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Prieširdžių virpėjimo gydymas elektrine kardioversija ir veiksniai, sąlygojantys jos efektyvumą / Direct current cardioversion of atrial fibrillation and factors influencing its effectivenessStanaitienė, Giedrė 02 October 2008 (has links)
Prieširdžių virpėjimas (PV) dažniausiai klinikinėje praktikoje pasitaikanti širdies aritmija. PV dažnis populiacijoje – 0,4–1 proc. ir su amžiumi didėja, o tarp vyresnių nei 80 metų žmonių išauga iki 8 proc. Per pastaruosius 20 metų hospitalizavimo dėl PV atvejų padaugėjo 66 proc. PV metu išnyksta normali prieširdžių sistolė, vyksta prieširdžių remodeliavimasis, širdies ertmėse susidaro trombai, trinka hemodinamika. Tai susiję su sunkiomis komplikacijomis: širdies funkcijos nepakankamumu, insultu ir padidėjusiu mirštamumu. Veiksmingiausias PV nutraukimo būdas – elektrinė kardioversija, kuri klinikinėje praktikoje taikoma nuo 1962 m.
Darbo tikslas – įvertinti prieširdžių virpėjimo gydymą elektrine kardioversija ir veiksnius, sąlygojančius jos efektyvumą. Darbo uždaviniai:
1. Nustatyti veiksnius, turinčius įtakos elektrinės kardioversijos efektyvumui.
2. Nustatyti ir įvertinti optimalią pradinio elektros impulso energiją, reikalingą prieširdžių virpėjimui nutraukti.
3. Nustatyti veiksnius, turinčius įtakos ankstyvajam prieširdžių virpėjimo atkryčiui po elektrinės kardioversijos.
4. Įvertinti veiksnius, nulemiančius elektrinės kardioversijos komplikacijas.
Kauno medicinos universiteto Kardiologijos klinikos Kardiologijos intensyviosios terapijos skyriuje 2005–2007 m. atliktas prospektyvusis atsitiktinių imčių klinikinis tyrimas. Ištirta 224 prieširdžių virpėjimu sergančių pacientų, kuriems nuspręsta taikyti elektrinę kardioversiją sinusinio ritmo atkūrimui. Atsitiktinai... [toliau žr. visą tekstą] / Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. AF occurs in 0.4 – 1 % of population and its frequency increases with age and reaches 8 % above 80 years age. During the last 20 years hospitalization for AF rate increased by 66 %. In AF normal atrial systole does not occur, atrial remodeling starts, intracardiac thrombi start forming, haemodynamics becomes compromised. That leads serious complications – heart failure, stroke and increased mortality rate. The most effective AF termination method is direct current cardioversion, which has been used in clinical practice since 1962.
The aim of the study was to evaluate the treatment of atrial fibrillation by direct current cardioversion and to identify the factors, contributing to its effectiveness.
The objectives of the study:
1. To identify the factors, contributing to the effectiveness of direct current cardioversion.
2. To estimate and to evaluate the optimal energy of the initial electrical impulse required to terminate atrial fibrillation.
3. To identify the factors, contributing to immediate recurrence of atrial fibrillation after successful direct current cardioversion.
4. To evaluate the factors, influencing complications after direct current cardioversion.
A prospective randomized clinical trial has been held in Intensive Care Unit of the Department of Cardiology of Kaunas Medical University Hospital between 2005 and 2007.
We examined 224 patients with AF, selected for electrical... [to full text]
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The Combined and Differential Effects of Monophasic and Biphasic Repetitive Transcranial Magnetic Stimulation on ERP-Indexed Attentional Processing in Treatment-Resistant DepressionHyde, Molly 10 December 2019 (has links)
In addition to low mood, major depressive disorder (MDD) is characterized by persistent cognitive deficits that impair daily functioning and resist improvement with conventional pharmacotherapies. Repetitive transcranial magnetic stimulation (rTMS) holds promise as an efficacious alternative, offering better outcomes than medication for patients with treatment-resistant depression (TRD). Yet, current rTMS protocols that administer sinusoidal biphasic pulses achieve remission in less than the majority. However, monophasic pulses may yield higher success rates based on greater cortical excitation/neuromodulation strength. MDD is associated with altered P300 event-related potentials (ERPs), indexing decreased attentional resource allocation and slower cortical processing speed. Using a cohort of 20 TRD patients who received high-frequency rTMS, this study aimed to assess the impact of monophasic and biphasic stimulation on attention-related P300 measures and their utility as correlates of clinical/cognitive response. Based on baseline and post-treatment change in P300 components, rTMS-induced increases in automatic attention/passive information processing differed by pulse type and predicted greater clinical improvement in depressed individuals. This study represents an important step towards identifying cognitive changes and underlying cortical mechanisms associated with rTMS response and targeted MDD treatment.
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Limiar de comando ventricular de marcapasso cardíaco após choque transtorácico utilizando diferentes formatos de onda : um estudo experimental / Ventricular pacing threshold of cardiac pacemaker after transthoracic external shock with different waveforms : an experimental studyAssumpção, Antonio Carlos, 1960- 12 December 2013 (has links)
Orientador: Orlando Petrucci Junior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T07:48:01Z (GMT). No. of bitstreams: 1
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Previous issue date: 2013 / Resumo: Introdução: O aumento do limiar de estimulação ventricular (LEV) tem sido observado após a administração de choque elétrico de cardioversão/desfibrilação transtorácico (CDT) para desfibrilação ventricular, contudo, poucos estudos têm avaliado este fenômeno no que diz respeito à energia e a forma de onda empregada para a CDT. Este estudo analisou o LEV após CDT de 360J, comparando-se os resultados após aplicação de onda de energia Mono e Bi. Método: Em suínos Landrace femininos foram implantados sistema de estimulação permanente de marcapasso, divididos em três grupos: sem indução de fibrilação ventricular (FV) e CDT com formato de onda monofásica (Mono) e bifásica (Bi) (Grupo I); indução FV, um minuto de observação sem intervenção, dois minutos de massagem cardíaca externa, e CDT Mono e Bi (Grupo II) e indução de FV, dois minutos de observação sem intervenção, quatro minutos de massagem cardíaca externa e CDT Mono e Bi (Grupo III). Após CDT, o LEV foi avaliado a cada minuto durante dez minutos. Resultados: Um total de 143 experimentos foram concluídos. No final do período de observação, os grupos I e II mostraram valores constantes LEV. O Grupo III mostrou aumento no LEV Mono e Bi com energia externa, sem diferença entre os formatos de ondas externas. O formato Mono foi associada a valores mais elevados de LEV quando o tempo de parada cardiorrespiratória (PCR) foi maior, o que não foi verificado na Bi. Conclusão: A CDT não tem impacto significativo sobre o LEV. Com onda Mono, observou-se aumento do LEV quando o período de PCR foi mais longo / Abstract: Introduction. Although an increase in the ventricular pacing threshold (VPT) has been observed after administration of transthoracic shock for ventricular defibrillation, few studies have evaluated the phenomenon in respect to the defibrillation waveform energy. Therefore, this study examined the VPT behavior after transthoracic shock with a monophasic or biphasic energy waveform. Method. Domestic Landrace female piglets implanted with a permanent pacemaker stimulation system were divided into 3 groups: no ventricular fibrillation (VF) induction and transthoracic shock with monophasic or biphasic energy (group I); VF induction, 1 minute of observation without intervention, 2 minutes of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group II); and VF induction, 2 minutes of observation without intervention, 4 minutes of external cardiac massage, and transthoracic shock with monophasic or biphasic energy (group III). After external shock, the VPT was evaluated every minute for 10 minutes. Results. A total of 143 experiments were performed. At the end of the observation period, groups I and II showed steady VPT values. Group III showed an increase in VPT with monophasic or biphasic external energy, with no difference between the external energy sources. The monophasic but not the biphasic waveform was associated with higher VPT values when the VF was longer. Conclusion. Defibrillation does not have a significant impact on pacing threshold, but a longer VF period is related to a higher VPT after defibrillation with monophasic waveform / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências
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PIS e COFINS e os regimes de tributação cumulativo, não-cumulativo e monofásico: limites e pressupostosFeitosa, Marcos Antonio Nepomuceno 15 June 2010 (has links)
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Previous issue date: 2010-06-15 / This work treats about the constitutional limitations and presuppositions applied to
the cumulative, non-cumulative and monophasic schemes of PIS and Cofins, from a
review of the constitutional criteria pertaining to each scheme and the compatibility of
the ordinary legislation with the standard of tax competence. To this end it was
analyzed the concept of "revenue", of "non-cumulative" and of "section of the
economical activity " adopted by the Constitution, that conflict with the used by the
ordinary legislator, then pointing the main unconstitutionalities of each schemes in
this work / O presente trabalho trata dos limites e pressupostos constitucionais aplicados aos
regimes cumulativo, não cumulativo e monofásico do PIS e da Cofins, partindo de
uma análise dos critérios constitucionais inerentes a cada um desses regimes e a
compatibilidade da legislação ordinária com a norma de competência tributária. Para
tanto, analisou-se o conceito de faturamento , de não cumulatividade e de setor
da atividade econômica adotado pela Constituição, conflitando com o empregado
pelo legislador ordinário, apontando em seguida as principais inconstitucionalidades
de cada um dos regimes abordados neste trabalho
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