos chamados de colocados, que são especificadores ou caracterizadores da base. Colocados são sempre selecionados em função da base. Além disso, outra forte característica das CLEs é o seu caráter semicomposicional ou fortemente composicional. Assim, para realizar tal objetivo, metodologicamente, escolhemos selecionar 37 CLEs a partir de termos típicos do Vocabulário Panlatino de Hemodinâmica da Realiter. A fim de constatar que os termos escolhidos participavam de colocações ativas na área, recorremos a artigos científicos (pesquisados na plataforma SciELO). Os artigos serviram de fonte para extrairmos as provas textuais das CLEs analisadas e para a formulação das definições dessas CLEs A análise dos dados permitiu que identificássemos as seguintes características das CLEs da Hemodinâmica: (i) quanto à extensão dos elementos (CLEs têm de 2 a 5 elementos); (ii) sobre a característica dos termos que exerciam papel de base nas CLEs examinadas (constituíram núcleos cem por cento nominais); (iii) sobre as características do complemento da base (complementos adjetivais, a maioria, e preposicionais); (iv) quanto aos tipos de Funções Lexicais (FLs) (adjetivais aplicadas a bases com complemento adjetival, preposicionais aplicadas a bases com complemento preposicional); (v) quanto à complexidade da FL (uso apenas de FL simples); e, por fim, (vi) sobre a necessidade de acréscimo de informação à FLs standards (em todos os casos houve acréscimo de informações para completar o sentido da definição, isto é, lançamos mão de FLs não-standards). / This study aims to analyze Specialized Lexical Combinations (SLCs) of Hemodynamic, with nominal base, through Meaning-Text Theory. SLCs are typical collocations (lexical groups) of specialized language that contain in their constitution a terminological unit, which may or may not be a base, in addition to elements called collocatives which are specifiers or characterizers of the base. Collocatives are always selected as a function of the base. In addition, another strong feature of SLCs is your semicomposicional or strongly compositional character. Thus, to achieve this goal, methodologically, we selected the 37 SLCs from typical terms present in the ‘Vocabulário Planlatino de Hemodinâmica’ of Realiter. In order to verify that the chosen terms participate in active placements in the area, we resorted to scientific articles from SciELO platform. The articles served as a source for extracting textual evidence for SLCs and formulating the definitions of SLCs. The analysis of the admissible data identifies the following characteristics of Hemodynamic SLCs: (i) the extension of the elements; (ii) the feature of terms that play the hole of base in the SLCs examined; (iii) the characteristics of the base complement; (iv) the types of Lexical Functions applied in the SLCs; (v) the complexity of LFs applied; and finally (vi) the necessity to increase information in the LFs standard (in all cases, there was added information to complete the meaning of the definition, we applied non-standard LFs).

Made available in DSpace on 2014-06-11T19:31:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-06-19Bitstream added on 2014-06-13T20:21:49Z : No. of bitstreams: 1 basile_lg_dr_arafcf.pdf: 670937 bytes, checksum: 31ebc03d1e00fdb390d2c7cfc07fe252 (MD5) / Universidade Estadual Paulista (UNESP) / Este estudo teve como objetivo verificar o efeito do consumo diário de suco de laranja pasteurizado sobre o estado nutricional, perfil lipídico, glicêmico e hemodinânico de 21 mulheres e 20 homens funcionários de uma universidade privada no município de São José do Rio Preto (SP). As mulheres receberam 500 mL de suco de laranja pasteurizado por dia e os homens 750 mL durante 8 semanas. Os métodos utilizados para a avaliação antropométrica foram: peso, altura, dobra cutânea tricipital, circunferência do braço e circunferência da cintura. Para a avaliação bioquímica foram realizadas dosagens de colesterol total, colesterol de HDL, triglicérides e glicemia. Para a avaliação hemodinâmica foram verificadas a pressão arterial sistólica e a diastólica. E para a avaliação dietética foi utilizado o recordatório alimentar de 24 horas e o questionário de freqüência alimentar. Todas as avaliações foram realizadas antes e após o período experimental. Os resultados mostraram que o colesterol total reduziu em 8,6% entre os homens e 4,8% entre as mulheres e o colesterol de LDL em 8,8% entre os homens e 9,5% entre as mulheres após a ingestão do suco de laranja pasteurizado. O colesterol de HDL aumentou em 4,1% entre as participantes do sexo feminino; e a glicemia de jejum, pressão arterial diastólica e triglicérides diminuíram respectivamente em 4,7%, 7,9% e 9,3% entre os participantes do sexo masculino. Não foram verificadas modificações nas variáveis antropométricas, com exceção da circunferência da cintura que reduziu 2,5% entre as participantes do sexo feminino. O consumo do suco de laranja pasteurizado aumentou a ingestão de energia (23,5%) e carboidratos (29,3%) pelas mulheres; de vitamina C em 261,9% pelos homens e 72,1% pelas mulheres; e de folato em 53,2% pelos homens e 38,7% pelas mulheres. A análise sensorial mostrou que os participantes aprovaram... / This study aimed at analyzing the effect of daily consumption of pasteurized orange juice on the nutritional status and glycemic, lipid and hemodynamic profiles of 20 men and 21 women employees of a private university in the city of São José do Rio Preto (SP). Women received 500 mL of pasteurized orange juice daily and men, 750 mL, for 8 weeks. The used methods for the anthropometric evaluation were: weight, height, triceps skinfold, arm circumference and waist circumference. For the biochemical evaluation were performed measurements of total cholesterol, cholesterol of high density lipoprotein, triglycerids and glycemia. For the hemodynamic evaluation, systolic and diastolic blood pressure was verified. For the dietetics evaluation was used the 24-hour food recollection and food frequency questionnaire. All evaluations were taken before and after the experimental period. The results have shown that the total cholesterol reduced 8,6% among men and 4,8% among women and cholesterol of low-density lipoprotein 8,8% among men and 9,5% among women after pasteurized orange juice ingestion. Cholesterol of high density lipoprotein has increased in 4,1% among the female participants, and fasting glycemia, diastolic blood pressure and triglycerids have decreased respectively in 4,7%, 7,9% and 9,3% among the male. Alterations on anthropometric variables were not shown, except on waist circumference, which has reduced 2,5% among female participants. Pasteurized orange juice consumption has increased women’s intake of energy (23,5%) and carbohydrates (29,3%) by women; the vitamin C in 261,9% by men and 72,1% by women; and folate in 53,2% by men and 38,7% by women. Sensory analysis has shown participants approved the quality of the product and added it easily to their regular diet. In brief, the study has shown that the regular ingestion of pasteurized orange juice, with daily doses of 500 mL for... (Complete abstract click electronic access below)

INTRODUÇÃO: Instabilidade hemodinâmica é uma condição comum nos pacientes críticos e usualmente associada aos quadros de choque. O débito cardíaco (DC) é o principal determinante da oferta de oxigênio, e uma importante variável a ser monitorizada nestes pacientes. A diferença arterio-venosa central de dióxido de carbono (△pCO2), é um índice que mostrou-se correlacionar inversamente com o DC em diversos estudos. OBJETIVOS: O objetivo deste estudo é avaliar o valor prognóstico do △pCO2 (utilizando uma amostra venosa central) em uma série heterogênea de pacientes com instabilidade hemodinâmica. MÉTODOS: Estudo prospectivo observacional conduzido em uma UTI geral de 18 leitos do Complexo Hospitalar da Santa Casa de Porto Alegre. Variáveis hemodinâmicos, coleta de gasometria arterial e venosa central, e lactato, foram realizadas na admissão e após 6, 12, 18 e 24 horas. A gravidade da doença foi avaliada pelo escore APACHE II e a a severidade da disfunção orgânica pelo escore SOFA. RESULTADOS: 60 pacientes foram analisados. A mortalidade ao fim de 28 dias foi de 43% (26/60). Não se observou diferença entre os valores médios de △pCO2 entre sobreviventes e óbitos em 28 dias. O tempo de permanência na UTI foi maior entre os pacientes com um △pCO2 “alargado”. Os valores médios de saturação venosa central de oxigênio (SvcO2) foram maiores no subgrupo de pacientes com △pCO2 normal. CONCLUSÃO: Este estudo mostrou que o △pCO2, em pacientes com instabilidade hemodinâmica, está relacionado com desfecho secundários importantes como uma maior permanência em UTI. A explicação fisiológica para isso deve-se a uma maior redução no fluxo sanguíneo (como sugerido por uma SvcO2 mais baixa) causando uma oferta inadequada de oxigênio na fase aguda da doença, resultando em maior tempo de recuperação. / BACKGROUND: Hemodynamic instability is a common condition in critically ill patients and is usually associated with shock. Cardiac output (CO) is the major determinant of oxygen supply and an important variable to be monitored in these patients. The venousarterial difference of partial pressure of carbon dioxide (△pCO2) ,is an index that have shown to be inversely correlate with the CO in several studies. OBJECTIVES: This study aims to evaluate the prognostic value of the △pCO2 (using a central venous sample) in a heterogeneous series of critically ill patients with hemodynamic instability. METHODS: A prospective observational clinical study was conducted in a 18-bed general ICU of the Santa Casa de Porto Alegre Hospital Complex. Hemodynamic measurements, collection of arterial and central venous blood gases, and lactate were performed on admission and after 6 , 12, 18 and 24 hours.The severity of patient’s disease was evaluated by the APACHE II score and the level of organic disfunction was evaluated by the SOFA score. RESULTS: A total of 60 patients were analyzed. The mortality rate at 28 days was 43% (26/60). There was no difference observed in mean △pCO2 between deaths and survivors after 28 days.The ICU stay was longer among patients with “enlarged” △pCO2.Mean central venous oxygen saturation values were higher in patients with normal △pCO2. CONCLUSION: This study showed that the △pCO2 in patients with hemodynamic instability is correlated with important secondary outcomes like higher ICU stay. The physiologic explanation is a reduction on blood flow (as suggested by lower ScvO2) causing a inadequate oxygen tissue delivery in the acute phase of the disease, resulting in a greater recovery time.

Abstract The increase of cardiac hemodynamic load that requires increased mechanical performance drives adaptation of the heart to maintain cardiac function. Modification of protein synthesis in cardiomyocytes allows the cells to adapt to the increased load. Cardiomyocyte hypertrophy and activation of cardiac fibroblasts over the long term is maladaptive and leads to heart failure (HF). Members of the transforming growth factor-&#946; (TGF-&#946;) superfamily contribute to the remodeling process. TGF-β1 acts as a paracrine messenger between cardiomyocytes and cardiac fibroblasts. Connective tissue growth factor (CTGF) modulates TGF-&#946; signaling and plays a role in the development of fibrosis. In the current study, we aimed to investigate whether blocking the actions of CTGF could alleviate ischemic injury and reduce cardiac remodeling. We determined whether blocking the action of these ligands would modulate cardiac hypertrophy and fibrosis. In the first study, we found that antagonizing the function of CTGF protected from transverse aortic constriction (TAC) -induced left ventricular remodeling. In the second study in myocardial infarction (MI) model, blocking the function of CTGF resulted in improved post-MI survival and this prevented to the decrease in left ventricular contractile function as compared to the situation in control mice. Treatment with CTGF mAb attenuated the development of dilated cardiomyopathy and limited the increase in cardiomyocyte size and deposition of interstitial fibrosis in a remote area. In the third study, targeting the TGF-&#946; superfamily members myostatin and activins, by administration of a soluble decoy receptor of activin receptor 2B (ACVR2B-Fc) did not affect the extent of MI injury or cardiac remodeling in MI -induced ischemic HF. Understanding the complex and converging pathways regulating cardiac remodeling is a major challenge, but it may allow for opportunities to develop new therapies, new medicines and provide new hope for people with these life-threatening diseases. / Tiivistelmä Sydämen lisääntynyt kuormitus vaatii lisääntynyttä supistusvoimaa, joka johtaa sydänlihaksen adaptaatioon pumppaustehon ylläpitämiseksi. Alkuvaiheessa sydämen liikakasvu on hyödyllistä, mutta pidempään jatkuessaan se johtaa lopulta pumppaustoiminnan heikkenemiseen ja sydämen vajaatoimintaan. Useiden signalointimekanismien on osoitettu säätelevän sydänlihaksen adaptoitumista patologisille tiloille. Transformoiva kasvutekijä –&#946; (TGF-&#946;) proteiiniperhe säätelee sydämen adaptoitumista sekä vasemman kammion seinämän myötäävyyttä venytykselle. TGF-&#946;1 indusoi supistuskykyisten myofibroblastien muodostumista sekä kollageenin tuotantoa. Runsas kollageenin tuotanto vahvistaa sydämen seinämää ja on tarpeen sydäninfarktivaurion korjaamisessa, mutta pitkään jatkuessaan se heikentää sydämen toimintaa ja altistaa rytmihäiriöille, sydämen vajaatoiminnalle sekä sydänperäiselle äkkikuolemalle. Sidekudoskasvutekijä (CTGF) säätelee TGF-&#946;1:n signalointia ja se osallistuu haavan paranemiseen sekä fibroosiin. Tutkimuksessa selvitettiin, voidaanko sidekudoskasvutekijän tai TGF-&#946; -perheen proteiinien toimintaa estämällä lievittää sydämen vajaatoiminnan kehittymistä. Koetuloksemme osoittavat, että CTGF:n toiminnan estäminen vasta-aineen (mAb) avulla vähentää hemodynaamisen liikakuormituksen indusoimaa vasemman kammion toiminnan heikkenemistä, kammion laajenemista sekä fibroosia. CTGF mAb myös vähentää kuolleisuutta ja estää sydämen toiminnan heikkenemistä sydäninfarktin jälkeen sekä lievittää sydäninfarktin jälkeistä dilatoivan kardiomyopatian kehittymistä. Aktiviinien ja myostatiinin toiminnan esto liukoisen aktiviinireseptori 2B:n (ACVR2B-Fc) avulla sen sijaan ei vaikuta sydäninfarktivaurioon tai iskeemisen vajaatoiminnan kehittymiseen. ACVR2B-Fc kuitenkin lisää luurankolihaksen kasvua, estäen sydämen vajaatoimintaan liittyvää luurankolihaskatoa. Sydämen hypertrofian ja vajaatoiminnan syntymisen kannalta keskeisten signaalinvälitysreittien tunnistaminen ja niiden toiminnan ymmärtäminen auttaisi kehittämään tehokkaampia lääkehoitoja sydänsairauksiin.

Functional Magnetic Resonance Imaging (fMRI) is one of the best techniques for neuroimaging and has revolutionized the way to understand the brain functions. It measures the changes in the blood oxygen level-dependent (BOLD) signal which is related to the neuronal activity. Complexity of the data, presence of different types of noises and the massive amount of data makes the fMRI data analysis a challenging one. It demands efficient signal processing and statistical analysis methods.  The inference of the analysis is used by the physicians, neurologists and researchers for better understanding of the brain functions.      The purpose of this study is to design a toolbox for fMRI data analysis. It includes methods to detect the brain activity maps, estimation of the hemodynamic response (HDR) and the connectivity of the brain structures. This toolbox provides methods for detection of activated brain regions measured with Bayesian estimator. Results are compared with the conventional methods such as t-test, ordinary least squares (OLS) and weighted least squares (WLS). Brain activation and HDR are estimated with linear adaptive model and nonlinear method based on radial basis function (RBF) neural network. Nonlinear autoregressive with exogenous inputs (NARX) neural network is developed to model the dynamics of the fMRI data.  This toolbox also provides methods to brain connectivity such as functional connectivity and effective connectivity.  These methods are examined on simulated and real fMRI datasets.

Diss. Linköping : Linköpings universitet, 2004.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 6 uppsatser.