Atualmente o diagnóstico da morte súbita dos citros (MSC) é realizado através de inspeção visual e coleta do material do porta-enxerto o que confere ao método elevado grau de subjetividade e imprecisão, além de demandar muito tempo para o levantamento de dados de infestação. Este trabalho pretende estudar as mudanças nas propriedades físicas e químicas acarretadas pela MSC em folhas e porta-enxertos de laranjeira doces (Citrus (L.) Osbeck), e desenvolver uma nova metodologia de diagnóstico da doença. Para tanto, folhas, porta-enxertos e seus extratos foram analisados através das seguintes técnicas espectroscópicas: absorção de luz uv-visível, absorção de infravermelho com transformada de Fourier, fluorescência e fluorescência induzida por laser. Além do estudo utilizando técnicas espectroscópicas foram realizados estudos utilizando técnicas de imagem de fluorescência de folhas saudáveis e doentes. Foram coletadas amostras de folhas saudáveis, doentes com a MSC e doentes com o declínio dos citros (DC). A comparação entre estas doenças é primordial visto que no campo os sintomas são muito parecidos, confundindo muito o sistema de avaliação de contaminação. Foram observadas mudanças significativas nos espectros de emissão de fluorescência para os três tipos de amostras e baseados nestas diferenças foi definido um índice capaz de diagnosticar a MSC e o DC. A técnica de imagens de fluorescência também trouxe informações importantes permitindo diferenciar plantas saudáveis e doentes de uma forma muito rápida. A junção da técnica de imagens com as espectroscópicas deu origem a uma nova metodologia de diagnóstico da MSC com potencial de ser muito mais rápida, precisa e não invasiva permitindo análises da folha in natura. / Currently, the diagnosis of citrus sudden death (CSD) is carried out by visual inspection and collection of the rootstock, which causes the method to be inaccurate and allows for much subjectivity, besides demanding much time to examine the infestation data. The present work intends to study changes in the physical and chemical properties resulting in CSD of leaves and rootstock material of sweet orange trees (Citrus (L.) Osbeck), as well as developing a new diagnosis methodology of the disease. Thus, leaves, rootstock and their extracts were analyzed by means of the following spectroscopic techniques: absorption of uv-visible light, absorption of infrared with Fourier transform, fluorescence and laser-induced fluorescence. Besides employing spectroscopic techniques, studies using fluorescence images of healthy and sick leaves were carried out. Samples of healthy leaves, sick leaves with CSD and sick leaves with citrus decline (CD) were collected. Comparison of these diseases is primordial since in the field the symptoms are similar, causing much confusion in the evaluation system of contamination. Significant changes were observed in the spectra of fluorescence emissions for the three types of samples and based on such differences an index capable of diagnosing CSD and CD was defined. The fluorescence image techniques also brought important information, thus allowing to quickly differentiate between healthy and sick leaves. Joining the technique of images with spectroscopy originated a new methodology of CSD, which is potentially much faster, precise and non-invasive, thus allowing in natura analysis of leaves.

Abstract Short QT syndrome is an inherited arrhythmia disorder characterized by a short QT interval, typical T-wave and ST-segment morphology and an increased risk of sudden cardiac death. The purpose of this thesis was to study the epidemiology and prognosis of the subjects with short QT intervals. Special attention was paid to the ECG changes that could illustrate the prognosis of subjects with short QT interval. The first study comprised a group of patients with short QT syndrome. We report clinical presentation, ECG morphology, the prevalence of genetic mutations and the results of therapies in this group of patients. The second study population consisted of 10 822 randomly selected middle-aged subjects followed up for 29 ± 10 years. QT intervals were measured using three correction methods for the heart rate in order to assess the prevalence and prognosis of those subjects with short QT intervals. The third population consisted of three patients with short QT syndrome and nine controls. Holter recordings were analyzed to compare transmural dispersion of repolarization between patients and controls and also to study their capability to change repolarization indexes from baseline to maximal values. In the fourth study ECGs from 10 patients with short QT syndrome were compared with ECGs of 12 asymptomatic subjects with short QT intervals. The aim was to find ECG abnormalities that would predict the outcome of the patients. We found 62% of patients to be symptomatic, 34% had cardiac arrest. Atrial fibrillation was common. Most of the patients received an ICD or were placed on hydroquinidine. The prevalence of QTc < 320ms was 0.10% and QTc < 340ms was 0.4%, respectively. Mortality or other serious symptoms did not differ between subjects and controls. We also found that the TPE/QT ratio as an index for abnormal transmural dispersion of repolarization was high compared to controls. Short QT syndrome patients had also lesser capacity to change the QT interval, indicating blunted autonomic response in SQTS. Ten SQTS patients had significantly shorter Jpoint–Tpeak interval and higher TPE/QT ratio compared to controls. In conclusion, shorter than normal QT interval might represent a novel short QT syndrome. However, in the general community short QT interval can reflect only the extreme end of the normal Gaussian distribution of QT intervals and these subjects carry a good prognosis. TPE/QT ratio and Jpoint–Tend intervals can be used as risk stratifiers in subjects with short QT intervals.

The occurrence of mid-latitude spread F (SF) over South Africa has not been extensively studied since the installation of the DPS-4 digisondes at Madimbo (30.88◦E, 22.38◦S), Grahamstown (33.32◦S, 26.50◦E) and Louisvale (28.51◦S, 21.24◦E). This study is intended to quantify the probability of the occurrence of F region disturbances associated with ionospheric spread F (SF) and L-band scintillation over South Africa. This study used available ionosonde data for 8 years (2000-2008) from the three South African stations. The SF events were identified manually on ionograms and grouped for further statistical analysis into frequency SF (FSF), range SF (RSF) and mixed SF (MSF). The results show that the diurnal pattern of SF occurrence peaks strongly between 23:00 and 00:00 UT. This pattern is true for all seasons and types of SF at Madimbo and Grahamstown during 2001 and 2005, except for RSF which had peaks during autumn and spring during 2001 at Madimbo. The probability of both MSF and FSF tends to increase with decreasing sunspot number (SSN), with a peak in 2005 (a moderate solar activity period). The seasonal peaks of MSF and FSF are more frequent during winter months at both Madimbo and Grahamstown. In this study SF was evident in ∼ 0.03% and ∼ 0.06% of the available ionograms at Madimbo and Grahamstown respectively during the eight year period. The presence of ionospheric irregularities associated with SF and scintillation was investigated using data from selected Global Positioning System (GPS) receiver stations distributed across South Africa. The results, based on GPS total electron content (TEC) and ionosonde measurements, show that SF over this region can most likely be attributed to travelling ionospheric disturbances (TIDs), caused by gravity waves (GWs) and neutral wind composition changes. The GWs were mostly associated with geomagnetic storms and sub-storms that occurred during periods of high and moderate solar activity (2001-2005). SF occurrence during the low solar activity period (2006-2008)can probably be attributed to neutral wind composition changes.

Master of Science / School of Family Studies and Human Services / Joyce Baptist / This study examined the efficacy of EMDR therapy as a treatment for unipolar depression. Results provide preliminary evidence for the efficacy of EMDR therapy. Of the 12 participants that received 10 sessions of EMDR therapy, four met the criteria for “Recovered,” six “Improved” and two reported no change in severity of depressive symptoms. Results further indicated that participants who experienced decline in depressive symptoms within the first six sessions of treatment had a higher probability to be meet the criteria for “Recovered.” A small sample comparison between EMDR therapy (n = 4) and CBT (n = 4) did not find any significant difference in terms of treatment outcome. In phase 2, participants in both groups either improved or recovered after 10 sessions of treatment. Sudden gains analysis indicated that 5 out of 12 EMDR therapy participants had sudden gains. Participants in sudden gains group were more likely to meet “Recovered” criteria than participants in no-gains group. Examination of attention bias found that depression was positively related to negative affect fixation duration and negatively related to positive affect fixation duration when only using female affect images. These findings support previous research that used attention bias to differentiate depressed and non-depressed persons. Clinical implication and further research are discussed.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23465号 / 医博第4772号 / 新制||医||1053(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 山本 洋介, 教授 松村 由美 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

The present study examined whether or not the temporal pattern of symptom change defined as sudden gains is applicable to and has significant ramifications for understanding recovery from eating disorders. Sudden gains were defined as stable and clinically significant changes that take place between two sessions of treatment. Data for the current study were drawn from an efficacy study of CBT for eating disorders which included session-by-session measures of eating disorder symptomatology. Predictors of sudden gains were measured by an observer coded scale that included ratings of therapist use interventions, client change in behaviors and beliefs, client engagement, and homework completion. Three research questions were addressed: First, is the phenomenon of sudden gains present in CBT for eating disorders? Second, do sudden gains in CBT for eating disorders follow the three-stage model proposed for sudden gain recovery in other disorders (i.e., cognitive changes during critical sessions => sudden gains => upward spiral that includes further cognitive changes and greater long-term symptom improvement (Tang & DeRubeis, 1999b)? Third, what are the predictors of sudden gains in CBT for eating disorders that distinguish the critical session that takes place right before the sudden gain? Findings suggest that many eating disordered clients (62%) experienced at least one sudden gain during the course of CBT treatment. Three distinct types of sudden gains were identified: total symptom sudden gains, eating-related sudden gains, and body-related sudden gains. The average magnitude of these sudden gains was large representing on average 35% of total symptom improvement. Clients who experienced total symptom and body-related sudden gains demonstrated fewer eating disordered symptoms than the other clients at posttreatment. During the session preceding the sudden gain, therapists had increased levels of cognitive interventions and empathy, and clients experienced more cognitive changes and increased motivation.

Cardiac arrest has been reported in patients with mitral valve prolapse; however, clinical characteristics and survival information are limited since most of the cases reported include autopsy data. Nine patients (2 male, 7 female) with mitral valve prolapse were identified who had cardiac arrest; ventricular fibrillation was documented in 8 patients; resuscitation was unsuccessful in 2. Eight had a history of palpitations (months to 15 years duration) and ventricular arrhythmias, 3 had a history (5-15 years) of recurrent syncope, and 1 was totally asymptomatic. Cardiac catheterization-angiographic studies in 8 patients demonstrated normal coronary artery anatomy and mitral valve prolapse. All 9 patients had auscultatory and echocardiographic evidence of mitral valve prolapse. Seven survivors (6 still alive) were followed from 3 to 14 years after cardiac arrest. A subset of patients with mitral valve prolapse and cardiac arrest is described in whom past medical history is compatible with cardiac arrhythmias or syncope, and whose long-term prognosis appears better than patients with other causes of cardiac arrest.

A predominantly right ventricular variant of isolated noncompaction cardiomyopathy is a potentially lethal disease entity, which only recently has become recognized in the clinical and cardiac imaging literature. There are currently few established morphologic criteria for the diagnosis other than right ventricular dilation and presence of excessive regional trabeculation. To date, there have been no autopsy reports of cases following either clinical diagnosis or sudden death. We report 2 adult cases of sudden unexpected death in which unexplained right ventricular dilation and prominent apical hypertrabeculation were the principal findings. The gross and microscopic results suggest pathological similarities between, or coexistence of, right ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathies.

A predominantly right ventricular variant of isolated noncompaction cardiomyopathy is a potentially lethal disease entity, which only recently has become recognized in the clinical and cardiac imaging literature. There are currently few established morphologic criteria for the diagnosis other than right ventricular dilation and presence of excessive regional trabeculation. To date, there have been no autopsy reports of cases following either clinical diagnosis or sudden death. We report 2 adult cases of sudden unexpected death in which unexplained right ventricular dilation and prominent apical hypertrabeculation were the principal findings. The gross and microscopic results suggest pathological similarities between, or coexistence of, right ventricular noncompaction and arrhythmogenic right ventricular cardiomyopathies.

Marfan's syndrome is a common connective tissue disease with different musculoskeletal, ophthalmic and cardiac manifestations. Marfan's patients carry increased risk for cardiac arrhythmias. Only three cases of atrial flutter in Marfan's patients are described in the literature. We report a fourth case of a young Marfan's patient who presents with typical atrial flutter after motor vehicle accident. After electrical cardioversion, sinus rhythm was restored but he had recurrent atrial flutter on follow up. The patient then underwent electrophysiological study and successful radiofrequency catheter ablation of the flutter circuit. Since discharge, the patient has had no documented arrhythmias on follow up.