Thesis (M.S.)--University of Wisconsin. School of Nursing, 1975. / eContent provider-neutral record in process. Description based on print version record.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 66-70).

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 113-115).

Thesis (M.S.)--University of Wisconsin--Madison, 1985. / Typescript (photocopy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 100-103).

Thesis (M.S.)--University of Wisconsin - Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 61-63).

Doctor of Philosophy / Department of Agronomy / Masaaki Tamura / Over the years proteins/peptides have evolved as promising therapeutic agents in the treatment of cancer. Considering the advantages of peptides such as their small size, ease of synthesis, tumor-penetrating ability and bio-compatibility, present report discusses proof of concept for 1. C1B5 peptide of protein kinase Cγ and a low dose of gemcitabine combination treatment for peritoneally disseminated pancreatic cancer and 2. dTAT peptide nanoparticles mediated gene (angiotensin II type 2 receptor gene) therapy for lung cancer. 1. A significant reduction in intraperitoneally (IP) transplanted pancreatic carcinoma growth was demonstrated with C1B5 peptide and gemcitabine co-treatment in an immunocompetent mouse model. Increased number of Granzyme B positive cells was observed in treated mice ascites, suggesting the involvement of immune response in tumor attenuation. The strong effect observed in combination treatment might be because of increase in lymphocyte recruitment by gemcitabine followed by C1B5 peptide mediated CD8+ T-cells or NK cells activation apart from direct cancer cell apoptosis. 2. To test dTAT peptide nanoparticles (dTAT NPs) mediated therapeutic gene delivery, luciferase reporter gene containing dTAT nanoparticles were synthesized (dTAT/pLUC/Ca2+). Synthesis conditions for nanoparticles were optimized based on dTAT/pLUC/Ca2+ nanoparticles transfection efficiency. With the optimized conditions, dTAT NPs containing AT2R, TRAIL or miR-34a pDNA (dTAT/pAT2R, dTAT/TRAIL or dTAT/miR- 34a) were synthesized. Therapeutic potential of these NPs was analyzed in lung adenocarcinoma containing mice by administering them intravenously (IV) or/and intratracheally (IV). Combination treatment with the IV injection of the new dTAT/pAT2R/Ca2+ formulation and the IT injection of the original dTAT/pAT2R/Ca2+ formulation is effective in attenuation of developed human bronchioloalveolar carcinoma in the SCID mouse lungs. Findings from the above mentioned studies have vital clinical relevance as it implies that peptides alone or when used as gene delivery systems may prove to be beneficial in the treatment of various stages of cancer.

INTRODUÇÃO: A deglutição é um processo complexo que requer a coordenação precisa de mais de 25 músculos, seis pares de nervos cranianos e os lobos frontais. O comprometimento neste processo, denominado de disfagia, pode aumentar a taxa de morbidade dos pacientes e também o risco para a aspiração, retardando a administração de uma nutrição adequada por via oral. A intubação orotraqueal prolongada, definida na literatura como período superior a 48 horas de intubação, poderá causar alterações na deglutição e ocasionar a disfagia após a extubação. O objetivo deste estudo foi verificar as variáveis independentes da avaliação fonoaudiológica da deglutição que são preditoras do risco de disfagia após intubação orotraqueal prolongada nas Unidades de Terapia Intensiva. MÉTODOS: Foi realizado um estudo transversal observacional. Participaram deste estudo 148 pacientes submetidos à avaliação em beira de leito da deglutição, no período entre setembro de 2009 e setembro de 2011. Todos os pacientes apresentavam histórico de intubação orotraqueal prolongada e foram admitidos em uma das Unidades de Terapia Intensiva de um grande hospital escola brasileiro. Os critérios de inclusão adotados foram: estabilidade clínica e respiratória; pontuação na Escala de Coma Glasgow acima de 14 pontos; idade acima de 18 anos; ausência de traqueostomia; ausência de doenças neurológicas; ausência de disfagia esofágica; ausência de procedimentos cirúrgicos envolvendo a área de cabeça e pescoço. Além disso, os pacientes deveriam ser submetidos à avaliação em beira de leito da deglutição no prazo de 48 horas após a extubação. A análise estatística incluiu a correlação entre os resultados obtidos no teste de deglutição de água e a pontuação do nível da deglutição. RESULTADOS: Os resultados indicaram que a presença de tosse e alteração da ausculta cervical durante a deglutição de água são variáveis preditoras independentes do risco de disfagia para o grupo testado. CONCLUSÃO: O estudo apontou as variáveis preditoras do risco de disfagia em pacientes submetidos à intubação orotraqueal prolongada. / INTRODUCTION: Swallowing is a complex process, that require the precise timing and coordination of more than 25 muscles, six cranial nerves and frontal lobes. Compromise of this process, or dysphagia, can result in profund morbidity, increasing the changes of aspiration and delaying the admistration of proper oral nutrition. It is know that an orotracheal tube might disturb these intricately choreographed events and cause post-extubation dysphagia. Prolonged intubation, typically defined as longer than 48 hours in the literature, is thought to contribute to swallowing dysfunction. The objective of this study is to elucidated independent factors that predict the risk of dysphagia after prolonged orotraqueal intubation in Intensive Care Units patients. METHODS: A cross-sectional, observational study design was used. Participants were 148 consecutive patients who underwent clinical bedside swallowing assessment, from September 2009 to September 2011. All patients presented a history of prolonged orotraqueal intubation and were admitted in one of the several Intensive Care Units of a large Brazilian school hospital. The adopted inclusion criteria were: to present clinical and respiratory stability, to present more than 14 points on the Glasgow Coma Scale; age above 18 years; absence of tracheostomy; absence of neurologic diseases, absence of esophageal dysphagia; absence of surgical procedures involving the head and neck. Also, to be included in the study, patients had to undergo a clinical swallowing assessment within 48 hours after extubation. The statistical analysis included the correlation of the results obtained on a water swallow test and the risk level for dysphagia. RESULTS: Results indicated that altered cervical auscultation and presence of cough during water swallow tests increase the likelihood of dysphagia in patients who underwent prolonged orotracheal intubation. CONCLUSION: The results of the study indicate factors that predict the risk of dysphagia after prolonged orotraqueal intubation.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.

INTRODUÇÃO: A deglutição é um processo complexo que requer a coordenação precisa de mais de 25 músculos, seis pares de nervos cranianos e os lobos frontais. O comprometimento neste processo, denominado de disfagia, pode aumentar a taxa de morbidade dos pacientes e também o risco para a aspiração, retardando a administração de uma nutrição adequada por via oral. A intubação orotraqueal prolongada, definida na literatura como período superior a 48 horas de intubação, poderá causar alterações na deglutição e ocasionar a disfagia após a extubação. O objetivo deste estudo foi verificar as variáveis independentes da avaliação fonoaudiológica da deglutição que são preditoras do risco de disfagia após intubação orotraqueal prolongada nas Unidades de Terapia Intensiva. MÉTODOS: Foi realizado um estudo transversal observacional. Participaram deste estudo 148 pacientes submetidos à avaliação em beira de leito da deglutição, no período entre setembro de 2009 e setembro de 2011. Todos os pacientes apresentavam histórico de intubação orotraqueal prolongada e foram admitidos em uma das Unidades de Terapia Intensiva de um grande hospital escola brasileiro. Os critérios de inclusão adotados foram: estabilidade clínica e respiratória; pontuação na Escala de Coma Glasgow acima de 14 pontos; idade acima de 18 anos; ausência de traqueostomia; ausência de doenças neurológicas; ausência de disfagia esofágica; ausência de procedimentos cirúrgicos envolvendo a área de cabeça e pescoço. Além disso, os pacientes deveriam ser submetidos à avaliação em beira de leito da deglutição no prazo de 48 horas após a extubação. A análise estatística incluiu a correlação entre os resultados obtidos no teste de deglutição de água e a pontuação do nível da deglutição. RESULTADOS: Os resultados indicaram que a presença de tosse e alteração da ausculta cervical durante a deglutição de água são variáveis preditoras independentes do risco de disfagia para o grupo testado. CONCLUSÃO: O estudo apontou as variáveis preditoras do risco de disfagia em pacientes submetidos à intubação orotraqueal prolongada. / INTRODUCTION: Swallowing is a complex process, that require the precise timing and coordination of more than 25 muscles, six cranial nerves and frontal lobes. Compromise of this process, or dysphagia, can result in profund morbidity, increasing the changes of aspiration and delaying the admistration of proper oral nutrition. It is know that an orotracheal tube might disturb these intricately choreographed events and cause post-extubation dysphagia. Prolonged intubation, typically defined as longer than 48 hours in the literature, is thought to contribute to swallowing dysfunction. The objective of this study is to elucidated independent factors that predict the risk of dysphagia after prolonged orotraqueal intubation in Intensive Care Units patients. METHODS: A cross-sectional, observational study design was used. Participants were 148 consecutive patients who underwent clinical bedside swallowing assessment, from September 2009 to September 2011. All patients presented a history of prolonged orotraqueal intubation and were admitted in one of the several Intensive Care Units of a large Brazilian school hospital. The adopted inclusion criteria were: to present clinical and respiratory stability, to present more than 14 points on the Glasgow Coma Scale; age above 18 years; absence of tracheostomy; absence of neurologic diseases, absence of esophageal dysphagia; absence of surgical procedures involving the head and neck. Also, to be included in the study, patients had to undergo a clinical swallowing assessment within 48 hours after extubation. The statistical analysis included the correlation of the results obtained on a water swallow test and the risk level for dysphagia. RESULTS: Results indicated that altered cervical auscultation and presence of cough during water swallow tests increase the likelihood of dysphagia in patients who underwent prolonged orotracheal intubation. CONCLUSION: The results of the study indicate factors that predict the risk of dysphagia after prolonged orotraqueal intubation.

Submitted in fulfilment of the Master's Degree in Clinical Technology, Durban University of Technology, 2010. / Introduction: The aim of this study was to establish the most reliable standard method for monitoring endotracheal tube cuff pressure in an intensive care unit. Methodology: The study was conducted at King Edward VIII Hospital ICU on adult patients undergoing prolonged intubation of more than 24 hours. Consent was obtained from the patient’s next of kin. The patient’s Pcuff for this study was recorded in two ways simultaneously for a period of 12 hours during the day. The principal investigator recorded the Pcuff thrice during the study period using the Posey cufflator®. Continuous recording was done using a pressure transducer connected to the Nihon Kohden BSM®. Factors causing changes in Pcuff were also documented. Results: Thirty-five critically ill adult patients were enrolled into the study. Nineteen (54.3%) of the subjects were male. Seventeen out of 35 subjects were studied for the entire 720 minute period. The mean time of study of the group was 667 minutes with the lowest period being 135 minutes for one patient. The group mean ± Standard deviation (SD) was 26.6 8.7 with a 95% confidence index of 9.2 – 44.0 and the median value was 25 for continuous readings. For the entire group, 13% of the time was spent in the low pressure range (< 20 cmH2O), while 23% was spent in the high pressure (> 30 cmH2O). A mean of 64% of the time was spent in the normal pressure range. Overall, the most frequently encountered events that caused pressure changes were body movement, coughing, head movement and suctioning accounting for 26.2%, 20.1%, 19.2% and 9.4% respectively. For intermittent readings, the mean ± SD of all patients for T0 was 25.3 ± 6.9; for T6 25.9 ± 8.7 and for T12 24.8 ± 3.8. The overall mean ± SD for all readings was 25.6 ± 7.1. For the entire group, 12% of the time was spent in the low pressure range (< 20 cmH2O), while 5% was spent in the high pressure (> 30 cmH2O). A mean of 83% of the time was spent in the normal pressure range. The correlation between intermittent pressure and the continuous reading at the same time was r = 0.87. iii Discussion: Continuous monitoring of Pcuff indicated that the endotracheal cuff pressure varies extensively during mechanical ventilation in critically ill patients, such variation being noted both between patients and within an individual patient. In an attempt to compare intermittent and continuous monitoring of endotracheal cuff pressures, a good correlation between the two measurements was demonstrated. However, the variations in pressures noted for an individual patient would not have been detected if endotracheal cuff pressures were monitored intermittently. Hence, with continuous monitoring the pressure changes may be detected early. Conclusion: Continuous monitoring of cuff pressure during mechanical ventilation in intensive care units is thus recommended for all patients. If intermittent monitoring is performed, it should be more frequently than eight-hourly. It is recommended that a pressure range of 20-30 cmH2O still be used as the normal range. The role of self adjusting pressure devices, although needing further exploration, holds much promise. / DUT Postgraduate Development Services.