Sammanfattning Bakgrund: Vid plötsligt dödsfall har närstående kort eller ingen tid till förberedelse. Detta kan påverka sorgeprocessen och risken för försämrad psykisk hälsa är hög. Sjuksköterskor bistår med stöd men bristande erfarenhet, otillräcklig bemanning och stressig arbetsmiljö kan försvåra stödinsatser. Syfte: Syftet var att beskriva närståendes erfarenheter av stöd från sjuksköterskor vid plötsligt dödsfall och att granska artiklarnas undersökningsgrupper. Metod: En beskrivande litteraturstudie med 13 vetenskapliga artiklar hämtade via databaserna PubMed, Cinahl samt genom manuella sökningar. Huvudresultat: Det stöd närstående efterfrågade från sjuksköterskor varierade. Informativa brister förknippades hos närstående med en ovilja hos sjuksköterskor att beröra svåra samtalsämnen. Sjukhusmiljön upplevdes främmande för många närstående, som kunde känna utanförskap. Genom gott bemötande, vägledning och inkludering av närstående i omvårdnaden skapades gemenskap. När närstående kände sig delaktiga och behövda skapades positiva känslor. När sjuksköterskor gav närstående chans att utnyttja den tid som fanns tillsammans med den döende och bistod med praktiskt stöd möjliggjordes kontinuerlig samvaro. Efter dödsfall kunde närstående känna sig övergivna. Ett avsked utan tidspress och inbjudan till uppföljning var betydelsefullt för närstående för att kunna gå vidare i livet. Slutsats: Erfarenhet av bristande information från sjuksköterskor var vanligt förekommande hos närstående, vilka även noterade om sjuksköterskor agerar undvikande i svåra situationer. Eftersom behovet av stöd varierar mellan närstående bör sjuksköterskor utgå från personcentrerade stödinsatser. Om sjuksköterskor får insikt i närståendes erfarenheter av stöd vid plötsligt dödsfall finns större möjligheter att kunna förbättra stödet för närstående i en sårbar situation. / Background: In a sudden death situation family members have little time for preparation. This can affect their process of grief and increase the risk of a negative psychological outcome. Nurses have the possibility of supporting the family, but lack of experience, shortage of staff, and a stressful environment can obstruct the support. Aim: The aim of this study was to describe family members’ experiences of support from nurses when a person dies a sudden death, and to investigate the sample groups of selected result studies. Method: A descriptive literature review, where 13 scientific articles were included. Articles were collected from the databases PubMed and Cinahl and through manual research. Main result: The type of support family members requested from nurses differed. Lack of information was associated with the nurses’ unwillingness to lift difficult topics. The hospital environment was an unfamiliar place for many family members, who could feel lost in the context. By including and guiding the family members, a feeling of becoming a team was generated. When the family members felt involved and needed, positive emotions evolved. When nurses gave practical support and created opportunities for family members to be close to the dying person, they could make use of precious time without interruption. After death occurred family members could feel abandoned. To be able to proceed in life, it was important that family members had enough time to say goodbye and were offered a follow-up meeting. Conclusion: Family members frequently experienced a lack of information from nurses and noticed if the nurse tried to avoid difficult situations. Acknowledging individual differences, makes it possible to apply person-centered support. If nurses gain knowledge of family members’ experiences of support on sudden death occasions, the nurses will have better chances of providing the support requested.

INTRODUÇÃO. O aumento da densidade de arritmia ventricular e a redução da variabilidade da freqüência cardíaca estão associados com risco de morte súbita e mortalidade total em insuficiência cardíaca. A inibição colinesterásica com brometo de piridostigmina (PIR) aumenta a variabilidade da freqüência de pessoas normais, porém seu efeito em pacientes com insuficiência cardíaca é desconhecido. OBJETIVOS. Testar a hipótese de que a administração a curto prazo de piridostigmina reduz a densidade de arritmia ventricular e aumenta a variabilidade da freqüência cardíaca em pacientes com insuficiência cardíaca. MÉTODOS. Pacientes com insuficiência cardíaca e em ritmo sinusal participaram de um estudo duplo-cego, cruzado, randomizado para placebo e piridostigmina (30mg VO de 8 em 8 horas por 2 dias). Monitorização eletrocardiográfica ambulatorial de 24 horas foi realizada para análise de arritmia e para avaliação dos índices do domínio do tempo da variabilidade da freqüência cardíaca. Pacientes foram separados em 2 grupos, de acordo com a densidade de arritmia ventricular. O grupo Arritmia (n = 11) incluiu pacientes com mais de 10 extrassístoles ventriculares por hora (ESV/h), e o grupo Variabilidade da Freqüêcia Cardíaca (n = 12) incluiu pacientes com um número de ESVs em 24 horas que não excedia 1 % do número total de intervalos RR. RESULTADOS. No grupo Arritmia, PIR resultou em uma redução de 65% no número de extrassístoles ventriculares (Placebo 266 + 56 ESV/h vs. PIR 173 + 49 ESV/h; p = 0,03). No grupo da Variabilidade da Freqüência Cardíaca, a administração de PIR resultou em um aumento do intervalo RR médio (Placebo 733 + 22 ms vs PIR 790 + 33 ms; p = 0,01), e nos índices do domínio do tempo da variabilidade da freqüência cardíaca PNN50 (Placebo 3 + 1,1 % vs PIR 6 + 1,6 %; p = 0,03) e RMSSD (Placebo 21 + 2 vs PIR 27 + 3; p = 0,008). CONCLUSÃO. Em pacientes com insuficiência cardíaca, PIR reduziu a densidade de arritmia ventricular e aumentou a VFC, provavelmente por seu efeito colinomimético. Estudos a longo prazo com PIR em insuficiência cardíaca devem ser realizados. / OBJECTIVE To test the hypothesis that short-term administration of pyridostigmine bromide (PYR) reduces ventricular arrhythmia density and increases heart rate variability in patients with congestive heart failure. BACKGROUND Increased ventricular arrhythmia density and reduced heart rate variability are associated with risk of sudden death and overall mortality in patients with heart failure. Cholinesterase inhibition with pyridostigmine bromide increases heart rate variability in normal subjects, but its effect in patients with heart failure is unknown. METHODS Patients with heart failure and in sinus rhythm participated in a double-blind, cross-over protocol, randomized for placebo and pyridostigmine (30 mg PO TID for 2 days). Twenty-four hour electrocardiographic recordings were performed for arrhythmia analysis and for the measurement of time domain indices of heart rate variability. Patients were separated in 2 groups, according to their ventricular arrhythmia density. The Arrhythmia Group (n = 11) included patients with more than 10 ventricular premature beats per hour (VPBs/h), and the Heart Rate Variability Group (n = 12) included patients with a number of VPBs in 24 hours not exceeding 1 % of the total number of RR intervals. RESULTS For the Arrhythmia Group, PYR resulted in 65 % reduction of ventricular ectopic activity (Placebo 266 ± 56 VPBs/h vs. PYR 173 ± 49 VPBs/h; P = 0.03). For the Heart Rate Variability Group, PYR administration resulted in an increment of mean RR interval (Placebo 733 ± 22 msec vs PYR 790 ± 33 msec; P = 0.01), and in the time domain indices of heart rate variability RMSSD (Placebo 21± 2 vs PYR 27 ± 3; P = 0.01) and PNN50 (Placebo 3 ± 1 % vs PYR .6 ± 2 %; P = 0.03). CONCLUSION In patients with heart failure, PYR reduced ventricular arrhythmia density and increased HRV, most likely due to its cholinomimetic effect. Long-term trials with PYR in heart failure should be conducted.

Apresentamos nesta tese a primeira geração direta de emaranhamento tripartite entre feixes intensos de luz. Medimos o emaranhamento entre os feixes sinal, complementar e bombeio refletido, produzidos por um Oscilador Paramétrico Ótico (OPO) operando acima do limiar de oscilação. A principal característica do nosso sistema é a diferença entre os comprimentos de onda dos campos (l0 = 532.251 nm, l1 = 1062.102 nm, e l2 = 1066.915 nm). Esta é a primeira medida de emaranhamento entre mais de dois subsistemas produzidos por uma única fonte no âmbito de variáveis contínuas. Para investigar a existência emaranhamento, utilizamos o critério de positividade sob transposição parcial (PPT). Este critério, aplicado a sistemas compostos por estados gaussianos, dispostos em bipartições do tipo 1×(N 1), torna-se necessário e suficiente na demonstração do emaranhamento. Realizamos também a caracterização do emaranhamento produzido quando submetemos os campos a perdas, identificando regiões de parâmetros onde os estados apresentam emaranhamento frágil ou robusto. A fim de garantir que estamos lidando com estados gaussianos, investigamos a estatística das flutuações dos campos, mostrando excelente acordo entre os valores dos momentos de ordem mais alta da fotocorrente medida e os valores esperados para uma distribuição gaussiana. O estudo que apresentamos é um passo importante para a elaboração de uma rede de informação quântica que possibilitará a comunicação entre diferentes sistemas físicos. / We present in this thesis the first direct generation of tripartite entanglement among bright beams of light. We measured the entanglement among signal, idler and reflected pump beams, produced by an Optical Parametric Oscillator (OPO) operating above the threshold. The main feature of our system is the difference between the wavelengths of the fields (l0 = 532.251 nm, l1 = 1062.102 nm, e l2 = 1066.915 nm). This is the first measurement of entanglement among more than two subsystems produced by a single source, in a continuous variable system. In order to investigate the existence of entanglement, we applied the criterion of positivity under partial transposition (PPT). This criterion, applied to systems composed of Gaussian states, arranged in 1×(N1) bipartition, becomes necessary and sufficient to demonstrate entanglement. We also characterized the entanglement when the fields are submitted to losses, identifying regions of parameters where the states have fragile or robust entanglement. To ensure that we are dealing with Gaussian states, we investigate the statistics of the fields, showing excelent agreement among values of higher order moments of the photocurrent measured and expected values for a Gaussian distribution. The present study is an important step in the development of a quantum information network formed by different physical systems.

Introdução: A morte súbita é a principal causa de morte na doença de Chagas, correspondendo de 55 a 65% dos casos. Observa-se que parte destas, ocorre em pacientes com função ventricular esquerda (FEVE) preservada, levando a acreditar que fatores desestabilizadores do substrato arritmogênico exercem um importante papel nestes eventos. Evidências já demonstraram a depressão parassimpática como fator contribuinte na gênese de arritmias diversas em presença de cardiopatia isquêmica. Assim, insiste-se na necessidade de se identificar precocemente quais os pacientes, no contexto da cardiopatia chagásica crônica, apresentam risco aumentado para o desenvolvimento de eventos arrítmicos complexos. Acredita-se que a avaliação autonômica identifique subgrupos distintos de risco. O presente estudo teve como objetivo determinar a sensibilidade do barorreflexo (SBR) em pacientes com doença de Chagas, nas formas indeterminada (GI) e arritmogênica com taquicardia ventricular não sustentada (GII) e com taquicardia ventricular sustentada (GIII) e, secundariamente, avaliar a associação entre a severidade da arritmia ventricular com o grau de comprometimento da SBR. Métodos: 42 pacientes foram submetidos à monitorização cardiovascular não invasiva pelo sistema Task Force ® onde foi determinada a SBR, utilizando o método da fenilefrina e analisada a variabilidade da frequência cardíaca (VFC) no domínio do tempo por meio da eletrocardiografia dinâmica de 24horas e a FEVE, por meio da ecocardiografia. Resultados: Observou-se diferença estatística significativa entre os grupos em relação à SBR em resposta à fenilefrina. O GIII apresentou o menor valor de SBR (6,09 ms/mmHg) quando comparado aos GII (11,84ms/mmHg) e GI (15,23ms/mmHg). Após comparação múltipla entre os grupos, verificou-se diferença significativa entre GI e GIII (p= 0,01). Quando se correlacionou SBR e densidade de extra-sístoles ventriculares (EV), observou-se que todos os pacientes portadores de baixa densidade de EV (< 10/hora) apresentavam SBR preservada (6,1ms/mmHg).Em contrapartida, entre aqueles com alta densidade de EV (>10/hora) somente 59% tinham SBR preservada (p=0,003). Nos pacientes com SBR deprimida (3,0-6,0 ms/mmHg) houve maior densidade de EV (p=0,01). Pacientes com SBR preservada apresentaram tanto função ventricular normal como moderadamente comprometida (66,7% com FEVE<40% e 79,5% com FEVE40%; p=0,62). O mesmo observou-se em pacientes com SBR moderadamente deprimida, (15,4% com FEVE<40% e 33,3% com FEVE40%; p=0,46). Não foi verificada correlação entre SBR e VFC. Ao se aplicar o modelo de regressão logística, observou-se que somente a SBR influenciou o aparecimento da taquicardia ventricular sustentada (p=0.028). Conclusão: A SBR está preservada na forma indeterminada da doença de Chagas e diminuída na forma arritmogênica. O comprometimento da SBR é progressivo e acompanha a evolução da doença, sendo mais intenso nos pacientes com arritmias ventriculares mais complexas. O grau de disfunção autonômica não se correlacionou com a função ventricular, mas, sim, com a densidade e a complexidade das arritmias / Introduction: Sudden death is the main cause of death in Chagas disease, corresponding to 55 to 65% of the cases. Some of these occur in patients with normal or almost normal left ventricular function (LVF), leading us to believe that factors that destabilize the arrhythmogenic substrate play an important role in these events. Evidences show parasympathetic depression to be a contributing factor in the genesis of diverse arrhythmias in the presence of ischemic heart disease. Thus, we insist on the need of an early identification of the patients, in the context of chronic Chagas heart disease, that are at increased risk of developing complex arrhythmic events. It is possible that autonomic assessment allows the identification of distinct risk subgroups. The objective of this study was to determine the baroreflex sensitivity (BRS) in patients with the indeterminate form of Chagas disease, (GI), and with the arrhythmogenic form of Chagas disease with nonsustained ventricular tachycardia (GII) and sustained ventricular tachycardia (GIII) and to assess the correlation between the severity of ventricular arrhythmia and the degree of BRS impairment. Methods: Forty-two patients were subjected to noninvasive cardiovascular monitoring using the Task Force® system. The phenylephrine method was used to determine BRS, 24- hour dynamic electrocardiography was used to analyze heart rate variability (HRV) over time and echocardiography was used to determine LVF. Results: A statistical difference was observed between the groups regarding their BRS to phenylephrine. GIII presented the lowest BRS value (6.09 ms/mmHg) when compared with GII (11.84ms/mmHg) and GI (15.23ms/mmHg). After multiple comparisons among the groups, a significant difference was found between GI and GIII (p=0.01). When BRS was correlated with ventricular extrasystole (VE) density, all patients who had low VE density (<10/hour) had preserved BRS (6.1ms/mmHg). On the other hand, only 59% of those with high EV density (>10/hour) had preserved BRS (p=0.003). In patients with moderately depressed BRS (3.0-6.0 ms/mmHg) there was a greater density of EV (p=0.01). Patients with preserved BRS had preserved or moderately compromised LVF (66.7% with LVF<40% and 79.5% with LVF40%; p=0.62) as had patients with moderately depressed BRS (15.4% with LVF<40% and 33.3% with LVF40%; p=0.46). There was no correlation between BRS and LVF. When the logistic regression model was applied, only BRS influenced the presence of sustained ventricular tachycardia (p=0.028). Conclusion: BRS is preserved in indeterminate Chagas disease and diminished in the arrhythmogenic form. The BRS impairment is progressive as the disease progresses, being more evident in patients with more complex ventricular arrhythmias. The degree of autonomic dysfunction did not correlate with ventricular function but with the density and complexity of the arrhythmias

Orientador: Edi Lucia Sartorato, Norma de Oliveira Penido / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-12T10:02:54Z (GMT). No. of bitstreams: 1 Bergmann_JessicaCarvalho_M.pdf: 1915638 bytes, checksum: b7423327cf7e6976bbe8c66c0e36e37b (MD5) Previous issue date: 2008 / Resumo: As causas da perda auditiva podem ser genéticas, ambientais ou causadas por comorbidades. As principais comorbidades incluem algumas doenças infecciosas, hematológicas, neurológicas e principalmente o schwannoma vestibular. Por sua vez, a Surdez Súbita caracterizase como uma surdez sensorioneural de 30dB em pelo menos 3 freqüências contínuas, de aparecimento abrupto e sem causa conhecida que pode manifestar-se em qualquer faixa etária, ocorrendo repentinamente ou de forma progressiva em um período de até 72 horas, podendo ser unilateral ou bilateral associado ou não a zumbidos e com menos freqüência a tonturas. Foram estudados 38 pacientes e indivíduos controles ouvintes onde 22 são provenientes da Universidade Federal de São Paulo formando o grupo A e 16 são provenientes da Fono Audio Clínica de Fortaleza (CE). O principal objetivo desse projeto foi determinar possíveis causas genéticas da Surdez Súbita nos indivíduos estudados. Para isso foi feito o rastreamento de mutações no gene da conexina 26 (GJB2), a detecção das deleções D(GJB6-D13S1830) e D(GJB6-D13S1854) no gene GJB6 e das mutações A1555G, C1494T, A827G, T961G e 961delT/insC presentes nos genes mitocondriais MTRNR1 (12S rRNA) e G7444A, A7445G presentes nos genes mitocondriais COI/MTTS1 (tRNAser(UCN)). Foi ainda rastreada a mutação G28T no gene TRMU, envolvido na modulação do fenótipo observado em algumas mutações mitocondriais. O sequenciamento automático das amostras foi realizado para detecção de outras mutações no gene GJB2. Dentre os indivíduos analisados, não foram encontrados nenhum com mutações genéticas nos genes GJB2 e GJB6. Três indivíduos apresentaram a mutação V27I um polimorfismo ainda sem correlação com a perda auditiva. A mutação G7444A foi encontrada em um indivíduo do grupo controle. Uma vez que esse indivíduo é ouvinte acredita-se que esta mutação isolada não possa causar perda auditiva mesmo associada com as mutações G28T do gene TRMU e A827G como foi observado nesse caso. A mutação A827G foi encontrada em 6 indivíduos 3 do grupo surdo e 3 do grupo controle, mas também não pôde ser correlacionada à perda auditiva nesses casos. A mutação G28T do gene TRMU foi encontrada em 14 indivíduos, sendo 9 pacientes surdos e 5 indivíduos do grupo controle, porém não foi possível associar essa mutação a perda auditiva. Pelos resultados obtidos nesse trabalho não foi possível a associação da Surdez Súbita com as mutações em nenhum dos genes estudados. Devido à grande heterogeneidade clínica e genética envolvida, ainda não é possível nem excluir ou afirmar a respeito dos aspectos genéticos da Surdez Súbita. / Abstract: Several factors have been postulated to elicit the etiology of idiopathic sudden sensorineural hearing loss. Sudden deafness is characterized as a sensorioneural disturb, having an abrupt onset and an unknown cause that can be revealed in any age, occurring suddenly or in a progressive way in a 3 day period, of more than 30dB hearing loss at three consecutive frequencies. It can be unilateral or bilateral with tinnitus present and giddiness. In this work 38 patients were studied with their hearing control. Of all this patients, 22 were originating of Federal University of São Paulo São Paulo forming the group A and 16 were from Fono Audio Clinica in Fortaleza (CE) forming the group B. The main objective of this project was to determine possible genetics causes of sudden deafness in patients who lost suddenly their hearing. The main causes of genetic deafness were researched, initiating for the screening of 35delG mutation in the connexin 26 gene (GJB2), D(GJB6-D13S1830) and _(GJB6-D13S1854) deletions, A1555G, C1494T, A827G, T961G and 961delT/insC mutation present in mitochondrial gene MTRNR1 (12S rRNA) and G7444A, A7445G present in mitochondrial gene COI/MTTS1 (tRNAser(UCN)). Screening for the mutation G28T present in TRMU was also made. Then, complete GJB2 gene was screened for other mutations and polymorphisms. Of all patients analyzed, was not found mutation in genes GJB2 and GJB6. Three patients showed a mutation V27I that is a polymorphism still without relation with hearing loss. The mutation G7444A was found in one individual of the control group. Once that this patient has a normal hearing it is strongly suggestive that this mutation by itself can not cause a hearing loss, even if it is associated with two other mutations, the A827G mutation and G28T (TRMU) mutation. The mutation A827G was found in 6 individuals, 3 from deaf patients and 3 from control individuals, but it is no possible to relation this mutation with the hearing loss. The mutation of the gene TRMU was found in 14 individuals, being 9 deaf patients and 5 control individuals. Despite of this mutation being in a regulation gene, it is unknown the relation between this mutation and the hearing loss. With this results we can conclude that idiopathic sudden deafness can not be caused by a mutation in any of this genes studied. Shall the large clinical heterogeneity and genetic involved on those cases, is still impossible a certain conclusion. We can not exclude the fact that these mutations can be in regions not studied in this work and related with the hearing loss. / Mestrado / Genetica Animal e Evolução / Mestre em Genética e Biologia Molecular

Bakgrund: Ett hjärtstopp är ett ytterst allvarligt tillstånd som påverkar inte bara patienten själv utan hela familjen, speciellt en nära anhörig. Patienten svävar mellan liv och död, och om patienten överlever är det ofta med mer eller mindre bestående men. Vid patientens sida finns de anhöriga som vill vara nära, hjälpa och stöda sin närstående samtidigt som det också kan vara en mycket svår situation för dem. Syfte: Syftet med den här kvalitativa litteraturstudien var att belysa anhörigas upplevelser av en närståendes hjärtstopp, för att i framtiden bättre kunna tillmötesgå dem inom vården. Metod: En kvalitativ sammanfattande litteraturstudie baserad på åtta vetenskapliga artiklar som hade studerat anhörigas upplevelser under själva hjärtstoppet, på intensiv-vårdsavdelningen eller efter hemkomst. Resultat: Hjärtstoppet var en kaotisk och traumatisk upplevelse för den anhöriga. Patienten var viktigast, all fokus var på patienten men det lämnade ofta den anhöriga ensam med den oro och rädsla situationen framkallat. Tillgång till kontinuerlig information och professionellt bemötande var ytterst viktigt för den anhöriga. Möjligheten att få vara nära närstående dygnet runt ingav säkerhet och trygghet. Brist på information och uppföljning efter utskrivning och en känsla av att vara ensam med allt ansvar var återkommande teman. Slutsats: Att som anhörig vara nära vid ett hjärtstopp var en stark existentiell upplevelse där alla aspekter av delaktighet fanns beskrivna; att veta, att göra och att vara. För bästa resultat, ett delaktigt vårdande i ljuset, krävs en samverkan mellan den vårdande personalen, patient och anhörig. Mer stöd och uppmärksamhet bör i framtiden riktas även mot den anhöriga. / Background: Sudden cardiac arrest is a life threatening condition, not only affecting the patient but the whole family. The patient’s life is on hold and if the patient survives, this is often with more or less physical and psychological complications. Close to the patient a family member or relative, tries to support and help the patient while at the same time the situation may be extremely stressful for the relative. Aim: The aim of this qualitative literature review was to get a better understanding of family members lived experiences during a loved one’s sudden cardiac arrest, in order to better also support the relatives in healthcare. Method: A summary of the literature based on eight qualitative studies on the perceptions of family members experiences of a sudden cardiac arrest by a loved one; during the cardiac arrest, at the intensive care unit and after discharge from hospital. Results: The cardiac arrest was experienced as a chaotic and traumatic event by the relative. The patient was the most important person at the moment but at the same time it left the relative alone with her feelings of anxiety and fear that the situation induced. Receiving information continuously about their next of kin’s condition as well as a considerate and professional encounter with the intensive care unit staff was important for the relative. The possibility to stay with the patient at the intensive care unit felt comforting, reassuring and safe. Lack of information and follow up, as well as a feeling of being alone with the responsibility, was a common theme after discharge from the hospital. Conclusion: To be present during the next of kin’s cardiac arrest was a strong existential experience where all aspects of involvement and participation were described; to know, to do and to be. For best results, an involving care in the light, collaboration between the professional care, the patient and the family member is needed. More support and attention should be given to family members in the future.

Le ventricule droit (VD) possède une embryogénèse, une géométrie et despropriétés biomécaniques différentes du ventricule gauche (VG). L’infundibulum pulmonaire(RVOT) est une origine fréquente d’arythmies dans le VD sain ou pathologique. La tétralogiede Fallot (TOF) est la cardiopathie congénitale cyanogène la plus fréquente et est associée àune dysfonction du VD. Si la correction chirurgicale a augmenté l’espérance de vie despatients TOF, à l’âge adulte les séquelles chirurgicales du VD et RVOT conduisent souvent àune insuffisance cardiaque, des arythmies voire la mort subite cardiaque. Les objectifs decette thèse sont de : (i) définir les propriétés électrophysiologiques et structurelles du VDsain chez le cochon et (ii) caractériser le remodelage arythmogène des ventricules dans unmodèle porcin de réparation de TOF (rTOF). Nous avons démontré la présence d’unehétérogénéité de repolarisation et de conduction dans le VD sain en lien avec un profild’expression spécifique des canaux ioniques dans le RVOT sub-épicardique. Une approchehistologique a également permis de mettre en évidence une structure tissulaire spécifique auRVOT contribuant au ralentissement de l’activation de cette région. Les coeurs des cochonsrTOF témoignent d’un remodelage électrophysiologique et structurel pro-arythmique du VDcaractérisé par une dispersion de la repolarisation, et un ralentissement de la conductioncorrélé à un remodelage moléculaire et structurel. Nous décrivons également la présenced’un remodelage arythmogène distinct dans le VG rTOF sur le plan électrique et structurelsans modification des propriétés hémodynamiques. En conclusion, ces travaux révèlent laprésence de substrats arythmogènes du VD sain et un profond remodelage pro-arythmiquedans les ventricules rTOF. / The right ventricle (RV) has different embryologic history, geometry andbiomechanics properties compared to the left ventricle (LV). The right ventricular outflow tract(RVOT) is a common arrhythmia origin in the healthy or pathological RV. Tetralogy of Fallot(TOF) is the most frequent cyanotic congenital heart disease and is associated with RVdysfunction. Surgical correction has significantly increased patient’s life expectancy butsurgical lesions often lead to heart failure, arrhythmias even sudden cardiac death inadulthood. The aims of this work are to: (i) define RVOT electrophysiological and structuralproperties in the healthy pig and (ii) characterize a potential arrhythmogenic remodeling inboth ventricles in a porcine model mimicking repaired TOF (rTOF). We showed the presenceof repolarization and conduction heterogeneities in the healthy RV in relation to a specific ionchannel expression profile in the RVOT epicardium. Moreover, an histological approachhighlighted the presence of a specific tissue structure likely to contribute to the slowconduction observed in this region. A pro-arrhythmic electrophysiological and structuralremodeling was found in the RV of rTOF pigs. This remodeling was characterized by anincreased dispersion of repolarization and slower conduction properties which were linked toa molecular and structural remodeling. Interestingly, we also described a distinct electricaland structural arrhythmogenic remodeling in the rTOF LV in the absence of hemodynamicalteration. To conclude, this work revealed the presence of an arrhythmogenic substratewithin the healthy RV and a profound arrhythmogenic remodeling of both ventricles in rTOF.

Master of Science / Department of Biological & Agricultural Engineering / Ajay Sharda / Discovered in 1971, sudden death syndrome (SDS), caused by the fungus Fusarium virguliforme, has spread from the US to South American and European countries. It has potential to infect soybean crops worldwide, causing yield losses of 10% to 15% and even 70% in extreme cases. There is a need for rapid spatial assessment of SDS. Currently, the extent and severity of SDS are scored using visual symptoms as indicators. This method can take hours to collect and is subject to human bias and changing environmental conditions. Color infrared (CIR) and thermal infrared (TIR) imagery detect changes in light reflectance (visible and near-infrared bands) and emittance (canopy temperature), respectively. Stressed crops may show deviations in light reflectiveness, as well as elevated canopy temperatures. The use of CIR and TIR imagery and flexible aerial remote sensing platforms offer an alternative for SDS detection and diagnosis compared to hand scoring methods. Crop stress and diseases have been detected using manned and unmanned aerial systems previously. Yet, to date, SDS has not been remotely assessed using CIR or TIR imagery collected with aerial platforms. The following research utilizes high throughput CIR and TIR imagery collected using a small unmanned aerial system (sUAS) to detect and assess SDS. A comparative evaluation of ground-based and aerial CIR methods for assessing SDS was conducted to understand the effectiveness of novel aerial SDS detection methods. Furthermore, a TIR case study investigating the use of potential thermal canopy changes for SDS detection was conducted to investigate the possibility of using TIR as an SDS indicator. CIR reflectance measured from a ground-based spectrometer and sUAS was collected data over a two-year period. Ground-based spectrometer data were collected weekly, while a sUAS collected aerial imagery late in the growing season each year before plant maturity. Pigment index (PI) values were derived from ground-based and aerial data. Results showed a strong negative correlation between SDS score and PI values. Aerial and ground-based data both showed strong correlations to SDS score, however, aerial data displayed a stronger relationship possibly due to minimal changes in environmental conditions. High SDS scores correlated strongly to aerial derived PI (R2 = 0.8359). Rapidly assessed high SDS allows for accurate screening of SDS critical for soybean breeding. The second year of the study investigated each component of SDS score, severity, and incidence. PI proved to have the best correlation with severity (R2 = 0.6313 and ρ = -0.8016) rather than incidence or SDS score. PI also correlated to SDS scores with R2 = 0.6159 and ρ = -0.7916. A sUAS mounted TIR camera collected imagery four times during the growing season when SDS foliar symptoms were just starting to appear. At the start of the study period, the correlation between canopy temperature and SDS is low (ρ = -0.2907), but increases over the growing season as SDS prevalence increases ending with a strong correlation (ρ = -0.7158). Early identification of SDS leads to the implementation of mitigation practices and changes in irrigation scheduling before the disease reaches severe symptoms. Early mitigation of SDS reduces yield loses for farmers. The use of both CIR and TIR aerial imagery captured using sUAS can provide rapid spatial assessments of SDS, which is required by both producers and plant breeders. PI derived from CIR imagery showing strong correlations to SDS score reinforce the idea of replacing the time-consuming traditional ground-based systems with the more flexible, faster, sUAS methods. TIR imagery was shown to be reliable in assessing SDS in soybeans further establishing another possible aerial method for early detection of SDS.

No description available.

Abstract “Early repolarization” (ER), consisting of J waves and ST-segment elevation in the standard 12-lead electrocardiogram (ECG), has been considered a benign finding for over 60 years until 2008 an over-presentation of ER ECG pattern in infero-lateral leads was described in patients with idiopathic ventricular fibrillation. The purpose of this thesis was to assess the prevalence and prognostic significance, and to characterize the clinical features of this ECG pattern primarily in the general population. This thesis investigated the electrocardiographic features of a total of 20,308 general population individuals, 565 athletes, 432 victims of sudden cardiac death and 532 survivors of an acute coronary event. The overall prevalence of infero-lateral ER ECG pattern in the general population samples was in range between 3.3 and 6.1 percent. ER seemed to have a heritable basis as siblings of individuals displaying the ER pattern had significantly increased odds for presenting this ECG pattern. Several strong associations between ER pattern and clinical factors were observed in all populations. The ER patterns with horizontal or descending ST-segments were associated with significantly increased arrhythmic mortality during a follow-up of 30±11 years, and high amplitude (&#62;0.2mV) J waves in the inferior leads were associated with a high risk of arrhythmic death (multivariate adjusted hazard ratio 3.13 (95% confidence interval 1.55 to 6.32). The ER ECG pattern was also independently associated with sudden cardiac death during an acute coronary event, with an odds ratio of 2.02 (95% CI 1.04 to 3.61) for suffering sudden death. The ER patterns with rapidly ascending ST-segments, the dominant type of ER ECG in young, healthy individuals, were not associated with any adverse outcomes. A multicentre meta-analysis of genome wide association study of ER ECG pattern performed in a total of 14,633 individuals pointed to an associated locus in KCND3 (Kv4.3) gene, which encodes a subunit of the Ito channel, but the association did not reach genome-wide significance and could not be replicated in all study populations. In conclusion, the results of these studies demonstrated that the ER ECG pattern with horizontal or descending ST-segments, especially in the inferior leads, is associated with an increased risk of sudden arrhythmic death in the general population, and that individuals carrying this ECG pattern are at increased risk of suffering fatal arrhythmia during an acute coronary event. The ER pattern with rapidly ascending ST-segments is common in young healthy athletes and is not associated with any increased risk of fatal events. Although the ER ECG pattern increases the relative risk of arrhythmic events, the absolute risk in an individual is low and therefore this ECG pattern should not be interpreted as a high-risk marker of mortality. The genetic background of this ECG pattern remains to be clarified. / Tiivistelmä Normaalissa 12-kytkentäisessä sydänfilmissä (EKG) J-aallosta ja ST-segmentin noususta koostuvaa varhaista repolarisaatiota (ER) pidettiin yli 60 vuotta hyvänlaatuisena muutoksena, kunnes vuonna 2008 ER:n esiintyminen alaseinä-lateraalikytkennöissä liitettiin idiopaattiseen kammiovärinään. Tämän väitöstutkimuksen tarkoitus oli selvittää EKG muutoksen esiintyvyys ja ennustearvo normaaliväestössä, sekä selvittää sen kliinisiä erityispiirteitä. Väitöstutkimusta varten tutkittiin 20,308 normaaliväestön henkilöä, 565 urheilijaa, 432 äkillisesti (sydänperäisesti) menehtynyttä henkilöä ja 532 akuutista sepelvaltimotautikohtauksesta selviytynyttä potilasta. ER-EKG:n kokonaisesiintyvyys alaseinä-lateraalikytkennöissä normaaliväestön otoksissa vaihteli 3.3&#160;% ja 6.1&#160;% välillä. ER-EKG:n esiintyessä merkittävästi muita useammin sisaruksilla ER-EKG vaikutti periytyvältä muutokselta, ja lisäksi kaikissa otoksissa ER-EKG liittyi useisiin muihin tunnettuihin kliinisiin muuttujiin. ER-EKG, ts. J-aallot, joita seurasivat horisontaalinen tai laskeva ST-segmentti, liittyivät merkittävästi lisääntyneeseen rytmihäiriökuolleisuuteen pitkän seuranta-ajan (30±11 vuotta) aikana, ja korkea-amplitudiset (&#62;0.2mV) J-aallot alaseinäkytkennöissä liittyivät korkeaan riskiin kuolla äkillisesti rytmihäiriöön (monimuuttuja-vakioitu riskisuhde 3.13, 95&#160;% luottamusväli 1.55–6.32). ER-EKG lisäsi lisäksi itsenäisesti sydänperäisen äkkikuoleman riskiä akuutin sepelvaltimotautikohtauksen aikana (vetosuhde 2.02, 95&#160;% luottamusväli 1.04–3.61). Etenkin nuorilla ja terveillä urheilijoilla esiintynyt EKG tyyppi, J-aallot ST-segmentin nousujen yhteydessä, ei liittynyt huonoon ennusteeseen. Monikeskusmeta-analyysi perimänlaajuisista assosiaatiotutkimuksista (GWAS) 14,633 henkilöllä antoi viitteitä geenimuutoksesta KCND3, joka koodittaa osaa Ito kanavasta, mutta löydöstä ei kyetty toistamaan kaikissa tutkituissa aineistoissa. Väitöstutkimuksen osatöiden perusteella ER-EKG muutos ilman ST-segmentin nousua, erityisesti alaseinäkytkennöissä esiintyessään, liittyy normaaliväestössä lisääntyneeseen riskiin sydänperäiselle rytmihäiriökuolemalle, ja että henkilöillä, joilla muutos esiintyy, on lisääntynyt riski menehtyä äkillisesti sepelvaltimotautikohtauksen aikana. ER-EKG ST-segmentin nousuihin liittyen on yleinen löydös nuorilla terveillä urheilijoilla ja se ei näytä liittyvän lisääntyneeseen riskiin rytmihöiriöille. Vaikka ER-EKG lisääkin suhteellista riskiä rytmihäiriöille ja ennenaikaiselle kuolemalle väestötasolla, absoluuttinen riski on pieni, eikä muutosta tulisi luokitella suureksi riskitekijäksi. Löydöksen geneettinen tausta on vielä avoin kysymys.