Au Maroc, de nombreux filons à Pb-Zn-Ag sont encaissés dans des séries paléozoïques recoupées par des granitoïdes tardi-varisques. L'association spatiale de ces filons avec ces intrusions magmatiques a souvent été interprétée comme la preuve d'un lien génétique entre la mise en place des granitoïdes et l'hydrothermalisme minéralisateur. Toutefois, des observations récentes permettraient d'envisager que ces minéralisations puissent être post-hercyniennes, remettant en cause les modèles génétiques, et donc les stratégies d'exploration de ces métaux. Le district polymétallique de Tighza-Jbel Aouam (Maroc central) où des minéralisations à Pb-Zn-Ag sont concentrées autour de petits stocks granitiques est un site privilégié pour étudier les relations spatio-temporelles entre les granitoïdes et les minéralisations associées. Les objectifs de la thèse ont donc été : (i) d'approfondir la minéralogie des minéralisations, (ii) d'utiliser les méthodes géochronologiques les plus pertinentes pour dater les minéralisations, (iii) d'étudier les transferts magmas-fluides-métaux depuis les zones profondes (manteau, croûte inf.) vers les zones les plus superficielles de la lithosphère, à l'aide de traceurs géochimiques. Les stocks et dykes granitiques de Tighza ont été analysés et datés par U/Pb sur zircons. Ces roches appartiennent à une lignée calco-alcaline potassique et les datations mettent en évidence trois évènements magmatiques et hydrothermaux associés: (i) entre 320 et 300 Ma, mise en place de quelques dykes et des stocks granitiques ; (ii) entre 300 et 280 Ma, mise en place d'un pluton, actuellement non affleurant, accompagné par un hydrothermalisme responsable de la formation d'une auréole de métamorphisme hydrothermal, et du développement de minéralisations à W-Au ; (iii) entre 280 et 240 Ma, mise en place d'un réseau important de dykes NE-SW, accompagné par un hydrothermalisme minéralisateur en Pb-Zn-Ag caractérisé par une altération à chlorite-muscovite-calcite des métasédiments encaissants. L'étude détaillée des paragenèses des filons à Pb-Zn-Ag a permis d'établir le caractère pulsatoire de la précipitation des minéralisations. Quatre paragenèses successives ont été identifiées : (P1) stérile à sidérite ± quartz ; (P2) à calcite ± ankérite + sphalérite + galène ± sidérite ± quartz ± calcédoine ; (P3) à sidérite + sphalérite + galène ± quartz ; (P4) stérile à quartz + calcite + pyrite. Ces assemblages minéralogiques synchrones s'accompagnent de minéraux accessoires à éléments des terres rares (monazite, xénotime, synchisite), responsables des hautes teneurs en REE des carbonates de gangue (≃ 700 ppm). Des monazites d'un filon à Pb-Zn-Ag ont pu être datées par Th/Pb à 255 ± 15. L'étude des sources des métaux (isotopes Pb) indique que le plomb des minéralisations Pb-Zn-Ag provient du lessivage de la croûte supérieure. L'étude des sources des fluides minéralisateurs en Pb-Zn-Ag indique une origine crustale (isotopes He, Ar), avec un fort effet tampon par les schistes encaissants les minéralisations (isotopes C, O). Les fluides minéralisateurs en W-Au, sont eux issus d'un mélange entre une source météorique et une source mantellique (isotopes He, Ar), et ont donc une origine distincte du système à Pb-Zn-Ag. Le gisement polymétallique de Tighza-Jbel Aouam est donc caractérisé par le télescopage de plusieurs épisodes magmatiques et hydrothermaux guidés par un accident d'échelle lithosphérique et conduisant à la formation : (i) de minéralisations W-Au mésothermales pouvant être assimilées à un type porphyre, suivies pas (ii) des minéralisations à Pb-Zn-Ag épithermales. Ces épisodes magmatiques et métallogéniques s'étalent sur une durée de près de 80 Ma à la fin de l'orogenèse varisque, et caractérisent parfaitement le contexte post-collisionnel de cet orogène, notamment les effets associés au réequilibrage thermique de la croûte pendant la période permo-triasique et le prérifting Atlantique. / In Morocco, many Pb-Zn-Ag vein-type deposits are hosted in paleozoic series crosscut by variscan granitoids. The spatial association of these veins with the magmatic intrusions has often been interpreted as evidence of a genetic link between the granitoids emplacement and the mineralizing hydrothermal event. However, recent data allow to consider a late-variscan emplacement of these mineralizations. Genetical models must thus be reviewed, as well as the exploration of these base metals strategy. The polymetallic district of Tighza-Jbel Aouam (Central Morocco), were Pb-Zn-Ag vein-type deposits are located around small granitic stocks, has been selected to study the spatial and temporal relationships between granitoids and associated mineralizations. The aims of this work have been: (i) to go further into the mineralizations mineralogy, (ii) to use appropriate geochronological methods to date the mineralizations, (iii) to study the magma-fluids-metals transfers from the deeper areas (mantle, deep crust) to the upper lithosphere, using geochemical tracers. Granitic stocks and dykes of Tighza have been analyzed and dated using U/Pb method on zircons. These rocks belong to a high-K calc-alkaline association and datations show three magmatic and associated hydrothermal events: 320 to 300 Ma, stocks with few dykes emplacement; 300 to 280 Ma, pluton emplacement with associated hydrothermal event and responsible for a hydrothermal metamorphic halo, mineralizing the W-Au ore; (iii) 280 to 240 Ma, NE-SW dykes network emplacement, associated with a Pb-Zn-Ag mineralizing hydrothermal event, characterized by a chlorite-muscovite-calcite alteration of the hosting metasediments. The detailed study of Pb-Zn-Ag veins paragenesis showed the pulsated character of the mineralization precipitations. Four successive paragenesis have been identified: (P1) siderite ± quartz; (P2) calcite ± ankerite + sphalerite + galena ± siderite ± quartz ± chalcedony; (P3) siderite + sphalerite + galena ± quartz ; (P4) quartz + calcite + pyrite. These synchrone paragenese are associated with REE-minerals (monazite, xenotime, synchisite) responsible for the high amount of REE in the gangue carbonates (≃ 700 ppm). Some monazites from a Pb-Zn-Ag vein have been dated at 255 ± 15 Ma using the Th/Pb method. The metals source study (lead isotopes) shows that the Pb of Pb-Zn-Ag mineralizations come from the upper crust leaching. The fluid sources study of Pb-Zn-Ag veins indicates a crustal origin (He, Ar isotopes) strongly buffered by the hosting shales (C, O isotopes). W-Au mineralizing fluids are stemming from a mixing of meteoric and mantellic fluids (He, Ar isotopes). W-Au and Pb-Zn-Ag are thus distinguished mineralizations. The polymetallic district of Tighza-Jbel Aouam is thus characterized by the superposition of several magmatic and hydrothermal events controlled by lithospheric scale leap, leading to the formation of: (i) mesothermal W-Au deposit which can be considered as a porphyry-type mineralization; (ii) epithermal Pb-Zn-Ag mineralization. These magmatic and metallogenic events last over 80 Ma after the end of the varican orogenesis, and characterize the post-collisional context of this orogen, in particular the effects of the thermal balance of the crust during the permo-triassic period and the Atlantic pre-rifting.

Análise da expressão de neurotrofinas durante a regeneração de nervo periférico de rato por enxerto venoso Enxertos de veias têm sido empregados para preencher lacunas em nervos periféricos transeccionados para melhor recuperação funcional. No entanto, vários inconvenientes, como a constrição do enxerto secundário foram observados. Uma nova alternativa para esta técnica foi desenvolvida. Simplesmente invertendo a veia de dentro para fora, chamado do Inside- out vein graft. As neurotrofinas são uma família de fatores neurotróficos conhecidos por desempenhar um papel significativo na regeneração de nervos periféricos. A família da neurotrofina é constituído por fator de crescimento nervoso (NGF), fator neurotrófico derivado do cérebro (BDNF), Neurotrofina-3 (NT-3) e Neurotrofina-4 (NT-4). No campo da neurobiologia, vários autores têm utilizado a técnica de PCR a fim de obter mais informações sobre os nervos regenerados. Neste estudo, foi utilizada a técnica de biologia molecular para explorar o papel e o nível das neurotrofinas durante a regeneração de nervos periféricos com enxerto de veia. O nervo isquiático de ratos foi seccionado e reparado com enxerto de veia invertida (IOVG) e técnicas de enxerto de veia padrão (SVG). No grupo controle, os ratos foram operados e o nervo isquiático foi mantido intacto. Os animais foram sacrificados após 6 e 12 semanas e os enxertos foram colhidos para observar o nível das neurotrofinas. Músculos EDL e Sóleo foram excisados e pesados para determinar a diferença de peso entre os grupos. Um pequeno segmento dos cotos distais de ambos os grupos SVG e IOVG também foram excisados e foram processados histologicamente para examinar a quantidade de axónios regenerados. Além disso, um outro pequeno segmento do coto distal foi processado para RT-PCR para analisar o nível das neurotrofinas nesta área.A tecnica do walk track analysis foi realizada para determinar o índice funcional do nervo isquiático nos grupos. Em 6 semanas, não ocorreu crescimento neuronal significativo no coto distal dos dois tipos de enxertos, porém um crescimento foi observado em 12 semanas. Não houve diferença significativa na massa muscular entre IOVG e SVG em ambos os períodos de tempo. No entanto, um aumento significativo na massa muscular foi observado a partir de 6 a 12 semanas nos grupos IOVG e SVG. Um aumento significativo na produção de NT-3 foi observado no grupo de SVG em ambos, enxerto e o coto distal quando comparados a partir de 6 a 12 semanas, no entanto, não houve aumento observado no nível de neurotrofinas dos outros tipos (NGF e NT-4) . Surpreendentemente, não houve aumento significativo da NT-3 no grupo IOVG. Conclui-se que, entre as neurotrofinas avaliadas neste estudo, não há nenhuma diferença significativa no seu nível de RNAm entre os dois grupos, exceto NT-3. Finalmente, uma vez que o nível de RNAm de NT-3 aumenta significativamente entre 6 e 12 semanas no grupo SVG e não no IOVG, observado por estas duas técnicas de nível molecular, estudos adicionais necessitam serem feitos para decifrar o mecanismo exato. / Vein grafts have been employed to bridge the gap in transected peripheral nerves to produce better functional recovery. However several disadvantages such as secondary graft constriction were observed and a new alternative to this technique was developed by simply reversing the vein inside out. Both inside out and standard vein grafts were successfully used in recovering the sensory segmental defect in humans. Neurotrophins are a family of eurotrophic factors known to play an important role in the regeneration of peripheral nerves. The neurotrophin family consists of Nerve Growth Factor (NGF), Brain Derived Neurotrophic Factor (BDNF), Neurotrophin-3 (NT-3) and Neurotropinh-4 (NT-4). In the neurobiology field, several authors have been using PCR technique in order to gain more information regarding regenerated nerves. In this study, we employed this molecular biology technique to explore the role and level of the neurotrophins during the peripheral nerve regeneration with vein graft. The sciatic nerve of rats were sectioned and repaired with Inside out vein graft (IOVG) and standard vein graft techniques (SVG). In the control group the rats were sham operated wherein the sciatic nerve was kept intact. The animals were euthanized at 6 and 12 weeks and the grafts were harvested to observe the level the neurotrophins. EDL and Sol muscles were excised and measured to determine any weight difference between the groups. A small segment of the distal stumps from both the SVG and IOVG groups were also excised and were subjected to histological process to examine the amount of regenerated axon. In addition, another small segment of the distal stump was processed for RT-PCR to further examine the level of the neurotrophins in this area. At 6 weeks, no significant neuronal growth was observed in the distal stump of both graft types but a distinct growth was seen at 12 weeks. Walk track analysis showed poor motor function recovery in the experimental groups during both time intervals. Morphometric analysis demonstrated no significant differences in the amount of myelination between both the groups. There was no significant difference in the muscle mass between IOVG and SVG in both time periods. However, a significant increase in both the muscle mass was observed from 6 to 12 weeks in the IOVG and SVG groups. A significant increase in the production of NT-3 was observed in SVG group in both the distal stump and graft segment when compared from 6 to 12 weeks; however there was no observed increase in the level of other neurotrophins (NGF and NT-4). Surprisingly, no significant increase of NT-3 was noticed in the IOVG group. We conclude that amongst the neurotrophins evaluated in this study, there is no significant difference in their mRNA level between both groups except NT-3. Also, since mRNA level of NT-3 increases significantly between 6 and 12 weeks in SVG and not in IOVG, it suggests that the mechanism by which these two techniques operate at a molecular level may differ and further studies need to be done to decipher the exact mechanism.

Orientador: Joyce Maria Annichino-Bizzacchi / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T22:14:32Z (GMT). No. of bitstreams: 1 Prado_LucasBessa_M.pdf: 3008068 bytes, checksum: 3758f8a952dfe1f77c113246b8e2a0bd (MD5) Previous issue date: 2013 / Resumo: A Trombose Venosa Profunda (TVP) é definida como uma oclusão parcial ou total da circulação venosa profunda. A heparina é um fármaco com ação anticoagulante e antitrombótica utilizado desde 1930. O custo, a via de administração (endovenosa ou subcutânea) e as doses repetidas são algumas das limitações do seu uso. Assim, o desenvolvimento de um produto que possa ser administrado por via subcutânea ou oral em um menor número de aplicações, torna-se um importante desafio e de grande aplicabilidade clínica. Sistemas de liberação sustentada permitem que o fármaco seja encapsulado e liberado gradativamente. Este estudo constituiu na preparação, caracterização e avaliação in vivo de nanopartículas de poli (?-caprolactona) (PCL) e quitosana como carreadores de heparina de baixo peso molecular (enoxaparina). As nanopartículas foram preparadas pelo método de dupla emulsão água/óleo/água e evaporação do solvente. A caracterização das nanopartículas foi realizada por microscopia eletrônica de varredura (MEV), onde foram observadas partículas esféricas e homogêneas. O diâmetro médio das nanopartículas foi de 512,8 ± 13,8 nm e o potencial zeta foi de +30,9 ± 1,3 mV. A eficiência de encapsulamento, analisada pelo método Azure II foi de 99,04 ± 0,001 %. A atividade anticoagulante in vivo da enoxaparina encapsulada foi avaliada pela atividade anti-Xa plasmática, através de método colorimétrico. Quando a enoxaparina livre foi administrada por via subcutânea observou-se um pico de atividade (0,5 UI/mL) em 1 hora, com um decréscimo gradual até 6 horas. A atividade anticoagulante da enoxaparina encapsulada em nanopartículas manteve-se por até 14 horas, quando foi administrada por via subcutânea, sugerindo que as nanopartículas podem permitir que a enoxaparina seja liberada de forma gradual, podendo ser uma vantagem na prática clínica. Após a administração das nanopartículas por via oral não se observou nenhuma atividade em até 14 horas, sugerindo que as nanopartículas não tenham sido absorvidas ou a enoxaparina tenha sido degradada no trato gastrointestinal. Para avaliação do efeito antitrombótico foi padronizado o modelo de TVP por estase e hipercoagulabilidade em ratos. Após administração subcutânea, houve uma significativa diminuição do tamanho do trombo formado tanto com o emprego de enoxaparina livre (p= 0,002) como após encapsulamento em nanopartículas (p= 0,0411) em comparação ao grupo controle. Quando foram administradas nanopartículas por via oral, os resultados mostraram que não houve diferença estatística em comparação ao grupo controle (p= 0,9476) e a um grupo de nanopartículas vazias (p= 0,9372). Em resumo, o método de dupla emulsão a/o/a mostrou-se eficiente para o encapsulamento de enoxaparina, proporcionando a obtenção de nanopartículas esféricas e com alta eficiência de encapsulamento. Pelos estudos in vivo, a enoxaparina encapsulada mostrou uma atividade anticoagulante com liberação sustentada, por um período superior ao obtido com a enoxaparina livre, com excelente efeito antitrombótico quando administrada por via subcutânea. Contudo, não se observou nenhum efeito anticoagulante ou antitrombótico quando as nanopartículas foram administradas por via oral. Novos experimentos com quitosanas de diferentes massas molares serão necessários na tentativa de possibilitar a absorção oral dessas nanopartículas / Abstract: Deep vein thrombosis (DVT) is defined as partial or total occlusion of the deep venous circulation. Heparin is a drug with anticoagulant and antithrombotic action used since 1930. The costs, administration vias (intravenous or subcutaneous) and the repeated doses are some limitations of its use. Thus, the development of a product that could be administered subcutaneous or orally in a smaller number of applications becomes a major challenge with huge clinical applicability. Sustained release systems allow the medication to be gradually encapsulated and released. This study was based on the preparation, characterization and in vivo evaluation of nanoparticles of poly (?-caprolactone) (PCL) and chitosan as carriers of low molecular weight heparin (enoxaparin). The nanoparticles were prepared by the double emulsion water/oil/water method and solvent evaporation. The nanoparticles characterization was performed by scanning electron microscopy (SEM), in which were observed spherical and homogeneous particles. The average diameter of the nanoparticles was 512.8 ± 13.8 nm and the zeta potential was +30.9 ± 1.3 mV. The encapsulation efficiency, analyzed by Azure II method, was 99.04 ± 0.001%. The in vivo anticoagulant activity of the encapsulated enoxaparin was evaluated by plasmatic anti-Xa activity performed by colorimetric method. When the free enoxaparin was subcutaneously administered a peak of activity was observed (0.5 IU/mL) in 1 hour with a gradual decrease until 6 hours. The anticoagulant activity of the nanoparticles encapsulated enoxaparin was kept until 14 hours when it was administered subcutaneously, suggesting that nanoparticles may allow the enoxaparin release by a gradual way, what could be an advantage on clinical practice. After the oral administration of the nanoparticles, any activity could be observed in until 14 hours, suggesting that or the nanoparticles might be not absorbed or the enoxaparin might be degraded on the gastrointestinal tract. In order to evaluate its antithrombotic effect, it was standardized a model of DVT by stasis and hypercoagulability in rats. After subcutaneous administration, there was a significative reduction on the thrombus size both with free enoxaparin (p= 0.002) and after encapsulation (p= 0.0411) in comparison with control group. When nanoparticles were administered orally, the results showed no statistical difference compared to the control group (p = 0.9476) and to a group of empty nanoparticles (p = 0.9372). In summary, the double emulsion method w/o/w was efficient for the enoxaparin encapsulation, providing the obtainment of spherical nanoparticles with high encapsulation efficiency. For in vivo studies, the encapsulated enoxaparin showed a sustained release anticoagulant activity for a higher period than that obtained with free enoxaparin, with an excellent antithrombotic effect when administered subcutaneously. However, there was no anticoagulant or antithrombotic effect when the nanoparticles were administered orally. Further experiments with chitosans of different molecular weights will be needed on the attempt to allow the oral absorption of these nanoparticles / Mestrado / Medicina Experimental / Mestre em Fisiopatologia Médica

This thesis describes the successful development and initial evaluation of a proof-of-concept wireless monitoring system for improving the effectiveness and safety of pneumatic compression therapy to help prevent deep vein thrombosis (DVT). In the development, an important objective was to make feasible the practical and commercial deployment of such improved therapy systems in future, by focusing on a cost-effective design and implementation. Over the years, pneumatic compression has been shown to be an effective solution for the prevention of DVT. However, different problems and complications related to the use of commercial pneumatic compression de-vices that typically include automatic pressure controllers and pneumatic compression sleeves have been reported. For example, one study reported a high percentage of improperly applied or nonfunctional pneumatic compression devices in routine usage. Technical problems, non-compliance, and human error were identified as the causes behind the failed therapies. Also, it was reported that dedicated in-service instruction did not improve the proper use of the pneumatic compression controllers and sleeves. In another study, significant unanticipated variations between expected and delivered pneumatic compression therapy were reported: expected therapy delivered only an average of 77.8% of the time during the therapy, and much of the time key values related to the outcome of the therapy were found to have variations great than 10%. Specific hazards have also been reported. For example, one patient developed acute compartment syndrome after wearing a pair of pneumatic compression sleeves with faulty pressure release valves. In another case, epidural analgesia masked a malfunction resulting from a reversed connection between four-way plastic tubing of the sleeves and the controller, exposing a patient to a hazardous pressure of around 300mmHg,blocking all blood flow for a prolonged period of time. Newer models of pneumatic compression sleeves and controllers from various manufacturers claim to improve therapy by, for example, increasing the peak blood flow velocity. However, there is no evidence in the published literature to support such claims. A published review of the literature from1970-2002 reached the conclusion that the most important factors in im-proving therapy with pneumatic compression devices, particularly during and after surgery, were the degree of conformance of delivered therapy to the prescribed therapy, patient compliance, and the appropriateness of the site of compression. The inability to monitor delivered therapy and patient compliance remains a problem in efforts to improve pneumatic compression therapy. The above-described problems were addressed in the successful development of the innovative prototype described in this thesis. This wireless monitoring system should improve the effectiveness and safety of pneumatic compression therapy. Also, innovative aspects of the system design allow for cost-effective integration into existing commercial controllers and sleeves. For example, an innovative and potentially patentable usage and reprocess indicator was developed for pneumatic compression sleeves to significantly improve their safety and to reduce their cost of use per patient. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第21824号 / 農博第2337号 / 新制||農||1067(附属図書館) / 学位論文||H31||N5196(農学部図書室) / 京都大学大学院農学研究科森林科学専攻 / (主査)教授 大澤 晃, 教授 北山 兼弘, 教授 北島 薫 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22361号 / 医博第4602号 / 新制||医||1043(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 上本 伸二, 教授 小西 靖彦, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Microscopic polyangiitis (MPA) is a rare condition characterized by nonspecific symptoms of fatigue, fever, or loss of appetite and additional symptoms related to areas of involvement. The rarity of the disease and its variable presentation can delay its diagnosis in the acute setting, potentially leading to delay in effective treatment and poor outcomes. This is a case report of a 68-year-old man, who presented to the hospital after being found poorly responsive at home. He was sedated and intubated in the field and brought to the ER. He was found to be hypotensive. History revealed abdominal aortic aneurysm, but no known history of GI bleed or use of blood-thinners. Physical exam revealed rhonchi throughout both lung fields, a soft, nondistended abdomen with normoactive bowel sounds, and cool extremities with weak palpable pulses. CBC was suggestive of anemia. BUN and creatinine were elevated indicating kidney injury. CT abdomen showed no acute pathology and an intact abdominal aortic aneurysm. CT chest revealed left lower lobe atelectasis and bilateral pulmonary edema. CT head was consistent with watershed infarction. Numerous blood transfusions were given. However, slow decline in hemoglobin continued to occur. Colonoscopy was considered for possible identification of the source of bleeding, however was not performed due to the family’s wish for conservative management. Bronchoscopy was performed, revealing extensive mucus plugging and bloody plugs. He was eventually weaned off sedation but remained largely unresponsive, occasionally opening his eyes to stimuli. On hospital day 7, necrotic lesions were noted on the patient’s ear and fingers. These findings prompted serologic studies for vasculitis that resulted in positive p-ANCA and myeloperoxidase antibodies, consistent with MPA. He was started on pulse dose IV steroids resulting in modest improvement in renal parameters and hemoglobin, but no discernible change in neurological status. The patient was transitioned to comfort care and palliative extubation was performed. Four days later, the patient expired. This case illustrates the potential for hypovolemic shock as a consequence of undiagnosed vasculitis. In this case, a definite diagnosis was not made, due to inability to perform a lung biopsy because of patient being on comfort measures. However, given that he was p-ANCA and myeloperoxidase positive, along with visualized blood on bronchoscopy, a presumptive diagnosis of MPA can be made. Although this patient may not have recovered even with early immunosuppressive treatment, vasculitis should be considered as a differential diagnosis in patients presenting in hypovolemic shock, especially if history, exam and noninvasive testing are unrevealing.

Context: Inferior vena cava (IVC) anomalies have a 0.5% incidence rate and could be associated with other congenital abnormalities. In later stage of the disease, trophic ulcers with or without deep vein thrombosis (DVT) is consistent finding.Case Report: A 29-year-old male patient presented with recurrent lower extremity ulcers. Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT.Conclusion: IVC anomaly should be suspected in a young patient presenting with unexplained venous thrombosis and recurrent ulcers of a lower extremity. IVC anomaly would inherently lead to blood flow stasis and endothelial injury. Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / This article analyzes the applicability of an appropriate design of blasting engineering for an underground mine to be used in a Peruvian grain context through the data collection and observation method using the Bieniawski rock mass geomechanical classification system, average vein power weighting, and operational dilution of the pits. The generation of solutions is under both the McCarthy approach formula and final results analysis of the dilution behavior obtained in relation to the initial ones. Moreover, the database provided by a mining company is analyzed with respect to the geological conditions for the rock mass classification of the roof box and floor box to determine the quality of the rock, ore grades, power of the vein, and the percentage of dilution. Then we proceed to determine the continuity and thickness of the vein in a given block and analyze the dilution based on the fundamental criteria of blasting engineering.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23573号 / 医博第4787号 / 新制||医||1054(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 中本 裕士, 教授 花川 隆, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM