No presente estudo, duas importantes situações foram abordadas no intuito de se melhor entender os mecanismos homeostáticos dos pressorreceptores na gênese da hipertrofia cardíaca em resposta à hipertensão renovascular: o efeito do tempo de clipe na artéria renal e o efeito dos níveis pressóricos e da variabilidade da pressão arterial. O curso temporal mostrou que, antes mesmo da instalação da hipertensão, há alteração da morfologia cardíaca, qual seja o desenvolvimento de uma hipertrofia ventricular excêntrica e, como forma de mecanismo compensatório, um aumento da expressão de algumas proteínas da homeostase do cálcio (fosfolambam fosforilada pela serina-16 e corrigido pelo fosfolambam total em 100% e fosfolambam fosforilado pela treonina-17 e corrigido pelo fosfolambam total em 54%). Uma vez instalada a hipertensão, observou-se um remodelamento ventricular esquerdo para o tipo concêntrico, com prejuízo da função diastólica e um desbalanço do sistema nervoso autonômico, com aumento da atividade simpática, observado pelo aumento da razão dos componentes de baixa freqüência (LF) e alta freqüência (HF) no tacograma (0,44 ± 0,10 vs. 0,20 ± 0,03 nos controles). A análise do efeito da pressão arterial e da variabilidade da pressão arterial mostrou uma correlação positiva com o grau de hipertrofia ventricular esquerda (r=0,76, p<0,01). A secção cirúrgica dos pressorreceptores somada à implantação do clipe na artéria renal mostrou adaptações cardiovasculares em níveis semelhantes (mesmo nível de hipertensão) e, por vezes maiores (modulação simpática para o coração e para os vasos, hipertrofia ventricular esquerda e disfunção diastólica), ao grupo cuja artéria renal foi estenosada e que permaneceu com os barorreceptores intactos. Estas respostas aconteceram num período de tempo três vezes menor na ausência do barorreflexo. Tais observações ressaltam o importante efeito homeostático do barorreflexo na gênese das respostas cardíacas adaptativas à hipertensão arterial / In the present study, two important situations were observed to evaluate the role of the baroreceptors in the genesis of cardiac hypertrophy in response to hypertension: the effect of the time-course of the clip in the renal artery and the effect of the level of arterial blood pressure (ABP) and blood pressure variability (ABPV). The time-course evaluation showed that even before hypertension was installed, cardiac alterations could be observed, as a left ventricular eccentric hypertrophy. Compensatory mechanisms, such as an increase in some calcium homeosthatic proteins, could also be noticed (increase in phosphorilated phospholmaban at threonin-17 corrected by total phospholamban in 54% and increase in phosphorilated phospholmaban at serine-16 corrected by total phospholamban in 100%). However, once hypertension was established, left ventricle morphology changed to a concentric hypertrophy, accompanied by a diastolic dysfunction and enhanced sympathetic modulation, observed by relation between low-frequency component (LF) and high-frequency component (HF) at tachogram (0,44 ± 0,10 vs. 0,20 ± 0,03 in control group). ABP and ABPV analyses showed an important positive correlation with the degree of left ventricular hypertrophy (r=0,76, p<0,01). However, the absence of baroreceptors in one of the hypertensive groups, evoked the same cardiovascular alterations (same level of hypertension) or even worse (sympathetic modulation for heart and vessels, left ventricular hypertrophy and diastolic dysfunction) reached by the hypertensive baroreceptors-preserved group. These cardiovascular responses were observed in a period that correspond one third of time to the group with intact baroreflex. These observations lead us to conclude the importance of homeosthatic effects of the baroreflex in the genesis of cardiac responses to hypertension

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No description available.

The increase in patients presenting to the emergency department (ED) for primary care poses a serious safety issue in the care that can be provided. In a care area that is overcrowded, physicians, nurses, ancillary department staff, and other care team members may have a difficult time delivering care. Poorly managed flow in the ED leads to overcrowding, and patients with life-threatening illnesses are less likely to be transitioned to designated specialized areas in a safe and efficient manner. The practice-focused question was whether processes to improve the flow of patients entering the ED decreased the number of patients leaving without being seen, decreased time from the time entering the ED to hospital admission, improved the average length of stay, and increased patient satisfaction. The plan-do-check-act methodology was used to address this quality improvement project. Results of the project demonstrated a decrease in the number of patients leaving without being seen, a decrease in the time entering the ED to hospital admission, a decrease in average length of stay, and an increase in patient satisfaction. This project provided positive social change to the patients, families, organization, and community by improving the ED processes to ensure patient needs were addressed as rapidly as possible.

Idrottshjärta är ett kardiovaskulärt tillstånd som uppträder under längre perioder av intensiv träning som orsakar strukturella, funktionella och elektriska förändringar hos hjärtat och är en fysiologisk anpassning som svar på ett ökat hemodynamiskt behov under fysisk ansträngning. De fysiologiska anpassningarna har dock blivit ett diagnostiskt dilemma att urskilja från de patologiska förändringarna såsom hypertrofisk kardiomyopati. Det finns därför ett behov av standardisering av kardiovaskulär screening hos idrottare för att upptäcka underliggande eller dolda kardiomyopatier som kan leda till allvarliga konsekvenser under fysisk ansträngning. Studiens ändamål var att undersöka den systoliska och diastoliska vänsterkammarfunktionen under ansträngning hos idrottare och öka förståelsen om vad som händer med de olika variablerna under arbete. Nio friska idrottare genomförde stressekokardiografi där cardiac index, ejektionsfraktion, fyllnadstryck, mitralisklaffplanets longitudinella rörelse (MAPSE), mitralisinflöde, vävnadsdoppler (e´ och s´) och veninflöde undersöktes före, under och efter ett ansträngningstest på ergometercykel. Variablerna under och efter cykeltestet jämfördes sedan med värdena i vila. Resultaten visade en signifikant ökning av cardiac index, MAPSE och vävnadsdoppler under ansträngning. Sammanfattningsvis visade studien att flera av variablerna förbättrades under ansträngning och en del av de visade sig vara relativt okänsliga för störningar och artefakter vilket kan vara användbart för framtida studie protokoll som avser utföra en hjärtstudie under arbete. / Athlete’s heart is a cardiovascular condition that occurs during extended periods of intense exercise that causes structural, functional and electrical changes of the heart and is a physiological adaptation in response to increased hemodynamic needs during physical exertion. However, the physiological adaptations have become a diagnostic dilemma to distinguish from the pathological changes such as hypertrophic cardiomyopathy. Therefore, there is a need for standardization of cardiovascular screening in athletes to detect underlying or hidden cardiomyopathies that can lead to severe consequences during physical exercise. The aim of the present study was to investigate the systolic and diastolic left ventricular function during exercise in athletes and to increase the understanding of what happens to the various variables during exertion. Nine healthy athletes conducted stress echocardiography where cardiac index, ejection fraction, filling pressure, mitral annular plane systolic excursion (MAPSE), mitral inflow, tissue Doppler imaging (e 'and s') and pulmonary venous inflow were examined before, during and after a cycle ergometer test. The variables during and after the cycle test were then compared to baseline. The results showed a significant increase in cardiac index, MAPSE, and tissue Doppler imaging during exertion. In conclusion, the study showed that several of the variables improved during exertion and some of them proved to be quite insensitive to disturbances and artifacts, which may be useful in future study protocols that consider carrying out a cardiac study during work.

No description available.

The relationship of current manual preference (phenotypic handedness) and family history of handedness (genotypic handedness) to memory for imageable stimuli was studied. The purpose of the study was to test the hypothesis that genotypic handedness was related to lessened cerebral lateralization of Paivio's (1969) dual memory systems. The structure of memory was not at issue, but the mediation of storage and retrieval in memory has been explained with reference to verbal or imaginal processes. Verbal mediation theories and supporting data were reviewed along with imaginal theories and supporting data for these latter theories. Paivio's (1969) dual coding and processing theory was considered a conceptual bridge between the competing positions.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13380号 / 論医博第2214号 / 新制||医||1047(附属図書館) / 京都大学大学院医学研究科外科系専攻 / (主査)教授 山下 潤, 教授 木村 剛, 教授 浅野 雅秀 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13428号 / 論医博第2232号 / 新制||医||1053(附属図書館) / (主査)教授 湊谷 謙司, 教授 佐藤 俊哉, 教授 福田 和彦 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13435号 / 論医博第2234号 / 新制||医||1054(附属図書館) / (主査)教授 石見 拓, 教授 佐藤 俊哉, 教授 湊谷 謙司 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM