Thesis (M.S.)--East Carolina University, 2009. / Presented to the faculty of the Department of Exercise and Sport Science. Advisor: Joseph Houmard. Title from PDF t.p. (viewed May 4, 2010). Includes bibliographical references.

Thesis (M.S.)--Ohio State University, 2005. / Includes bibliographical references (leaves 45-47). Available online via OhioLINK's ETD Center

Kein

Made available in DSpace on 2014-06-11T19:27:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-27Bitstream added on 2014-06-13T19:57:00Z : No. of bitstreams: 1 luperini_bco_me_botfm.pdf: 564910 bytes, checksum: 91757ff2101acf986d486de210c8c0ba (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A obesidade é uma desordem multifatorial que envolve fatores hereditários, ambiente e estilo de vida, e suas consequências não são apenas sociais ou psicológicas, mas estão também relacionadas à presença de co-morbidades como a hipertensão arterial, diabetes tipo 2, doenças cardiovasculares e vários tipos de câncer. Sabe-se, hoje, que há genes relacionados ao peso corporal, embora as relações entre genética e obesidade sejam ainda questões de muito debate. Portanto, o presente estudo teve como objetivos avaliar os níveis de danos no DNA (teste cometa) em linfócitos de pacientes obesas (n=300) e mulheres eutróficas (n=300); a frequência de polimorfismos dos genes FTO (rs9939609) e APM1: 45T/G (rs2241766) e a existência de associação entre essas variantes gênicas e a incidência de lesões genotóxicas nessas populações. Os dados obtidos evidenciaram que as mulheres obesas possuem maiores níveis de lesões primárias no DNA de linfócitos, incluindo purinas e pirimidinas oxidadas, independentemente de seus genótipos para os genes FTO e APM1. A avaliação das variantes do gene FTO mostrou que os genótipos AA e TT foram, respectivamente, mais e menos frequentes nas pacientes obesas do que nas mulheres do grupo controle e que aquelas com a variante AA em ambos os grupos apresentaram maiores níveis de lesões nos DNA. Para o gene APM1, o genótipo TT foi o mais frequente em ambos os grupos, mas as mulheres com as variantes TG+GG foram as que apresentaram níveis mais elevados de lesões genotóxicas. Esses resultados indicaram, portanto, que a obesidade está relacionada a níveis mais altos de lesões genotóxicas em linfócitos de sangue periférico e que o genótipo AA do gene FTO, além de ser mais frequente em mulheres com obesidade mórbida está associado a maiores níveis de danos no DNA, assim como o alelo G do gene APM1. Assim sendo, pode-se... / Obesity is a multifactorial disorder which involves heredity, environment and lifestyle. Its consequences are not just social or psychological, but also related to the presence of comorbidities such as hypertension, type 2 diabetes, cardiovascular disease and various types of cancer. Although some genes have been associated to body weight, the relationship between genetics and obesity are still object of debate. Therefore, this study aimed to assess the level of DNA damage (comet assay) in lymphocytes from morbid obese patients (n=300) and normal weight women (n=300); the frequencies of FTO (rs9939609) and APM1: 45T/G (rs2241766) gene polymorphisms and the relationship between these gene variants and the amount of genotoxic damage were also investigated. Data showed higher level of DNA primary lesions, including oxidized purines and pyrimidines, in lymphocytes of obese than in eutrophic women, regardless their FTO and APM1 genotypes. The AA and TT FTO genotypes were respectively more and less frequents in obese patients than in the control population. Those women with the AA variant, in both groups, presented the highest levels of DNA damage. For APM1 gene, TT genotype was the most frequent in both groups, however women with the allele G (TG+GG variants) presented the highest levels of genotoxic damage. These results indicated that obesity is associated to high levels of genotoxic damage in peripheral blood lymphocytes, and that the AA genotype of the FTO gene is related to morbid obesity and to the highest levels of DNA damage, as well as the G allele of the APM1 gene. In conclusion, obese patients with FTO AA genotypes are at higher risk... (Complete abstract, click access below)

Orientador: Daisy Maria Favero Salvadori / Banca: Celso Vieira de Souza Leite / Banca: Elza Tiemi Sakamato Hojo / Banca: Maria Rita Marques de Oliveira / Banca: Rozangela Verlengia / Resumo: A obesidade é uma desordem multifatorial que envolve fatores hereditários, ambiente e estilo de vida, e suas consequências não são apenas sociais ou psicológicas, mas estão também relacionadas à presença de co-morbidades como a hipertensão arterial, diabetes tipo 2, doenças cardiovasculares e vários tipos de câncer. Sabe-se, hoje, que há genes relacionados ao peso corporal, embora as relações entre genética e obesidade sejam ainda questões de muito debate. Portanto, o presente estudo teve como objetivos avaliar os níveis de danos no DNA (teste cometa) em linfócitos de pacientes obesas (n=300) e mulheres eutróficas (n=300); a frequência de polimorfismos dos genes FTO (rs9939609) e APM1: 45T/G (rs2241766) e a existência de associação entre essas variantes gênicas e a incidência de lesões genotóxicas nessas populações. Os dados obtidos evidenciaram que as mulheres obesas possuem maiores níveis de lesões primárias no DNA de linfócitos, incluindo purinas e pirimidinas oxidadas, independentemente de seus genótipos para os genes FTO e APM1. A avaliação das variantes do gene FTO mostrou que os genótipos AA e TT foram, respectivamente, mais e menos frequentes nas pacientes obesas do que nas mulheres do grupo controle e que aquelas com a variante AA em ambos os grupos apresentaram maiores níveis de lesões nos DNA. Para o gene APM1, o genótipo TT foi o mais frequente em ambos os grupos, mas as mulheres com as variantes TG+GG foram as que apresentaram níveis mais elevados de lesões genotóxicas. Esses resultados indicaram, portanto, que a obesidade está relacionada a níveis mais altos de lesões genotóxicas em linfócitos de sangue periférico e que o genótipo AA do gene FTO, além de ser mais frequente em mulheres com obesidade mórbida está associado a maiores níveis de danos no DNA, assim como o alelo G do gene APM1. Assim sendo, pode-se... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Obesity is a multifactorial disorder which involves heredity, environment and lifestyle. Its consequences are not just social or psychological, but also related to the presence of comorbidities such as hypertension, type 2 diabetes, cardiovascular disease and various types of cancer. Although some genes have been associated to body weight, the relationship between genetics and obesity are still object of debate. Therefore, this study aimed to assess the level of DNA damage (comet assay) in lymphocytes from morbid obese patients (n=300) and normal weight women (n=300); the frequencies of FTO (rs9939609) and APM1: 45T/G (rs2241766) gene polymorphisms and the relationship between these gene variants and the amount of genotoxic damage were also investigated. Data showed higher level of DNA primary lesions, including oxidized purines and pyrimidines, in lymphocytes of obese than in eutrophic women, regardless their FTO and APM1 genotypes. The AA and TT FTO genotypes were respectively more and less frequents in obese patients than in the control population. Those women with the AA variant, in both groups, presented the highest levels of DNA damage. For APM1 gene, TT genotype was the most frequent in both groups, however women with the allele G (TG+GG variants) presented the highest levels of genotoxic damage. These results indicated that obesity is associated to high levels of genotoxic damage in peripheral blood lymphocytes, and that the AA genotype of the FTO gene is related to morbid obesity and to the highest levels of DNA damage, as well as the G allele of the APM1 gene. In conclusion, obese patients with FTO AA genotypes are at higher risk... (Complete abstract, click access below) / Mestre

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A obesidade mÃrbida à uma doenÃa muito freqÃente nos dias de hoje. O paciente obeso mÃrbido apresenta importantes alteraÃÃes fisiolÃgicas e anatÃmicas, alÃm de comorbidades de grande significado clÃnico, particularmente cardiovasculares, respiratÃrias e metabÃlicas, exigindo do mÃdico anestesiologista pleno conhecimento dessas peculiaridades, para que possa realizar uma abordagem segura, tendo em vista que os procedimentos cirÃrgicos tÃm sido cada vez mais constantes nesse grupo de indivÃduos. O objetivo deste estudo clÃnico, prospectivo e nÃo aleatÃrio, foi avaliar os efeitos da administraÃÃo do agente agonista &#945;2 adrenÃrgico clonidina, como fÃrmaco coadjuvante de tÃcnica anestÃsica padronizada para cirurgia da obesidade em 36 pacientes que pertenciam ao grupo de obesidade mÃrbida do Hospital UniversitÃrio Walter CantÃdio. Foram distribuÃdos em dois grupos: o primeiro grupo composto por 25 pacientes recebeu clonidina administrada em infusÃo contÃnua na dose de 2 mcg/kg de peso ideal, iniciada dez minutos antes da induÃÃo anestÃsica e mantida em seguida, na dose de 0,4 a 0,7 mcg/kg/h de peso ideal, tendo sido descontinuada no inÃcio do fechamento da aponeurose; o segundo grupo composto por 11 pacientes, nÃo recebeu a infusÃo do agente agonista, entretanto todo o restante da tÃcnica anestÃsica foi igual. As principais variÃveis avaliadas foram a pressÃo arterial sistÃlica e diastÃlica, a freqÃÃncia cardÃaca, o Ãndice bispectral (BIS), a concentraÃÃo expirada de sevoflurano (CESEV), a sensaÃÃo de dor, o mini-exame do estado mental (MEEM) e os nÃveis glicÃmicos. Quanto aos dados demogrÃficos, nÃo houve diferenÃa entre os dois grupos estudados. Com relaÃÃo aos parÃmetros hemodinÃmicos, houve aumento da pressÃo sistÃlica e diastÃlica no momento da incisÃo cirÃrgica no grupo controle (P < 0,05). NÃo houve diferenÃa na funÃÃo cognitiva. Foi verificada uma melhor analgesia pÃs-operatÃria no grupo clonidina (P< 0,05). NÃo houve diferenÃa significativa no comportamento glicÃmico no perÃodo peri-operatÃrio quando foram analisados os dois grupos, porÃm quando se analisou apenas os pacientes do grupo clonidina, observou-se que nos nÃo diabÃticos, ocorreu um aumento significativo da glicemia durante o perÃodo intra-operatÃrio (P < 0,05), no entanto, sem ultrapassar o valor de 200 mg/dl. Houve maior controle hemodinÃmico intra-operatÃrio com a utilizaÃÃo da clonidina. O grupo clonidina apresentou um despertar mais rÃpido ao final da cirurgia e tambÃm obteve melhor analgesia no perÃodo pÃs-operatÃrio. O uso do fÃrmaco nÃo interferiu com o retorno das funÃÃes cognitivas. Em baixas doses, a clonidina nÃo determinou alteraÃÃes nos nÃveis glicÃmicos no perÃodo peri-operatÃrio, entretanto, nos pacientes diabÃticos em que o agonista foi administrado, observou-se um melhor controle da glicemia, o que nÃo foi demonstrado nos pacientes nÃo diabÃticos. Os pacientes dos dois grupos nÃo apresentaram efeitos adversos. / Morbid obesity is very frequent nowadays. The morbidly obese patient presents important anatomical and physiological changes, and comorbidities of great clinical significance, particularly cardiovascular, respiratory and metabolic demands of the physician anesthesiologist must be aware of these peculiarities, so you can make a safe approach, considering that the surgical procedures have been increasingly appearing in this group of individuals. The objective of this clinical, prospective and not randomized, was to evaluate the effects of administration of the &#945;2-adrenergic agonist clonidine as an adjunct to drug standardized anesthetic technique for obesity surgery in 36 patients who belonged to the group of morbid obesity at the university hospital . Were divided into two groups: the first group of 25 patients received clonidine administered by continuous infusion at a dose of 2 mcg / kg ideal body weight, which started ten minutes before induction of anesthesia and then maintained at a dose from 0,4 to 0,7 mcg / kg / h of ideal weight, having been discontinued in the early closure of the aponeurosis and the second group of 11 patients did not receive the infusion of the agonist, however the rest of the anesthetic technique was equal. The main variables evaluated were systolic and diastolic blood pressure, heart rate, bispectral index (BIS), the expired concentration of sevoflurane, pain sensation, the mini-mental state examination (MMSE) and levels glucose. With regard to demographics, there was no difference between the two groups. With respect to hemodynamic parameters, an increase of systolic and diastolic blood pressure at the time of surgical incision in the control group (P <0.05). There was no difference in cognitive function. It was observed a better postoperative analgesia in the clonidine group (P <0.05). There was no significant difference in glycemic levels in the peri-operative when they examined the two groups, but when we examined only patients in the clonidine group, we observed that in nondiabetic patients, there was a significant increase in blood glucose during the intraoperative (P <0.05), however, not to exceed 200 mg / dl. There was greater intraoperative hemodynamic control with the use of clonidine. The clonidine group showed a more rapid awakening at surgery and also achieved better analgesia in the postoperative period. The use of the drug did not interfere with the recovery of cognitive function. At low doses, clonidine did not cause changes in glucose levels in the perioperative period, however, in diabetic patients in which the agonist was administered, there was a better glucose control, which was not demonstrated in nondiabetic patients. Patients in both groups showed no adverse effects.

Introdução: A prevalência de obesidade cresce rapidamente na população brasileira. Para obesidade mórbida, o único tratamento efetivo é a cirurgia bariátrica, que proporciona redução do peso, das comorbidades associadas e aumento da qualidade de vida. O objetivo deste estudo foi verificar o impacto da cirurgia bariátrica na saúde bucal dos pacientes com obesidade mórbida através de uma coorte prospectiva. A hipótese é que a cirurgia bariátrica poderia causar piora da saúde bucal. Método: Todos os pacientes que realizaram cirurgia bariátrica no Hospital Nossa Senhora da Conceição entre outubro de 2009 e janeiro de 2011 foram convidados a participar do estudo. Medidas: foram realizados exames bucais (cárie, pelo índice ICDAS; índices de placa e sangramento gengival; fluxo salivar em repouso e estimulado; uso de próteses) e entrevistas (dados sócio-demográficos, hábitos bucais, sensação subjetiva de boca seca, doenças sistêmicas e medicamentos em uso) em duas etapas, uma linha de base um dia antes da cirurgia e um exame de acompanhamento seis meses após a cirurgia. Foi realizada análise descritiva das variáveis, qui-quadrado, teste exato de Fischer, teste t de student para amostras pareadas e teste de Mann-Whitney. 9Continua) Resultados: Trinta e nove pacientes concluíram as duas etapas do estudo. Houve redução estatisticamente significativa na prevalência de hipertensão arterial (p<0,01), diabetes (p<0,01), número de medicamentos utilizados diariamente (p<0,01), sensação subjetiva de boca seca (p<0,01) e aumento do fluxo salivar estimulado (p<0,01). Conclusão: Os resultados mostram melhora na saúde bucal dos pacientes submetidos à cirurgia bariátrica, já que a sensação de boca seca diminuiu e o fluxo salivar aumentou. Estes 6 resultados rejeitam a hipótese do estudo e podem ser reflexo da melhora na saúde sistêmica destas pessoas e da redução significativa do número de medicamentos utilizados por elas diariamente. / Background: The prevalence of obesity is increasing in the Brazilian population. For morbid obesity, the only effective treatment is bariatric surgery, resulting in weight reduction, less comorbidities and icreased quality of life. The aim of this study was to assess the impact of bariatric surgery in oral health parameters of morbid obese patients by a prospective cohort study. The hypothesis is that bariatric surgery causes oral health deterioration. Methods: All patients who underwent bariatric surgery at the Nossa Senhora da Conceição Hospital between October 2009 an January 2011 were invited to participate. Thirty-nine patients completed the two stages of the study, a baseline one day before surgery and a follow-up after six months. Measurements: Oral examinations were performed (caries by means of the ICDAS index, plaque index, gingival index, rest and stimulated saliva flow and use of prostheses) and followed by a questionnaire (socio-demographic data, oral health behavior, xerostomia, systemic diseases and medicines intake) in two distinct moments, a baseline 1 day before surgery and a follow-up examination six months after surgery. Analysis was carried out by means of, chi-square, Fischer’s exact test, paired samples Student’s t test and Mann-Whitney test. Results: There was a statistically significant reduction in the prevalence of hypertension (p<0,01), diabetes (p<0,01), number of medications taken daily (p<0,01), subjective sensation of dry mouth (p<0,01) and increased stimulated salivary flow (p<0,01). Conclusions: The results show improvement in oral health of patients undergoing bariatric surgery, as the sensation of dry mouth decreased and salivary flow increased. These results reject the hypothesis of the study and may reflect the improvement in the systemic health of morbid obese people and the significant reduction in the number of drugs used by them.

<p>Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI>40 kg/m²), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course.</p><p>The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach.</p><p>The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients.</p><p>Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology</p><p>(pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state.</p><p>This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.</p>

Roux-en-Y gastric bypass (RYGBP) sustains weight loss and ameliorates diseases common in the morbid obese (BMI&gt;40 kg/m2), but leaves the stomach and duodenum inaccessible. Morbidly obese patients have increased operative risks and in other fields minimal surgery is known to facilitate the postoperative course. The aim of this thesis was to evaluate hand-assisted laparoscopy in RYGBP and develop techniques to study the excluded stomach. The hand-assisted technique was developed in 13 patients and subsequently compared to open surgery in a blinded, prospective, randomised trial of 50 patients. Hand-assistance was feasible with a low need for conversions or re-operations. The duration of surgery was longer (150 versus 85 minutes) and postoperative results were similar to those in open surgery. Thus, the patients did not appear to derive benefits from hand-assisted laparoscopy. Interventional radiology accessed the excluded stomach and allowed endoscopy, barium studies and acid measurements. Chronic gastritis and low acid production were found. After RYGBP, 8 of 22 patients (36%) had duodenogastric bile reflux (DGBR), when studied by HIDA-scintigraphy. No DGBR was seen among controls. The gastric mucosa was evaluated by serology (pepsinogen I (PGI), H. pylori and H,K-ATPase) in 64 patients before and 1-4 years after operation. RYGBP, in contrast to gastric restriction, had reduced PGI levels postoperatively. According to serology, the mucosa is atrophic or in a resting state. This study focuses on safety in RYGBP. Hand-assisted laparoscopy was feasible, but not favourable compared to an optimised open procedure. The excluded stomach is no longer inaccessible and characterised by chronic gastritis, low acid production and frequent bile reflux.

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [110]-123).