Afin de satisfaire les exigences de sécurité requises dans l’aviation civile, la stratégie adoptée consiste à multiplier les chaînes de mesure pour une même information. Il est aujourd’hui recommandé d’introduire une chaîne de mesure dissemblable (reposant sur un principe physique différent) afin d’augmenter le niveau de sécurité. Dans cette optique, Thales mène des travaux sur le développement d’un anémomètre laser Doppler embarqué sur aéronef. Ce capteur, composé de quatre axes LiDAR (Light Detection And Ranging) répartis autour de l’avion, permet d’estimer la vitesse air par l’analyse de la réflexion de l’onde laser émise sur les particules présentes dans l’air.L’objectif de ces travaux est de concevoir une chaîne de traitement du signal LiDAR adaptée à un capteur sur avion. Cette chaîne, basée sur une représentation temps-fréquence, inclut des étapes de détection du signal utile optimisée pour les conditions de faible ensemencement en particules, de sélection des aérosols utiles dans un nuage et d’estimation robuste afin de contrôler la qualité de la mesure. Cette chaîne de traitement, évaluée lors d’une campagne d’essais réalisée à l’observatoire du Pic du Midi, apporte un gain de performances élevé dans les situations critiques. L’architecture du système a été le second axe d’étude. Une méthode d’estimation du vecteur vitesse à partir des estimations effectuées sur chaque axe LiDAR et d’un modèle aérodynamique de l’avion permet de compenser les perturbations observées à proximité de ce dernier. Puis, une procédure d’optimisation de l’architecture est proposée afin d’améliorer les performances du capteur. Les performances de la chaîne de traitement présentée devront être évaluées en conditions réelles, lors d’essais en vol, afin de sonder une grande variété de conditions atmosphériques et d’évaluer le gain apporté et les faiblesses éventuelles du traitement proposé en fonction de ces conditions. / The method use to respect security requirements in civil aviation consists in multiplying measuring chains for the same information. Now, it is recommended to add a dissimilar measuring chain, based on a different physical principle, in order to improve security level. Thus, Thales works on the development of a laser Doppler anemometer embedded on aircraft. This sensor is composed by four LiDAR (Light Detection And Ranging) axis distributed around the aircraft and air speed is estimated by the analysis of the reflection of the emitted laser wave on particles.This thesis objective is to design a LiDAR signal processing chain adapted to an aircraft sensor. The process is based on a time-frequency representation and it includes methods for signal detection in low concentrated air mass, useful particles selection in clouds and robust estimation to control measure reliability. The process has been evaluated during a test campaign realized at the Pic du Midi observatory. Its performances are greatly improved, especially in critical situations.The system architecture has also been studied. An estimation method designed from estimations performed on different LiDAR axis and an aerodynamic model of an aircraft is proposed in order to compensate for air mass perturbations close to the aircraft. Then, an optimization process is presented to improve sensor performances.The signal processing chain will have to be evaluated by flight tests, to explore a large atmospheric conditions variety and to quantify its strengths and weaknesses depending on conditions.

La réduction des nuisances sonores est un enjeu permanent pour les acteurs de l’aéronautique. L’optimisation de la réduction de bruit apportée par les traitements acoustiques tapissant la nacelle des réacteurs turbofan passe par une caractérisation précise des matériaux employés dans l’environnement aéroacoustique d’utilisation, qui met en jeu un écoulement rasant de vitesse importante combiné à de forts niveaux sonores. L’objectif de cette thèse est de développer une méthode inverse pour la détermination de l’impédance acoustique de liners soumis à un écoulement rasant, basée sur des mesures non intrusives du champ de vitesse acoustique au-dessus du matériau par Vélocimétrie Laser Doppler (LDV). L’impédance de liner est obtenue par minimisation de l’écart entre le champ de vitesse acoustique mesuré et le champ simulé numériquement en résolvant les équations d’Euler linéarisées bidimensionnelles harmoniques, discrétisées par un schéma Galerkin discontinu. Le gradient de la fonction objectif minimisée est calculé via la résolution, à chaque itération, des équations directes et adjointes. Une première étape de validation du solveur est effectuée sur des cas-tests académiques, puis sur des cas expérimentaux impliquant des mesures de pression acoustique en paroi rigide opposée au liner. Dans un second temps, la méthode est appliquée à des mesures de vitesse acoustique obtenues par LDV dans le banc B2A de l’ONERA en l’absence d’écoulement. La dernière étape consiste à prendre en compte l’effet d’un écoulement rasant de profil cisaillé. Les impédances identifiées à partir de mesures LDV en présence d’écoulement ont notamment permis de gagner en compréhension sur les phénomènes d’absorption intervenant dans le banc B2A. / While aircraft noise constraints become increasingly stringent, efficient duct treatment of turbofan engines requires an accurate knowledge of liner impedance with grazing flow at high acoustic levels. This thesis aims at developing an impedance eduction method in the presence of grazing flow. The inverse process is based on acoustic velocity fields acquired by Laser Doppler Velocimetry (LDV) above the liner. The liner acoustic impedance is obtained by minimization of the distance between the measured acoustic velocity field and the simulated one. Computations rely on the resolution of the 2D linearized Euler equations in the harmonic domain, spatially discretized by a discontinuous Galerkin scheme. The gradient of the objective function is achieved by the resolution, at each iteration on the liner impedance, of the direct and adjoint equations. The solver is first validated on academic test cases, then on experimental results of acoustic pressure measurements at the rigid wall opposite the liner. Secondly the method is applied to acoustic velocity measurements obtained by LDV above the liner without flow, in the ONERA B2A test bench. The last step consists in taking into account the effects of a sheared grazing flow. The impedances educed from LDV measurements in the presence of flow namely allowed to gain insight into the absorption phenomena occuring in the B2A test bench.

With the goal to continue interplanetary exploration and search for past or existent life on Mars, software and hardware for unmanned subsurface drills are being developed. Unlike drilling on Earth, interplanetary exploration drills operate with very low available power and require on-board integrated health monitoring systems, with quick-response recovery procedures, under complete autonomous operations. As many drilling faults are not known a priori, Earth-based direction and control of an unmanned interplanetary drilling operation is not practical. Such missions also require advanced robotic systems that are more susceptible to structural and mechanical failures, which motivates a need for structural health monitoring techniques relevant to interplanetary exploration systems. Structural health monitoring (SHM) is a process of detecting damage or other types of defects in structural and mechanical systems that have the potential to adversely affect the current or future performance of these systems. Strict requirements for interplanetary drilling missions create unique research problems and challenges compared with SHM procedures and techniques developed to date. These challenges include implementing sensors and devices that do not interfere with the drilling operation, producing "real-time" diagnostics of the drilling condition, and developing an automation procedure for complete autonomous operations. Thus, the completed thesis work presents basic research leading to the dynamic analysis of rotating structures with specific application to interplanetary subsurface drill systems, and the formulation of an autonomous, real-time, dynamics-based SHM technique for drilling applications. This includes modeling and validating the structural dynamic system, with and without damage or faults, for a prototype interplanetary subsurface drill, exploring the use of Laser Doppler Velocimeter sensors for use in real-time SHM, developing signal filters to remove inherent harmonic components from the dynamic signal of rotating structures, developing an automation procedure with the associated software, and validating the SHM system through laboratory experiments and field tests. The automated dynamics-based structural health monitoring technique developed in this thesis presents advanced research accomplishments leading to real-time, autonomous SHM, and it has been validated on an operating dynamic system in laboratory and field tests. The formulated SHM and drilling operation also met or exceeded all specified requirements. Other major contributions of this thesis work include the formulation and demonstration of real-time, autonomous SHM in rotating structures using Laser Doppler Velocimeter sensors.

[pt] O presente trabalho consiste no projeto, construção e qualificação de um aparato para o estudo experimental de bolhas de separação laminar sobre uma placa plana. A previsão do comportamento das bolhas de separação é importante para o projeto de aeronaves, turbinas e geradores eólicos, pois o desprendimento dessas bolhas tem grande impacto na performance de aerofólios. A dinâmica das bolhas não é bem compreendida, além de ser difícil de ser capturada por simulações numéricas que utilizam modelagem da turbulência. Por isso, ensaios experimentais são muito utilizados para a calibração dos modelos utilizados em simulações de engenharia. Neste trabalho, foram criados equipamentos para simular experimentalmente bolhas de separação laminar sobre uma placa plana. Os dispositivos foram projetados para o canal de água do Laboratório de Engenharia de Fluidos da PUC-Rio. O gradiente de pressão necessário para induzir a separação da camada limite e consequente formação da bolha foi ajustado com uma parede falsa, de modo a criar um canal convergente-divergente com a placa plana. Foi projetado um mecanismo de sucção da camada limite na parede falsa para evitar a separação do escoamento nessa superfície. A localização e as vazões de cada ponto de sução foram determinadas com o auxílio de simulações numéricas. Também foi projetado e testado um sistema de sopro e sucção para a excitação de ondas de instabilidade do tipo Tollmien-Schlichting na camada limite da placa plana. O funcionamento de cada dispositivo foi avaliado através da medição da velocidade do escoamento. Para isso, foram empregadas técnicas de medição por velocimetría laser doppler e velocimetría por imagem de partículas. Os resultados obtidos validam o projeto e qualificam o aparato para o estudo de bolhas de separação laminar. / [en] The present work involves the design, construction and performance test of an apparatus for the investigation of laminar separation bubbles in a flat plate boundary layer. Laminar separation bubbles are relevant for many engineering applications and the dynamic of such bubbles has a strong impact on the performance of aircrafts and turbines. The separated boundary layer reattaches to the surface due to the laminar-turbulent transition in the bubble region. This dynamic process is highly challenging for flow simulation tools used for engineering purposes. Thus, there is a demand for experimental studies that can be used for calibration of models present in those simulation tools. To this end, an apparatus was designed and built for the water channel of the Laboratory of Fluid Engineering at PUC-Rio. The boundary layer separation on the flat plate was induced by imposing a constant adverse pressure gradient to the flow. To this end a false wall was built, in order to form a converging-diverging channel with the flat plate. Flow separation on the false wall was avoided using a suction mechanism that was designed to reduce locally the boundary layer thickness. Location of suction and suction flow rates were determined with aid of numerical simulations. In addition, it was designed and built a disturbance source to generate Tollmien-Schlichting waves in the boundary layer of the flat plate. This device was used to trigger the boundary layer transition in a controlled manner. All equipment were tested and their designs were validated against experimental measurements. Laser Doppler anemometry and Particle Image Velocimetry techniques were adopted for assessment of each equipment. Results validate the design and show that separation bubbles can be investigated in detail using this apparatus.

La propagation d'une onde acoustique en guide est associée, pour de forts niveaux, à un certain nombre de phénomènes de l'acoustique non linéaire. Parmi ces phénomènes, les écoulements redressés (ou vent acoustique), l'effet d'une discontinuité et la transition à la turbulence, à l'étude dans ce mémoire, sont associés à la génération d'écoulements induits. L'étude expérimentale de ces phénomènes repose sur l'adaptation des méthodes de vélocimétrie Laser : Vélocimétrie Laser par effet Doppler (VLD) et Vélocimétrie par Images de Particules (PIV) à la mesure des différents écoulements. Ainsi, des mesures PIV en sortie de convergent, viennent compléter des mesures VLD réalisées antérieurement. Dans l'espoir de mieux appréhender les spécificités de la transition à la turbulence en guide d'onde acoustique, l'évolution de la couche limite de Stokes est étudiée pour des amplitudes de vitesse acoustique croissantes. Une étude expérimentale des écoulements redressés dans un guide d'onde à section carrée est proposée et les spécificités liées à cette géométrie sont recherchées. En outre, l'évolution des tourbillons du vent acoustique en guide d'onde cylindrique est analysée lorsque le vent devient rapide et certains facteurs pouvant être à l'origine de cette évolution sont modifiés. La répartition harmonique dans le guide est ainsi modifiée, puis l'influence des conditions thermiques est abordée en couplant les mesures de vitesses à des mesures de température moyenne dans le guide et en paroi. Une comparaison avec des résultats issus de simulations numériques permet de conforter l'évolution des écoulements redressés observée. / High amplitude acoustic propagation in a guide is associated with several non linear phenomena including acoustic streaming, discontinuity effects and transition to turbulence. Those phenomena are studied in this work and are all associated with acoustically induced flows. The present experimental study therefore is based on velocimetry laser techniques: Laser Doppler Velocimetry (LDV) and Particle Image Velocimetry (PIV), wich are fitted to the measurement of the different flow velocity components. Firstly, PIV measurements at the exit of a convergent enable to complement previous LDV measurements. Then, in order to a better understanding of the specificity of transition to turbulence in acoustics, the evolution of the Stokes boundary layer is studied for increasing acoustic velocity amplitudes. Then an experimental study of acoustic streaming in a square channel is reported, and the influence of the geometry is examined. Moreover, the evolution of acoustic streaming vortices in a cylindrical waveguide is analyzed for fast streaming and some parameters that could control such evolution are modified. The harmonicdistribution inside the guide is changed and then the influence of thermal conditions is studied by coupling velocity measurements and mean temperature measurements inside the waveguide and along the wall. Some comparisons between measured streaming velocities and numerical simulation results are presented.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas. / Leprosy, a disease known for its characteristic insensitive skin patches, is the main cause of peripheral neuropathy in endemic countries. Leprosy reactions are well-known for promoting nerve function impairment by neuritis which range from asymptomatic to exuberant clinical pictures. These neuropathy characteristics make early diagnosis exceptionally challenging as the need to intervene in order to prevent permanent nerve damage. This prospective clinical study was done selecting leprosy patients regardless their clinical form, who had presented leprosy reaction at the Souza Araújo Out-patient clinic, FIOCRUZ, Rio de Janeiro. The objective was to study the neurologic, the neurophysiological, and the nerve image pattern before and after the treatment of leprosy reactions.Twenty five patients at the time of leprosy reactions and one year after the reaction treatment had been evaluated by means of neurologic examination, physiotherapyc examination, nerve conduction study, evaluation of thickness and echogenicity of the committed nerves through the use of ultrasound, Laser Doppler fluxometry, and also by the quantitative sensory test. The patients were divided in three groups: eight patients had acute neuritis, nine had silent neuritis, and eight had skin reaction without neuritis.This study was approved by the ethics committee of the Oswaldo Cruz Foundation.In the evaluated patients presenting reactional episodes there had been a male predominance (60%), a multibacillary group predominance (80%) and a borderline-lepromatosus (36%) clinic form predominance. The isolated neuritis was the most frequent leprosy reaction, followed by neuritis associated with type 1 reaction, and by neuritis associated with type 2 reaction. The most common motor nerve affected by neuritis was peroneal, followed by ulnar nerve whereas most common sensory nerve affected was sural.The characteristic electroneuromyography pattern of leprosy reactions was multiplex mononeuropathy. The ultrasound, Laser Doppler fluxometry, and the quantitative sensory test together with the clinical examination and with the nerve conduction study were helpful exams for initial evaluation and follow-up treatment of leprosy reaction. A motor function improvement had been observed after the treatment but the same didnt occur regarding the sensory function.Throughout these studies it had been observed a need of a multidiscipline follow up for leprosy patients with specialized exams in order to have reaction diagnoses and early treatment avoiding neurological sequelae

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas. / Leprosy, a disease known for its characteristic insensitive skin patches, is the main cause of peripheral neuropathy in endemic countries. Leprosy reactions are well-known for promoting nerve function impairment by neuritis which range from asymptomatic to exuberant clinical pictures. These neuropathy characteristics make early diagnosis exceptionally challenging as the need to intervene in order to prevent permanent nerve damage. This prospective clinical study was done selecting leprosy patients regardless their clinical form, who had presented leprosy reaction at the Souza Araújo Out-patient clinic, FIOCRUZ, Rio de Janeiro. The objective was to study the neurologic, the neurophysiological, and the nerve image pattern before and after the treatment of leprosy reactions.Twenty five patients at the time of leprosy reactions and one year after the reaction treatment had been evaluated by means of neurologic examination, physiotherapyc examination, nerve conduction study, evaluation of thickness and echogenicity of the committed nerves through the use of ultrasound, Laser Doppler fluxometry, and also by the quantitative sensory test. The patients were divided in three groups: eight patients had acute neuritis, nine had silent neuritis, and eight had skin reaction without neuritis.This study was approved by the ethics committee of the Oswaldo Cruz Foundation.In the evaluated patients presenting reactional episodes there had been a male predominance (60%), a multibacillary group predominance (80%) and a borderline-lepromatosus (36%) clinic form predominance. The isolated neuritis was the most frequent leprosy reaction, followed by neuritis associated with type 1 reaction, and by neuritis associated with type 2 reaction. The most common motor nerve affected by neuritis was peroneal, followed by ulnar nerve whereas most common sensory nerve affected was sural.The characteristic electroneuromyography pattern of leprosy reactions was multiplex mononeuropathy. The ultrasound, Laser Doppler fluxometry, and the quantitative sensory test together with the clinical examination and with the nerve conduction study were helpful exams for initial evaluation and follow-up treatment of leprosy reaction. A motor function improvement had been observed after the treatment but the same didnt occur regarding the sensory function.Throughout these studies it had been observed a need of a multidiscipline follow up for leprosy patients with specialized exams in order to have reaction diagnoses and early treatment avoiding neurological sequelae

Hipertensos têm rarefação capilar e disfunção endotelial microcirculatória, tornando-se mais vulneráveis a lesões em órgãos-alvo. O estudo buscou avaliar o efeito de seis meses de tratamento farmacológico sobre densidade capilar e reatividade microvascular a estímulos fisiológicos e farmacológicos em hipertensos de baixo risco cardiovascular. Secundariamente testou-se a existência de diversidade nas respostas a diferentes estratégias anti-hipertensivas. Foram recrutados 44 pacientes, com 46,71,3 anos e 20 normotensos com 48,01,6 anos. Avaliaram-se dados antropométricos e laboratoriais e dosaram-se no soro o fator de crescimento vascular endotelial (VEGF), receptor Flt-1 para VEGF e óxido nítrico (NO). A contagem capilar foi por microscopia intravital, captando-se imagens da microcirculação no dorso da falange do dedo médio e contando os capilares com programa específico. Repetia-se o procedimento após hiperemia reativa pós-oclusiva (HRPO) para avaliar o recrutamento capilar. A reatividade vascular foi testada por fluxometria Laser Doppler, iontoforese de acetilcolina (Ach), HRPO e hiperemia térmica local (HTL). Os pacientes foram distribuídos aleatoriamente para dois grupos de tratamento: succinato de metoprolol titulado a 100 mg diários ou olmesartana medoxomila titulada a 40 mg diários, empregando-se, se necessário, a hidroclorotiazida. Os controles seguiram o mesmo protocolo inicial e após seis meses todos os testes foram repetidos nos hipertensos. As variáveis clínicas e laboratoriais basais eram semelhantes em comparação aos controles e entre os dois grupos de tratamento. Após seis meses, havia pequenas diferenças entre os grupos na relação cintura-quadril e HDL. A densidade capilar antes do tratamento era significativamente menor que no grupo controle (71,31,5 vs 80,61,8 cap/mm2 p<0,001 e HRPO 71,71,5 vs 79,52,6 cap/mm2 p<0,05) e, com o tratamento, aumentou para 75,41,1 cap/mm2 (p<0,01) no estado basal e para 76,81,1 cap/mm2 à HRPO (p<0,05). À reatividade vascular, a condutância vascular cutânea (CVC) em unidades de perfusão (UP)/mmHg era similar à HTL nos controles e hipertensos e aumentou com o tratamento nos dois subgrupos (metoprolol:1,730,2 a 1,900,2 p<0,001 e olmesartana:1,490,1 a 1,870,1 p<0,001). A CVC máxima à HRPO era menor nos hipertensos: 0,30(0,22-0,39) que nos controles: 0,39(0,31-0,49) com p<0,001. Após tratamento, aumentou para 0,41(0,29-0,51) com p<0,001. O aumento foi significativo apenas no grupo olmesartana (0,290,02 a 0,420,04 p<0,001). A diferença entre o tempo para atingir o fluxo máximo à HRPO aumentou no grupo metoprolol após tratamento 3,0 (-0,3 a 8,8) segundos versus olmesartana 0,4 (-2,1 a 2,4) segundos p<0,001. À iontoforese, a área sob a curva de fluxo (AUC) era similar nos grupos e aumentou com o tratamento, de 6087(3857-9137) para 7296(5577-10921) UP/s p=0,04. O VEGF e receptor não diferiam dos controles nem sofreram variações. A concentração de NO era maior nos hipertensos que nos controles: 64,9 (46,8-117,6) vs 50,7 (42-57,5) M/dl p=0,02 e não variou com tratamento. Em conclusão, hipertensos de baixo risco têm menor densidade e menor recrutamento capilar e ambos aumentam com tratamento. Apresentam também disfunção endotelial microcirculatória que melhora com a terapia. / Capillary rarefaction and microcirculatory endothelial dysfunction are hallmarks of hypertension, rendering patients vulnerable to target organ lesions. The study aimed at assessing the effect of a six-month treatment period upon capillary density and microvascular reactivity to physiological and pharmacological stimuli. In addition, two different treatment strategies were tested for possible differences between effects upon those variables. A total of 44 patients were recruited, mean age 46.71.3 years and 20 normotensive individuals served as controls, mean age 48.01.6 years. Anthropometrical and laboratory data were collected, as well as plasma levels of vascular endothelial growth factor (VEGF), its receptor Flt-1 and nitric oxide (NO). Capillary density was obtained by intra-vital microscopy of the dorsum of the middle phalanx before and after post-occlusive reactive hyperemia (PORH). Capillary loops were counted by a semi-automated software. Microvascular reactivity was tested by laser Doppler flowmetry (LDF), and the challenges consisted of acetylcholine iontophoresis, local thermal hyperemia (LTH) and PORH. Patients were randomly allocated to either one of two treatment arms: metoprolol succinate uptitrated to 100 mg daily or olmesartan medoxomil uptitrated to 40 mg daily, with addition of hydrochlorothiazide if necessary. Controls underwent the same initial protocol and all tests were repeated in patients after six months. Baseline clinical and laboratory parameters were similar between patients and controls and between the two treatment groups. After six months there were slight, although significant, differences between the two groups in waist/hip ratio and HDL-cholesterol. In the whole cohort, pretreatment capillary density was significantly reduced compared to controls (71.31.5 vs 80.61.8 cap/mm2 p<0.001 and PORH 71.71.5 vs 79.52.6 cap/mm2 p<0.05). After treatment it increased to 75.41.1 cap/mm2 (p<0.01) at rest and 76.81,1 cap/mm2 during PORH. During LTH, cutaneous vascular conductance (CVC) in perfusion units (PU)/ mmHg was similar in patients and controls and increased significantly in both subgroups (metoprolol: from 1.730.2 to 1.900.2 p<0,001 and olmesartan: from 1.490.1 to 1.870.1 p<0.001). Maximal CVC during PORH was reduced in hypertensive patients: 0.30 (0.22-0.39) compared to controls: 0.39(0.31-0.49) with p<0.001. After therapy it increased to 0.41(0.29-0.51) with p<0.001. The change was significant only for the olmesartan subgroup (from 0.290.02 to 0.420.04 p<0.001). After treatment, the difference in time spent to reach peak flow during PORH inreased significantly in patients taking metoprolol but not in those taking olmesartan: -3.0 (-8.8 to 0.2) and 0.4 (-2.1 to 2.4) seconds after vs before, respectively p<0,001. Area under the Ach iontophoresis flow curve (AUC) was similar in controls and hypertensive patients, and increased after treatment, from 6087 (3857-9137) to 7296 (5577-10921) PU/s p=0.04. VEGF and Flt-1 receptor were similar among all groups and did not change with treatment. NO levels were higher in hypertensive individuals than in controls: 64.9 (46.8-117.6) vs 50.7 (42.0-57.5) M/dl p=0.02 and did not change with treatment. In conclusion, low-risk hypertensive patients show reduced capillary density/recruitment, and endothelial microvascular dysfunction. Both improve with treatment

Background: The relationship between erectile dysfunction and risk factors of atherosclerosis has been confirmed by a number of previous investigations. There are also plausible pathophysiological mechanisms explaining the observed association. One of the tested hypotheses in our work was the assumption that risk factors of atherosclerosis would be more prevalent in men with erectile dysfunction than in controls selected from the representative sample of the Czech population. Our work did not confirm this hypothesis. Most likely explanation can be greater representation of younger-middle aged men in our group than in the Czech post-Monica study in which the age distribution was equal. On the other hand authors of the Czech post-Monica study admit worse compliance in younger participants of their survey. Nevertheless, the risk factors of atherosclerosis occur very frequently in males with erectile dysfunction. Results: In our group mean cardiovascular risk calculated according to the SCORE chart was 3.39% (±3,39). In the Czech post-MONICA study conducted between 2007 and 2008 the mean SCORE risk reached 2.47%. There was a trend, though not statistically significant, towards direct relationship between the severity of ED and the SCORE CVD risk. Asymptomatic atherosclerosis was detected in 56.25% of our study...

Estudos de diagnóstico de vitalidade pulpar em dentes decíduos traumatizados, através da Fluxometria Laser Doppler (FLD), têm utilizado dentes tratados endodonticamente, porém o diagnóstico clínico é realizado em dentes necrosados. O objetivo deste estudo foi avaliar a FLD como teste de vitalidade pulpar em incisivos superiores decíduos traumatizados necrosados, desvitalizados (DES), antes e após tratamento endodôntico. Foram analisados em 57 crianças, de 40 a 85 meses de idade, valores de fluxo de dois dentes: IC DES - I VIT - 1 incisivo central necrosado (leitura antes e após a endodontia) e 1 incisivo central ou lateral vitalizado (leitura repetida em 2 sessões); I VIT - I VIT - 2 incisivos centrais ou laterais vitalizados (leitura em sessão única). Foi utilizado o Fluxômetro Laser Doppler (Moor Instruments, moorLab, Axminster, Inglaterra), diodo laser emitindo no comprimento de onda de 780nm, banda Doppler em 15kHz, sonda MP13 posicionada na vestibular a 4mm da margem gengival e estabilizada com posicionador de silicone. Foram avaliados dois parâmetros: F(UA), valor de fluxo de um único dente em unidades arbitrárias; F(%), variação percentual entre pares de dentes de um mesmo paciente. Estes parâmetros foram aplicados nos grupos antes e após a endodontia: F(UA) antes, F(UA) após, F(%) antes e F(%) após. No parâmetro F(UA), para os 29 IC DES antes, a variação de fluxo foi de 2,3 a 11,1UA, a média foi de 5,4UA e o desvio-padrão de 2,5UA. Para os 29 I VIT antes, a variação foi de 4,2 a 16,1UA (9,6 ± 3,5UA). Na segunda sessão, para os 29 IC DES após, foi de 1,3 a 7,4UA (3,4 ± 1,6UA), e para os 29 I VIT após foi de 3,6 a 19,7UA (9,3 ± 3,6UA). Para os 62 I VIT analisados em única sessão, a variação foi de 5,0 a 16,5UA (9,3 ± 2,4UA). No parâmetro F(%), para os 29 pares de IC DES antes - I VIT antes a variação foi de 28,0 a 98,1% (57,4 ± 17,2%). Para os 29 pares de IC DES após - I VIT após, de 18,0 a 84,5% (37,9 ± 15,2%). Para os 31 pares de I VIT - I VIT, foi de 57,5 a 146,5% (99,9 ± 23,3%). A performance dos parâmetros foi estimada pela área sob a curva ROC (AUC). Para F(UA) antes, a AUC foi de 0,862, para F(%) antes, a AUC foi de 0,941, para F(UA) após, a AUC foi de 0,975. Seus desempenhos, considerando intervalo de confiança de 95%, foram considerados entre moderadamente acurados e altamente acurados. Para F(%) após, a AUC foi de 0,987, sendo seu desempenho altamente acurado. Após comparação das AUCs, somente foi observada diferença significante, p=0,002, entre F(UA) antes e F(UA) após. Os pontos de corte propostos foram baseados nos dados obtidos antes da endodontia: para F(UA), valores menores ou iguais a 6,5UA classificam os dentes como desvitalizados e para F(%), valores menores ou iguais a 66,9%. Conclui-se que F(UA) e F(%) são parâmetros capazes de diferenciar dentes decíduos necrosados de dentes vitalizados, assim como de diferenciar dentes tratados endodonticamente de dentes vitalizados. / Studies on diagnosis of dental pulp necrosis in traumatized primary teeth using laser Doppler flowmetry (LDF) evaluate teeth with endodontic treatment; however, clinical diagnosis is performed in teeth with pulp necrosis. The aim of this study was to evaluate the LDF as pulp vitality test in traumatized primary upper incisors, with pulp necrosis (DES), before and after endodontic treatment. The pulpal flux values of 57 children, aged from 40 to 85 months, were evaluated: IC DES - I VIT - 1 central incisor with pulp necrosis (readings before and after endodontic treatment) and 1 vital central or lateral incisor (readings in 2 sessions); Control group: I VIT - I VIT - 2 vital incisors (readings in 1 session). The Laser Doppler Flowmeter (Moor Instruments, moorLab, Axminster, UK) was used. It is a diode laser emitting at 780 nm and bandwidth at 15 kHz. A MP13 probe was placed on the buccal surface of the tooth, 4mm from the gingival margin using silicone splints. Two parameters were evaluated: F(AU), the flux value of each tooth in arbitrary units, and F(%), the percentage variation of the flux value between pairs of teeth in the same patient. The two parameters were used before and after endodontic treatment: F(AU) before, F(AU)after, F(%) before and F(%) after. In the 29 IC DES before, F(AU) ranged from 2.3 to 11.1AU; the mean was 5.4AU and the standard deviation was 2.5AU; in the 29 I VIT before, ranged from 4.2 to 16.1AU (9.6 ± 3.5AU); in the 29 IC DES after, the values ranged from 1.3 to 7.4AU (3.4 ± 1.6AU), and in the 29 I VIT after, from 3.6 to 19.7AU (9.3 ± 3.6AU). In the 62 I VIT analyzed in one session, the values ranged from 5.0 to 16.5AU (9.3 ± 2.4AU). In respect to F(%), in the 29 pairs of IC DES before - I VIT before, the values ranged from 28.0 to 98.1% (57.4 ± 17.2%); in the 29 pairs of IC DES after - I VIT after, from 18.0 to 84.5% (37.9 ± 15.2%); in the 31 pairs of I VIT - I VIT, from 57.5 to 146.5% (99.9 ± 23.3%). The performance of both tests was estimated by the area under the ROC curve (AUC). Regarding F(AU) before, the AUC was 0.862; in F(%) before, the AUC was 0.941; in F(AU) after, the AUC was 0.975. The performances were classified between moderate and highly accurate (95% Confidence Interval). Regarding F(%) after, the AUC was 0.987 and its performance was highly accurate. Comparing the AUCs, there was statistical significance (p=0.002), between F(AU) before and F(AU) after. The cut-off values were based on data before endodontic treatment. The F(AU) values that were equal to or smaller than 6.5AU, and the F(%) values that were equal to or smaller than 66.9% classified the tooth as non-vital The two parameters studied, F(AU) and F(%), are able to distinguish non-vital primary teeth from vital teeth, and to distinguish vital teeth from teeth with endodontic treatment.