Skeletal muscle regeneration is a multifaceted process requiring the spatial and temporal coordination of myogenesis as well as angiogenesis. While these processes are often studied independently, recent evidence from our lab has shown that the resident adult stem cell population within skeletal muscle, called satellite cells, begins secreting soluble growth factors likely to contribute to the proangiogenic response. The overall aim of this study is to investigate the role of pro-angiogenic factors secreted by satellite cells during skeletal muscle regeneration. Results from the study indicate that Hepatocyte Growth Factor (HGF) is a critical protein for the proangiogenic effect of satellite cells. It was also shown that in hypoxic environments, such as those seen in an injury state, it appears that satellite cells decrease their proangiogenic effect if oxygen levels fall below a threshold level. This decrease in pro-angiogenic effect in the hypoxic environment appears to be due to the decrease in HGF expression and protein secretion and is not compensated for by the increase in Vascular Endothelial Growth Factor secretion also seen in the hypoxic response. Furthermore, the regulation of HGF in these hypoxic conditions appears to be in part due to increased levels of hypoxia inducible factor, which are acting on the hypoxia response element site found on the HGF promoter. In the last set of experiments, this injury response was further investigated as the effect of satellite cell mediated angiogenesis was examined in the disease state of muscular dystrophy. Here, we also observed a reduction in angiogenesis from media conditioned by satellite cells from dystrophic muscle compared to healthy muscle. Overall, this study further strengthens the case for satellite cells as important mediators of the angiogenic response in regenerating muscle and may serve as a potential site for therapeutic intervention in the future.

Peripheral arterial disease (PAD) affects approximately 200 million individuals worldwide. It is characterized by a reduction in blood flow to the lower extremities due to atherosclerosis. This can result in leg pain, tissue loss, and ultimately amputation. Revascularization procedures aim to restore blood flow, but up to 50% of patients require another intervention within a year. Revascularization monitoring and early detection of failure are crucial in preventing limb loss and adverse cardiovascular events. However, current evaluation methods do not directly measure perfusion and are limited in a significant segment of PAD patients, such as those with diabetes and renal insufficiency. Diffuse optical imaging (DOI) techniques are promising tools to overcome these limitations. Employing near-infrared light, they are non-invasive, non-ionizing, contrast-free, and cost-effective methods that are sensitive to hemodynamic parameters such as changes in oxy-, deoxy-, and total hemoglobin concentration, making DOI ideal for revascularization monitoring. In this dissertation, I investigate and develop DOI systems for the purpose of monitoring lower extremity revascularization procedures in PAD patients. We utilize a contact-based diffuse optical spectroscopy (DOS) system to monitor localized foot perfusion in an ongoing clinical study of 100 patients undergoing lower extremity angiography. I demonstrate the utility of DOS measurements to provide valuable insights into revascularization related hemodynamic remodeling and to predict revascularization success. Furthermore, I also develop a clinic friendly contact-free diffuse optical tomography (DOT) system that is better-suited for PAD patients with ulcers. I show that this system can provide spatial maps of perfusion within the foot. Collectively, this work establishes diffuse optical imaging as a valuable imaging modality for the evaluation of lower extremity perfusion.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-16T19:35:17Z No. of bitstreams: 1 NayanaXimenes.pdf: 1996792 bytes, checksum: 8b0defdcfad78f68778fa5403df3c0ef (MD5) / Made available in DSpace on 2017-05-16T19:35:17Z (GMT). No. of bitstreams: 1 NayanaXimenes.pdf: 1996792 bytes, checksum: 8b0defdcfad78f68778fa5403df3c0ef (MD5) Previous issue date: 2014-11-21 / Regular physical activity has been beneficial post - cardiac surgery. Early resistance exercise training improves functional capacity, clinical status, cardiac function and survival of patients, leading to a reduction of the harmful effects of prolonged bed rest, reduced care costs and hospital stay. Objective: To evaluate the effects of resistance exercise during hospital postoperative coronary artery bypass grafting (CABG). Methods: It was performed a randomized controlled trial with 37 patients subjected to isolated CABG between August 2013 and May 2014, distributed by simple drawing into two groups: control group (n = 20) that received conventional physiotherapy and intervention group (n = 17) underwent resistance exercise. Pulmonary function and functional capacity were assessed preoperatively, on discharge from the intensive care unit (ICU) and hospital discharge by spirometry and six minute walk test (6MWT). For statistical analyze were utilized Shapiro-Wilk, Mann-Whitney, Student's t, Fisher and G tests. Variables with p < 0.05 were considered significant. Results: The groups were homogeneous in terms of demographic, clinical, and surgical variables. No effect of resistance exercise on pulmonary function was observed when compared to control group. However, in intervention group it was maintained functional capacity during assessments periods when compared to the control group which was observed significant reducing (p < 0.0001). It was Observed a significant reduction in length of hospital stay (6.3 ± 1 2 vs. 7.6 ± 2.5 days) (p = 0.03). Conclusion: In this study, the resistance exercise during hospital CABG postoperative provided maintaining functional capacity and reduction of hospital stay when compared to conventional physiotherapy. / A prática de atividade física tem sido benéfica pós - cirurgia cardíaca. O exercício resistido precoce melhora a capacidade funcional, quadro clínico, função cardíaca e sobrevida dos pacientes, promovendo a diminuição dos efeitos prejudiciais do repouso prolongado no leito, redução dos custos com a assistência e tempo de internação hospitalar. Objetivo: avaliar os efeitos do exercício resistido na fase hospitalar do pós-operatório de revascularização do miocárdio (RM). Métodos: realizou-se um ensaio clínico controlado randomizado com 37 pacientes submetidos à RM isolada, com circulação extracorpórea entre agosto de 2013 e maio de 2014, distribuídos por sorteio simples em dois grupos: grupo controle (n = 20) que realizou fisioterapia convencional e grupo intervenção (n = 17) submetidos ao exercício resistido. A função pulmonar e a capacidade funcional foram avaliados no pré-operatório, alta da unidade de terapia intensiva (UTI) e alta hospitalar pela espirometria e teste de caminhada de seis minutos (TC6M). Para análise estatística empregaram-se os testes de Shapiro-Wilk, Mann-Whitney, t-Student, Fisher e G. variáveis com p < 0,05 foram consideradas significativas. Resultados: Os grupos apresentaram-se homogêneos quanto às variáveis demográficas, clínicas e cirúrgicas. Não se observou efeito do exercício resistido na função pulmonar quando comparado ao grupo controle. Entretanto, no grupo intervenção houve manutenção da capacidade funcional nos três períodos avaliados quando comparado ao grupo controle para o qual se observou queda significativa (p < 0,0001).Observou-se redução significativa do tempo de internação hospitalar (6,3 ± 1,2 vs. 7,6± 2,5 dias) , (p = 0,03) .Conclusão:No presente estudo, o exercício resistido na fase hospitalar do pós-operatório de RM proporcionou manutenção da capacidade funcional e redução do tempo de internação hospitalar quando comparado a fisioterapia convencional.

"March 2003" Includes bibliographical references (leaves 61-68). Appendices: Publications arising from the research portfolio. 1. Conducting a systematic review -- 2. The effectiveness of mechanical compression devices in attaining hemostasis after removal of a femoral sheath following femoral artery cannulation for cardiac interventional procedures : a systematic review -- 3. Effectiveness of mechanical compression devices in attaining hemostasis after femoral sheath removal Contains three separate research projects, presented as separate reports, but all related to one area of interest - interventional cardiology. Seeks to identify effective femoral sheath removal practices after interventional cardiac procedures and determine patient's perceptions of the education prior to and after interventional procedures.

"March 2003" / Includes bibliographical references (leaves 61-68). / 1 v. (various pagings) : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Contains three separate research projects, presented as separate reports, but all related to one area of interest - interventional cardiology. Seeks to identify effective femoral sheath removal practices after interventional cardiac procedures and determine patient's perceptions of the education prior to and after interventional procedures. / Thesis (D.Nurs.Sc.)--University of Adelaide, Dept. of Clinical Nursing, 2003

Σκοπός: Ο σκοπός της παρούσας μελέτης ήταν να ερευνηθεί κατά πόσο η ανάσπαση του τμήματος ST και η θετικοποίηση του κύματος Τ στις Q – απαγωγές του ΗΚΓ κατά τη διάρκεια της δοκιμασίας κόπωσης πρό της εξόδου από το νοσοκομείο, μπορούν να συνεισφέρουν στη κλινική αντιμετώπιση των ασθενών με πρόσφατο έμφραγμα μυοκαρδίου. Εισαγωγή: Η κλινική σημασία αυτών των ΗΚΓ ευρημάτων παραμένει αμφισβητούμενη, παρά το γεγονός ότι σε αρκετές μελέτες σχετίζεται με την ύπαρξη μυοκαρδιακής βιωσιμότητας όπως και λειτουργικής αποκατάστασης μετά από επαναγγείωση. Από τη στιγμή που η επιλογή των ασθενών που συμμετέχουν σε κάθε μελέτη μπορεί να εξηγήσει τα διαφορετικά αποτελέσματα, η αξία αυτών των ευρημάτων στη τωρινή εποχή της θρομβόλυσης πρέπει να διευκρινισθεί. Μέθοδος: Στη μελέτη έλαβαν μέρος 101 ασθενείς, ηλικίας 58+11 έτη, με πρόσφατο, πρώτο, ανεπίπλεκτο Q – έμφραγμα μυοκαρδίου (εκ των οποίων 56% ήταν πρόσθια, 57% θρομβολυμένα με κλάσμα εξώθησης αριστεράς κοιλίας 43 + 7%). Οι ασθενείς προ της εξόδου από το νοσοκομείο υποβάλλονταν σε υπομεγίστη δοκιμασία κόπωσης. Ακολούθως, σε απουσία σοβαρής ισχαιμίας, διενεργείτο διαδοχικά μελέτη δυναμικής ηχοκαρδιογραφίας με χρήση δοβουταμίνης (DSE), σπινθηρογράφημα μυοκαρδίου με θάλλιο – 201 (201Tl-SPECT) και αγγειογραφία των στεφανιαίων αρτηριών. Αποτελέσματα: Οι ασθενείς με ανάσπαση του τμήματος ST στη μέγιστη κόπωση έχουν μεγαλύτερης έκτασης εμφράγματα (peak CPK 2351+1465 versus 1671+1132 U/L, p<0.05) και περισσότερο επηρεασμένη συστολική λειτουργία με κριτήριο τον αριθμό των μυοκαρδιακών τμημάτων με συμπεριφορά ουλώδους ιστού τόσο στη δυναμική ηχοκαρδιογραφία με χρήση δοβουταμίνης (p<0.05) όσο και στο σπινθηρογράφημα μυοκαρδίου με θάλλιο – 201 (p<0.01). Η επίπτωση βιωσιμότητας και / ή ισχαιμίας δεν διέφερε στις δύο ομάδες. Τα αποτελέσματα ήταν παρόμοια και στη χαμηλής φόρτισης κόπωση. Η εντόπιση του εμφράγματος στο πρόσθιο τοίχωμα και η παρουσία > 3 τμημάτων με συμπεριφορά ουλής στη DSE ήταν μεταξύ των ανεξάρτητων θετικών προβλεπτικών παραγόντων της ανάσπασης του ST στη μέγιστη άσκηση. Η θετικοποίηση του κύματος Τ απεδείχθει το ίδιο αναποτελεσματική στη πρόβλεψη βιωσιμότητας και / ή ισχαιμίας. Κατά τη διάρκεια της μακρόχρονης κλινικής παρακολούθησης που ακολούθησε (31+13 μήνες), η συχνότητα των συμβαμάτων ήταν χαμηλή (8 % για θάνατο ή μη θανατηφόρο ΟΕΜ) και δεν διέφερε μεταξύ των ομάδων. Συμπέρασμα: Σε ασθενείς με πρόσφατο Q – έμφραγμα μυοκαρδίου, χωρίς κλινικά και ΗΚΓ κριτήρια σημαντικής υπολειπομένης ισχαιμίας, οι ανασπάσεις του διαστήματος ST κατά την δοκιμασία κοπώσεως εκφράζουν την μεγάλη έκταση του εμφράγματος. Η δυνατότητα αυτών των ST/T μεταβολών του ΗΚΓ να συνεισφέρουν στη ανίχνευση βιωσιμότητας και ισχαιμίας και στη διαστρωμάτωση κινδύνου αυτών των ασθενών , αποδεικνύεται χαμηλή. Τά κλασσικά κλινικά κριτήρια που χρησιμοποιούνται και σήμερα αποδεικνύονται ιδιάτερα αποτελεσματικά στη επιλογή των ασθενών χαμηλού κινδύνου. / Objectives: The aim of this prospective study was to investigate whether ST segment elevation and T wave normalization in Q-wave leads on pre-discharge exercise electrocardiogram (ECG) can contribute to patient management after recent myocardial infarction (MI) Background: The clinical relevance of these exercise ECG changes remains controversial despite accumulating evidence of their association with myocardial viability as well as functional recovery after revascularization. Since patient selection may explain the discordant results across the studies, the value of these ST/T abnormalities in the thrombolytic era should be better defined. Methods: One-hundred one patients, aged 58+11 years, with a recent, first, uncomplicated Q-wave MI (56% anterior, 57% thrombolyzed, ejection fraction 43+7%) underwent predischarge, submaximal treadmill testing followed, in the absence of severe ischemia, by dobutamine stress echocardiography, thallium-201 single photon emission computed tomography and coronary angiography. Results: Patients with, as compared with those without ST elevation at peak exercise had more severe infarctions (peak creatine kinase 2351+1465 versus 1671+1132 U/L, p<0.05) and more extensively impaired left ventricular contractility due to scar tissue as based on the number of segments with scar on echocardiography (p<0.05) or scintigraphy (p<0.01). However, the incidence of myocardial viability and ischemia was not different between the two groups. Results were similar for ST elevation at low level exercise. Anterior infarction location and at least three scarred segments on dobutamine stress echocardiography were among the independent predictors of ST elevation at peak ergometric exercise. T wave normalization was similarly inaccurate in identifying viability or ischemia. Over long-term follow-up of 31+13 months, the event rate was low ( 8 % for death or nonfatal MI) and did not differ between groups with or without these exercise-induced ST/T wave changes. Conclusions: In patients after acute, Q-wave MI without severe ischemia according to clinical and standard ECG criteria, exercise-induced ST elevation is associated with larger infarctions. The contribution of these ST/T changes to identify patients with myocardial viability or ischemia and for risk stratification is poor. In-hospital management of these patients based on routine clinical practice is sufficient for selection of a population with a relatively low long-term risk.

Thesis (D.Nurs.Sc.)--University of Adelaide, Dept. of Clinical Nursing, 2003. / "March 2003" Includes bibliographical references (leaves 61-68).

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1434141. ProQuest document ID: 1130610501. Includes bibliographical references (p. 42)

Recent large randomized controlled trials (RCTs) have shown that renal revascularization does not confer added benefit to unselected patients with atherosclerotic renovascular disease (ARVD) treated with multi-targeted medical therapy. Results suggest that contemporary medical vascular protection therapy has contributed to improved clinical outcomes in ARVD. However, patients with †̃high-riskâ€TM clinical features have largely been excluded from RCTs and there is consistent observational evidence that this specific patient subgroup may gain benefit from revascularization. Timely identification of these patients through risk stratification and prediction of outcomes post-revascularization remain important challenges. The main aims of this epidemiological research project were to explore how treatment and clinical end-points in ARVD have evolved over the past three decades, to identify the determinants of long-term end-points in ARVD, to investigate the effect of revascularization in a selected †̃high-riskâ€TM subgroup, to investigate novel biomarker association of key end-points and finally to develop a clinical risk prediction model that can aid risk stratification and patient selection for revascularization. These individual studies were all based on a local database that includes details of demographic and clinical data for patients with ARVD referred to our tertiary renal centre between 1986 and 2014. Primary end-point measures included death, progression to end-stage kidney disease, cardiovascular events and a composite end-point composed of the first of any of the above events. Management of ARVD has been influenced by RCT results, leading to a decline in the number of revascularization procedures performed. Traditional cardiovascular risk factors together with baseline renal function and proteinuria are the most important determinants of adverse events in ARVD thus advocating the use of multi-targeted medical therapy and aggressive risk factor control in all patients with ARVD. Nonetheless ARVD is a heterogenous condition and results of this research project show that revascularization can be of benefit in patients with rapidly deteriorating renal function, bilateral severe ARVD and/or < 1g/day baseline proteinuria. A panel of novel biomarkers may have incremental risk predictive value when used in conjunction with more traditional risk factors, and NT-proBNP levels may aid patient selection for revascularization. A simple clinical risk-prediction score based on easily obtainable variables may be used as a bedside tool to help risk stratification and facilitate patient selection for revascularization, thus encouraging a more patient-specific therapeutic approach.

Orientador: Orlando Petrucci Júnior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T17:01:26Z (GMT). No. of bitstreams: 1 Baptista_VanessaCristina_M.pdf: 1454154 bytes, checksum: dc039f58961bfe31946dfa04724885d1 (MD5) Previous issue date: 2012 / Resumo: Introdução: A qualidade de vida após a revascularização do miocárdio não é frequentemente avaliada. Formas de estimar a qualidade de vida após a operação são úteis para prognóstico e discussão com o paciente sobre as opções disponíveis de tratamento. Objetivo: Avaliar a utilidade do teste de caminhada de seis minutos e do EuroSCORE como indicadores prognóstico de qualidade de vida em pacientes submetidos à revascularização do miocárdico. Material e Método: Estudo prospectivo observacional em pacientes submetidos à operação de revascularização do miocárdio. Foram avaliados as características clínicas, o índice EuroSCORE, teste de caminha de seis minutos e questionário para avaliação de qualidade de vida o questionário SF-36. No período pré-operatório os pacientes foram avaliados e divididos em dois grupos conforme a distância percorrida no teste de caminhada: grupo A (caminhou mais de 350 metros) e grupo B (caminhou menos de 350 metros). Resultados: Foram incluídos no estudo 87 pacientes, com idade média semelhante no grupo A comparado ao B (59 ± 9,5 anos vs. 61 ± 9,3 anos; P= 0,24) o mesmo foi observado para o EuroSCORE (2 ± 1 % vs. 3 ± 3%; P= 019). Os pacientes do grupo A caminharam mais no teste de 6 minutos após dois meses de operação (436 ± 78 m vs. 348 ± 87m; P<0,01) quando comparado ao grupo B. Observamos que a qualidade de vida era inferior no grupo B em relação ao grupo A no período pré-operatório nos domínios: capacidade funcional, aspectos físicos, estado geral de saúde, vitalidade e aspectos sociais. A qualidade de vida melhorou após dois meses em ambos os grupos. Conclusões: O teste de caminhada de 6 minutos no pré-operatório tem correlação com a qualidade de vida após dois meses de operação de revascularização do miocárdio. O EuroSCORE não tem correlação com a qualidade de vida após dois meses de operação. A qualidade de vida melhorou de forma geral em todos pacientes, sendo maior a melhora da qualidade de vida naqueles que caminharam menos que 350 metros no pré-operatório / Abstract: Introduction: The quality of life after coronary artery bypass surgery (CABG) is not often assessed in the literature. Tools for quality of life assessment are useful for analysis of long-term results, and it is effective for a conference with the clinical team and family's patient. Objective: Assess the quality of life in patients undergoing myocardial revascularization using the six-minute walk test and the EuroSCORE index. Material and Method: Prospective observational study with patients who undergoing CABG. The clinical variables, the EuroSCORE index, the six-minute walk test, and the SF-36 test were recorded. The patients were assessed at preoperative time and at 2 months of postoperative period. According their six-minute walk test results, the patients were divided into two groups: group A (walked more than 350 meters) and group B (walked less than 350 meters) at the preoperative time. Results: Eight-seven patients were included. Age and EuroSCORE index was comparable in both groups (59 ± 9.5 years vs. 61 ± 9.3 years; P = 0.24) and (2 ± 1%vs. 3. ± 3%; P = 019), respectively. The group A walked distance was higher than the group B after 2 months of operation (436 ± 78 m vs. 348 ± 87 m; P <0.01). The quality of life was lower in the group B compared to the group A at the preoperative period in the following domains: functional capabilities, limitations due to physical aspects, overall health feelings, vitality, and social aspects. Quality of life improved after two months in both groups. Conclusions: The six-minute walk test at the preoperative time is associated with the quality of life after two months of CABG. The EuroSCORE has not correlation with the quality of life after two months of operation. In overall, quality of life has improved in all patients. The improvement in the quality of life was greater in those patients who walked distances lower than 350 meters at the preoperative time / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências