Objetivo: O presente estudo avaliou o efeito dos cuidados de fisioterapia respiratória, no período pós-operatório, na incidência de complicações pulmonares em pacientes submetidos à esofagectomia. Métodos: Este estudo retrospectivo avaliou 70 pacientes consecutivos (nenhuma exclusão) divididos em 2 grupos: controle (GC; N=30) e fisioterapia respiratória (GFR; N=40). As informações referentes aos períodos pré, peri e pós-operatório foram obtidas através do prontuário médico dos pacientes. Resultados: Os pacientes dos GC e GFR apresentaram média de idade (53,57 ± 12,51 vs 56,55 ± 14,23 anos) e de índice de massa corpórea (22,38 ± 3,41 vs 22,68 ± 3,91 kg/m2) semelhantes, assim como o percentual de diagnóstico de neoplasia que foi de 80% em ambos os grupos. As durações da cirurgia e da anestesia também foram similares entre GC e GFR, respectivamente (370 vs 390 min e 483,83 ± 98,45 vs 496,88 ± 125,77 min). Os pacientes submetidos à esofagectomia que receberam cuidados de fisioterapia respiratória (GFR) apresentaram uma redução nas complicações pulmonares quando comparado com o grupo controle (15,0% vs 36,3%; p<0,05). Esta foi conseqüente à redução na incidência de derrame pleural (10% vs 23%), atelectasia (2,5% vs 3,3%) e broncopneumonia (2,5% vs 10%). Foi também verificado que os pacientes do GFR fizeram menor uso de antibióticos (cefalosporina de 3ª geração), com finalidade terapêutica (p<0,05) e permaneceram menos tempo com o dreno no hemitórax direito (p<0,05). Conclusão: Nossos resultados sugerem que os cuidados de fisioterapia respiratória no período pós-operatório reduzem a incidência de complicações respiratórias, beneficiando os pacientes submetidos à esofagectomia. / The main goal of the present study was to evaluate the effect of late postoperative chest physiotherapy on pulmonary complications in patients submitted to oesophagectomy. This retrospective study involved a sample of 70 consecutive oesophagectomy patients (none excluded) who were divided into two groups as follows: control group (no physiotherapy) and chest physiotherapy group. Patients receiving chest physiotherapy were not submitted to positive airway pressure ventilation. Our results show that patients in the control group were similar to those in the chest physiotherapy group in terms of age and body mass index (53.5 ± 12.5 years vs. 56.5 ± 14.2 years; 22.3 ± 3.4 kg/m2 vs. 22.6 ± 3.9 kg/m2). Patients in the control group and chest physiotherapy group, respectively, also presented the same rate of surgery for malignant disease (80% vs. 80%), surgical time (370 vs. 390 min) and anaesthesia duration (483.8 ± 98.4 min vs. 496.8 ± 125.7 min). Patients in the chest physiotherapy group less frequently presented pulmonary complications (15% vs. 36.3%; p < 0.05), pleural effusion (10% vs. 23%), atelectasis (2.5% vs. 3.3%), and bronchopneumonia (2.5% vs. 10%). Among chest physiotherapy group patients, antibiotic (thirdgeneration cephalosporins) treatment regimens were of shorter duration (p < 0.05). In addition, right hemithorax drainage was less prolonged among the chest physiotherapy group patients (p < 0.05). Our results suggest that chest physiotherapy reduces pulmonary complications in patients undergoing oesophagectomy.

INTRODUÇÃO: Os pacientes portadores de obesidade mórbida submetidos a tratamento cirúrgico para obesidade através de cirurgias desabsortivas-restritivas, após considerável perda de peso, podem apresentar excessos dermogordurosos nas várias regiões do corpo, freqüentemente associados à dificuldade de higiene pessoal e deambulação, maior incidência de infecções cutâneas, insatisfação com a imagem corporal, piora na auto-estima e nos relacionamentos profissionais e afetivos, além da piora da qualidade de vida. Naqueles pacientes com excessos dermogordurosos em abdome e flancos, e ptose da região glútea, a abdominoplastia circunferencial tem demonstrado ser uma solução cirúrgica eficaz. OBJETIVO: Avaliar as alterações na qualidade de vida dos pacientes submetidos a abdominoplastia circunferencial, nos aspectos afetivo-relacional, profissional, social e orgânico. MÉTODOS: Dezesseis pacientes do sexo feminino, que realizaram abdominoplastia circunferencial entre agosto de 2000 e janeiro de 2005, e eram acompanhadas no ambulatório de Cirurgia Plástica da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foram submetidas à entrevistas psicológicas semidirigidas, que consistiram de 31 questões, cujas respostas obtidas foram tabuladas e divididas em categorias. Utilizando-se a Escala Diagnóstica Adaptativa Operacionalizada (EDAO), e tendo como princípio norteador o critério adaptativo, as respostas foram classificadas como adequadas, pouco adequadas ou pouquíssimo adequadas. Através de notas atribuídas a cada resposta, foi possível a avaliação quantitativa nos quatro setores de funcionamento (afetivo-relacional, produtividade, sócio-cultural e orgânico) e a classificação diagnóstica das pacientes quanto à adequação. RESULTADOS: No setor afetivo-relacional, dez pacientes (62,5%) apresentaram respostas adequadas e cinco (31,25%), pouco adequadas. No setor produtividade, dez pacientes (62,5%) apresentaram respostas adequadas e quatro (25%), pouco adequadas. No setor sócio-cultural, treze pacientes (81,25%) apresentaram respostas adequadas. No setor orgânico, dez pacientes (62,5%) apresentaram valores máximos em todos os indicadores avaliados. Sete pacientes (43,75%) apresentaram adaptação eficaz e seis (37,5%), ineficaz leve. CONCLUSÕES: As análises, qualitativas e quantitativas, realizadas através da EDAO, concluiram que houve benefício efetivo aos pacientes submetidos a abdominoplastia circunferencial, nos aspectos físico, profissional, social e orgânico. / INTRODUCTION: Morbid obesity patients submitted to surgical treatment through disabsorptive/restrictive procedures, after considerable weight loss, may present skin and fat excess throughout different body regions, frequently associated with restrictions on personal hygiene and deambulation, greater incidence of skin infections, body image dissatisfaction, worsening of self-steem and of professional and affective relationships, besides down grading quality of life in general. On those patients that present skin and fat excess on the abdomen, flanks and gluteal ptosis, the circumferential abdominoplasty has demonstrated to be an effective surgical solution. OBJECTIVE: To evaluate the modifications on the quality of life of patients that underwent circumferential abdominoplasty on affective/relational, professional, social and organic aspects. METHODS: Sixteen female patients that underwent circumferential abdominoplasty between August 2000 and January 2005 were followed on the outpatient clinic of the Plastic Surgery Division of the Hospital das Clínicas of the University of São Paulo, and were submitted to semi-directed psychological interviews that consisted in 31 questions whose answers were tabulated and separated in categories. One used the Operational Adaptive Diagnostic Scale (OADS) and observing the adaptive patterns as the main criterion, the answers were classified as fairly, poorly and least poorly adequate. Through grades attributed to each answer, it was possible to evaluate quantitatively the four aspects of observation (affective/relational, professional, social and organic) and to establish a classification of the patients relative to their adaptive adequacy. RESULTS: On the aspect affective/relational, ten patients (62.5%) presented fairly adequate answers and five (31.25%) poorly adequate ones. On the productivity aspect, 10 patients (62.5%) presented fairly adequate answers and four (25%) poorly adequate ones. On the social/cultural aspect, 13 patients (81.25%) presented fairly adequate answers. On the organic aspect, 10 patients (62.5%) presented maximum grades in all evaluated criteria. Seven patients (43.75%) presented effective adaptation and six (37.5%) slightly ineffective. CONCLUSIONS: The qualitatively and quantitatively analysis made through OADS showed that there was effective benefit to the patients submitted to circumferential abdominoplasty on the physical, professional, social and organic aspects.

À cause de difficultés d’observations, les recherches passées en biomécanique de l’abdomen soumis aux chocs se sont essentiellement limitées à la description de comportements externes. Cette étude s’intéresse au comportement interne d’organes abdominaux à l’aide de techniques récentes : l’échographie ultrarapide et l’élastographie par ondes de cisaillement. Tout d’abord, l’effet de conditions de perfusion sur la géométrie et le module de cisaillement interne de reins de porc ex vivo a été évalué. L’effet considérable de la pression appliquée a été observé, avec 80mmHg en artère conduisant à l’état le proche de l’in vivo. Ensuite, à l’aide de l’échographie ultrarapide, les comportements internes de reins porcins et humains dans cet état de référence ont été observés lors de compressions à des vitesses entre 0.08 et 8 s-1. Si pour le porc, la partie centrale (bassinet) se déforme plus, le rein humain a semblé avoir une déformation plus homogène. Enfin, à partir des résultats, un nouveau protocole a permis d’observer les comportements du côlon et du foie in situ lors d’impacts sur trois sujets d’anatomie. Dans l’ensemble, cette étude montre ainsi la possibilité de quantifier la relation entre chargement externe et interne grâce à l’échographie ultrarapide lors d’impacts / Due to limitations of observation techniques, past researches in impact biomechanics on the abdomen have been mostly limited to the description of the externals responses. This study focuses on the internal response of abdominal organs using recent observation techniques: ultrafast ultrasound imaging and shearwave elastography. First, the effects of perfusion conditions on the geometrical and internal shear moduli of ex vivo porcine kidneys were evaluated. The considerable effect of the applied pressure was observed, with 80mmHg in artery being closest to the in vivo state. Then, the internal responses of porcine and human kidneys were observed during compressions (rates: 0.08 to 8s-1). If in the porcine specimen the central part (pelvis) deformed the most, the human kidney seemed to have a more homogenous response. Finally, a protocol was developed to observe the responses of the colon and the liver in situ during impacts performed on three post mortem human subjects. Overall, this study demonstrates the possibility to establish a link between external and internal responses during impact using ultrafast ultrasound imaging

Orientador: Sebastião Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T21:01:54Z (GMT). No. of bitstreams: 1 Tonella_RodrigoMarques_M.pdf: 1794716 bytes, checksum: 39387ec279a5a2fa4d65487b1583c298 (MD5) Previous issue date: 2006 / Resumo: Objetivo: Verificar a eficácia da eletroestimulação nervosa transcutânea (TENS) no alívio da dor pós-operatória (PO) relacionada à fisioterapia em pacientes submetidos a cirurgias abdominais. Desenho: Estudo clínico, prospectivo e randomizado, incluindo 48 pacientes, no 1º PO, apresentando escore de dor = 3 pontos na escala visual, divididos em três grupos: controle (n=14): com rotina analgésica habitual, sem TENS e com fisioterapia; estudo (n=18), recebendo rotina analgésica habitual mais TENS, e fisioterapia; contraste-placebo (n=16), recebendo rotina analgésica habitual, TENS desligada e fisioterapia. Uma escala visual analógica de dor foi apresentada ao paciente antes (M1) e depois da TENS (M2) e após fisioterapia (M3), para realizar: tosse, incentivador respiratório, mudança de decúbito (lateral e sentado), quantificando a efetividade da eletroanalgesia. O tempo de eletroestimulação foi 30min, com 150Hz de freqüência e largura de pulso entre 150-250µs. Resultados: Houve alívio significativo da dor no grupo TENS, comparando-se os três grupos, apenas para o procedimento tosse, no M3 (p=0,015). Dentro do grupo TENS houve diminuição significativa da dor para tosse (p=0,003) [M1xM3]; para decúbito lateral (p=0,025), sentar-se (p=0,001) e utilizar o incentivador inspiratório (p=0,017) [M1xM2]; e ao se mudar para decúbito lateral (p=0,03) e sentar-se (p=0,001) [M1xM3]. Não houve diferenças significativas dentro do grupo contraste. Conclusões: Houve diminuição da dor no grupo TENS, para alguns momentos e parâmetros. Entretanto, é necessário cautela na análise, pois a casuística e as diferenças são pequenas. Assim, estudos adicionais são necessários, já que a utilização da TENS está indicada apenas como coadjuvante no controle da dor pós-operatória relacionada a procedimentos fisioterapêuticos / Abstract: Objective: To verify the effectiveness of transcutaneous electrical nerve stimulation (TENS) for the relief of pain caused by physiotherapic procedures in post-operative (PO) abdominal surgery patients. Design: Prospective, randomized clinical trial including 48 patients in the 1st PO day divided into three groups: control: treated with normal analgesic routine, without TENS, and physiotherapy; TENS: treated with routine analgesia plus TENS, and physiotherapy; and SHAM: treated with routine analgesia, TENS-sham, and physiotherapy. The frequency was 150 Hz, with pulse width between 150-250 µs, the intensity was maximal, comfortable for the patient and the treatment was applied for 30 minutes. An analogical visual scale for pain scoring was shown to the patient before (M1) and after application of TENS (M2) and after physiotherapy (M3), for procedures; cough, incentive spirometer, and decubitus changing, trying to quantify the effectiveness of TENS. Results: By comparing the 3 groups, it was found a significant difference in the relief of pain in TENS group, only for cough at M3 (p=0.015). Inside the TENS group, it was fond significant difference in the relief of pain for cough (p=0.003) [M1xM3]; and to lateral decubitus (p=0.025), sitting down (p=0.001) and to the incentive spirometer (p=0.017) [M1xM2]; and to lateral decubitus (p=0.03) and sitting down (p=0.001) [M1xM3]. There wasn¿t any significant reduction of pain in the sham group. Conclusions: Although a reduction of pain has been observed in the TENS group, these findings must be analyzed with caution, therefore the casuistry is small and the differences were not so great. Thus, applying TENS method must be better studied, thus being indicated only as adjuvant in the control of postoperative pain / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Ce travail de thèse avait pour but de mieux comprendre, chez les vaches en lactation, le degré de plasticité et d’adaptation des métabolismes énergétique et protéique dans les tissus de l’aire splanchnique et mammaire vis-à-vis une augmentation de l’approvisionnement en acides aminés (AA) en début de lactation ou de l’équilibre des rations avec du tourteau de soya (TS) comparé avec du tourteau de canola (TC), ou ensilage de maïs comparé avec ensilage d’herbe. Dans la première expérience, nous avons déterminé comment un apport accru en AA affectait les performances zootechniques ainsi que les flux nets de lactate, glycérol et β-OH-butyrate, le flux corporel de glucose (FCG) et les flux totaux et nets du glucose dans les tissus drainés par la veine porte (TDVP), le foie et la glande mammaire chez des vaches en début de lactation. Tout d’abord, la perfusion d’AA a augmenté de façon marquée la production de lait et de lactose. Cette expérience a permis de suggérer que les vaches ont des priorités métaboliques pour les AA autres que la néoglucogenèse. Par conséquent, d'autres substrats glucogéniques tels que le lactate et la mobilisation de réserves corporelles jouent un rôle important dans cet intervalle de la transition pour soutenir la demande d’énergie. Dans la deuxième expérience, nous avons comparé les effets d’une source protéique avec un régime à base d'ensilage de maïs, en comparant le TS avec le TC, et de la source de fourrage avec un régime alimentaire à base de TC, comparant l’ensilage de maïs avec l'ensilage d'herbe, en mesurant la production de lait, les paramètres ruminaux, la digestibilité de l’azote ainsi que le métabolisme splanchnique et mammaire des composants énergétiques et protéiques chez des vaches en lactation établie. La substitution de TS par TC répond efficacement aux besoins énergétiques et protéiques au niveau splanchnique et mammaire chez les vaches laitières en lactation. Nos résultats suggèrent qu’une augmentation post-hépatique de l'offre d’AA limitatifs et l'amélioration des interactions énergétiques et protéiques dans l’ensemble splanchnique et mammaire entraînent les augmentations de performances observées avec les rations contenant du TC. / The aim of this study was to better understand, in lactating dairy cows, the degree of plasticity and adaptation of energy and protein metabolism in splanchnic and mammary tissues with an increased amino acid (AA) supply in early lactation or, later in lactation, when rations are balanced with soybean meal (SBM) compared with canola meal (CM), or corn silage compared with grass silage. In the first study, experimental procedures were performed to determine how an increased AA supply affected zootechnical performances together with net flux of lactate, glycerol and β-OH-butyrate, whole body rate of appearance (WB-Ra) of glucose, and total and net fluxes of glucose in portal-drained viscera, liver and mammary gland in cows in established lactation. First, the AA abomasal infusion significantly increased milk and lactose yields. This experience suggests that cows have metabolic priorities for AA other than gluconeogenesis. Therefore, other glucogenic substrates such as lactate and the mobilization of body fat could play an important role in this interval transition to support energy demand. In the second experiment, we have compared the effects of protein source in a corn silage-based diet, comparing soybean meal (SBM) vs. canola meal (CM), and of forage source with CM-based diet, comparing corn vs. grass silage, measuring milk production, ruminal parameters, digestibility of nitrogen and splanchnic and mammary metabolism of energy and nitrogen metabolites in lactating cows in established lactation. In this work, we found that the substitution of SBM by CM responds with efficiency to the splanchnic and mammary needs of energy and protein in lactating dairy cows. With an increased net portal absorption of methionine with CM, observations in this second experiment suggest that a post-liver increased supply of limitative AA and a potential improvement of the energy and protein interaction across the splanchnic and mammary tissues drive the better performances observed in cows fed the CM-based diets.

Pacientes submetidos ao tratamento cirúrgico da obesidade mórbida apresentam perda ponderal acentuada e dismorfismo corporal e, com frequência, solicitam cirurgias plásticas visando um contorno corporal mais adequado. Os resultados dessas cirurgias plásticas são, em parte, limitados pela qualidade da pele resultante do grande emagrecimento. O presente estudo observacional teve como objetivo comparar fragmentos de pele da região epigástrica de 20 pacientes após perda ponderal acentuada consequente à cirurgia bariátrica com 20 pacientes portadores de obesidade mórbida, no sentido de analisar as alterações estruturais da pele como consequência do emagrecimento. A análise histomorfométrica foi realizada sobre o sistema colagênico através da metodologia Picrossírius/luz polarizada, e sobre o sistema elástico através da metodologia resorcinafucsina de Weigert. Foram observados, a redução das fibras colagênicas grossas (p=0,048); o aumento das fibras colagênicas finas (p=0,0085); e o aumento da densidade das fibras elásticas (p=0,0000009033) no grupo de pacientes emagrecidas. Não houve diferença entre os grupos quanto à média de idades (p=0,917) e quantidade total de fibras colágenas (p=0,3619). Os resultados evidenciaram as alterações estruturais da derme decorrentes do emagrecimento acentuado, demonstradas por meio do remodelamento colagênico, com a consequente redução das fibras espessas, organizadas, estruturadas e direcionadas em prol do aumento de fibras finas, desalinhadas e frouxamente dispostas, isso em associação ao aumento da elasticidade da pele. Isto explica cientificamente a já estabelecida percepção clínica das alterações cutâneas dos pacientes emagrecidos após cirurgias bariátricas, apresentando menor resistência e maior flacidez, quando comparadas ao período anterior ao emagrecimento / Post-bariatric patients develop body contour deformities and need plastic surgery procedures for reduction of excess skin and subcutaneous tissue. The results of these contouring procedures are typically limited by the poor quality of the skin. This observational study compared the epigastric skin of 20 post-bariatric with massive weight loss women with 20 women with morbid obesity through histomorphometric analysis of collagen fibers (picrosiriuspolarization) and elastic fibers (Weigert\'s resorcin-fuchsin). A reduction of thick collagen fibers (p=0.048), increase of thin collagen fibers (p=0.0085) and increase of the density of elastic fibers (p=0.0000009) were observed in the group of post-bariatric patients. There was no difference between the groups for mean age (p=0.917) and the total amount of collagen fibers (p=0.3619). These results represent structural changes in the dermis due to the massive weight loss once it demonstrates collagen modifications with reduction of thickness, organized and structured fibers, increase of thin, misaligned and disarranged fibers, and augmentation of the density of elastic fibers. This brings the scientific explanation for the established clinical perception that the skins of post-bariatric patients are less resistant and with more laxity when compared with what they were before the bariatric surgery

Diss. (sammanfattning)--Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

L'objectif premier de ce travail a été la mise au point d'une méthode nouvelle d'évaluation des résistances respiratoires, basée sur les différences entre les variations de sections du thorax et de l'abdomen, mesurées par pléthysmographie à variation d'inductance. L'évaluation de cette différence a été examinée par différentes formulations de la distance Thorax-Abdomen. C'est la distance entre asters (aster : représentation vectorielle des quatre premières harmoniques d'une décomposition en série de Fourier de chaque cycle respiratoire), qui présente la plus grande sensibilité, la plus faible variabilité et la meilleure reproductibilité. Chez des sujets sains, cette distance augmente significativement avec des charges résistives croissantes (3 à 13 cmH2O.l-1.s), additionnées sur la totalité du cycle respiratoire, aussi bien dans la position assise qu'en décubitus dorsal. Les droites de régressions distances-résistances des différents sujets, sont parallèles entre elles, suggérant la possibilité d'utiliser une droite de pente commune pour évaluer les variations de résistance respiratoire. Un essai de validation de la méthode, au cours de tests à la méthacholine, ne nous a pas permis de montrer une augmentation de la distance Thorax-Abdomen avec la résistance des voies aériennes, mesurée par pléthysmographie corporelle, chez tous les sujets. Au cours d'addition de charges résistives chez le sujet sain, l'étude des caractéristiques ventilatoires et de la variabilité cardiaque a montré (1) une augmentation significative des durées inspiratoires et expiratoires et du volume courant, une faible diminution de la ventilation minute comme en témoigne les faibles variations de la teneur en CO2 du gaz expiré, alors que la forme des cycles respiratoires et le rapport durée inspiratoire/durée totale restent inchangés, et (2) pas de modification de la valeur moyenne de la période cardiaque mais une augmentation de la variabilité, essentiellement en raison d'une augmentation de l'arythmie sinusale d'origine respiratoire. Il n'existe pas de différence significative entre les indices spécifiques de l'arythmie sinusale d'origine respiratoire, à une même fréquence respiratoire, qu'elle résulte d'une addition de résistance ou qu'elle soit obtenue par une ventilation à fréquence imposée.

Traffic accidents are the second leading cause of child fatality among children younger than 15 years of age. In the course of 10 years, the implementation of child restraint systems has decreased child fatality in traffic accidents with 50%, for children younger than 15 years. To gain an understanding of the kinematics and injury mechanisms of children in cars, finite element based human body models, representing higher biofidelity compared to crash test dummies, are developed. An FP7 European project, PIPER, developed a child HBM with an associated framework for scaling, morphing and positioning. The PIPER child HBM is scalable between the ages of 1.5-6YO, with scalable anthropometrics. This makes the PIPER child HBM, a powerful tool for analyzing children in vehicles.  There are insufficient analyses conducted with the PIPER child HBM, due to its recent release. The purpose is thus to study the robustness of the HBM and its sensitivity to variation of lap belts by conducting a parametric study. Injury analysis and its sensitivity to lap belt variations were in addition studied in terms of kinematics by the study of submarining, the pelvic interaction with the lap belt, and the study of injuries related to the skull, brain, kidneys and liver. A full frontal crash simulation of a 6YO PIPER child HBM, with anthropometrics, covering the 50th percentile, have been investigated. The 6YO PIPER child HBM was seated with no booster, Volvo booster cushion and Volvo highback booster, with variations of the lap belt. The hip interactions and the submarining response of the 6YO PIPER child HBM were studied, by the study of the lap belt interactions with the pelvis and abdominal organs. The abdominal organs were related to the liver and kidneys, and compared to published threshold values.  This study showed that the overall robustness of the model was questionable. With respect to kinematics, the model indicated higher robustness, however, when conducted the crash simulations with the 6YO PIPER child HBM, it was concluded that the robustness was low due to repeated premature terminations. The 6YO PIPER child HBM revealed repeated errors such as, mesh distortions, negative volume and shooting nodes. When studying the sensitivity of the 6YO PIPER child HBM, when varying the lap belt angles, as well as changing the type of boosters in addition to vehicle anchorage positions, it could be seen that the 6YO PIPER child HBM was able to capture variations with respect to lap belt positioning. Hence, the model seems to be capable of providing relevant information regarding sensitivity for lap belt variations from the kinematic perspective, in terms of being able to capture kinematic o↵set, submarining and pelvis interaction with the lap belt. However, with respect to predicted abdominal injuries and head injuries, the sensitivity was not as distinct. Some limitations were observed in which the 6YO PIPER child HBM indicated unrealistic predicted injuries related to the head, which was associated with excessive movement of the 6YO PIPER child HBM. / Trafikolyckor är den näst vanligaste orsaken till barndödlighet i världen bland barn yngre än 15 år. Inom loppet av 10 år har användning av bilbarnstolar i fordon minskat barndödligheten med 50% hos barn under 15 år. För att få en ökad förståelse om barn i bilar framtogs finita element humanmodeller som har en detaljerad anatomi samt responser liknande till människan. Ett FP7 finansierat europeiskt projekt, PIPER, skapade en barnhumanmodell med en tillhörande programvara som används för skalning, förvandling, och positionering av barnhumanmodellen. Humanmodellen är skalbar för åldrarna 1.5 år upp till 6 år, med olika antropometriska värden. Detta gör att PIPER barnhumanmodellen är ett kraftfullt verktyg att använda sig av för att studera barn i bilar. Då PIPER barnhumanmodell lanserades nyligen, finns det i dagsläget bristfällig information om humanmodellen och programmet. Syftet var därmed att undersöka hur robust modellen var samt hur dess känslighet var mot variationer av höftbältet genom en parameterstudie. Skadors känslighet studerades dessutom mot variationer av höftbältet genom att studera kinematiken i form av underglidning och höftens interaktion med höftbältet. Dessutom studerades känsligheten på skador relaterade till skallen, levern och njurarna. I denna studie har en frontalkrock med en 6 årig PIPER barnhumanmodell med antropometriska värden, som innefattar 50:e percentilen, undersökts. Den 6åriga PIPER barnhumanmodellen var placerad utan bilbarnstol, på en Volvo bälteskudde och på en Volvo bältesstol, där höftbältet sedan varierades. Höftens interaktion och PIPER barnhumanmodellens respons för variationer i höftbälte studerades. Interaktionerna med höften och bukorganen var relaterade till skador på levern och njurarna genom att jämföra med publicerad data. Denna studie påvisade att den generella robustheten av modellen kunde ifrågasättas. Modellen hade ändock högre robusthet med hänsyn på kinematiken, men på grund av de upprepande felen vid simuleringarna, kunde man konstatera att robustheten på den 6åriga PIPER barnhumanmodellen var låg. När höftbältet varierades, både när bilbarnstol varierades såväl som vinkel på höftbälte, kunde man konstatera att den 6åriga PIPER barnhumanmodellen kunde fånga skillnaderna med hänsyn på höftbältets vinkel. Modellen var dessutom kapabel till att fånga känsligheten från det kinematiska perspektivet i form av kinematisk förskjutning, underglidningen samt höftens interaktion med höftbältet. Modellen påvisade däremot ingen distinkt känslighet med hänsyn på skador relaterade till bukorganen samt huvudet. Några begränsningar observerades där den 6åriga PIPER barnhumanmodellen indikerade orealistiska skador på huvudet, som var relaterade till modellens överrörlighet. / FFI, Assessment of Passenger Safety in Future Cars

Orientador: Lourenço Sbragia Neto / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T14:56:26Z (GMT). No. of bitstreams: 1 Goncalves_FrancesLilianLanhellas_M.pdf: 3789177 bytes, checksum: e9b1048e4d4f077e540d297c2a998419 (MD5) Previous issue date: 2008 / Resumo: Gastrosquise é um defeito congênito da parede abdominal anterior no qual as alças intestinais ficam herniadas e em contato com o líquido amniótico (LA). Assim, a exposição ao LA resulta em várias disfunções intestinais pós-natal. Para reduzir o tempo de exposição ao LA em modelo animal, usou-se um hidrogel de N-isopropilacrilamida (NIPAAm) copolimerizado com ácido acrílico (Aac), que rapidamente intumesce na presença de LA. O hidrogel foi usado para cobrir as alças expostas até o fim da gestação. A gastrosquise foi induzida em fetos de ratas fêmeas da raça Sprague-Dawley através de um corte paramediano à direita do cordão umbilical para exposição parcial das alças com 18,5 dias de gestação. Os fetos foram separados em quatro grupos: controle (C), apenas gastrosquise (G), gastrosquise + cobertura das alças com adesivo de fibrina - Beriplast® (GA) e gastrosquise + cobertura das alças com adesivo de fibrina e aderido um pedaço de hidrogel seco (GAH). Os animais foram colhidos por cesárea com 21,5 dias de gravidez e o hidrogel foi cuidadosamente removido. Os fetos e as alças intestinais foram pesados e análise morfométrica foi realizada. Resultados mostraram que o hidrogel após intumescimento pesou 34X que seu peso seco; ele possui carga elétrica assim como a maioria das proteínas presentes no LA e sua retirada não provocou lesão à camada serosa do intestino exposto como visto na MEV. A comparação dos grupos C e GAH com os grupos G ou GA mostrou que o peso, o diâmetro, a espessura das camadas e da parede intestinais foi significativamente menor nos grupos C e GAH quando comparados aos grupos G e GA indicando processo inflamatório. Sendo assim, a aplicação do hidrogel aderido pelo adesivo de fibrina mostrou servir como uma efetiva proteção das alças herniadas, com uma redução significante da inflamação na gastrosquise. / Abstract: Gastroschisis is a congenital defect of the anterior abdominal wall which leads the fetal bowel to herniate into the amniotic cavity. There, exposition to amniotic fluid (AF), results in severe postnatal intestinal dysfunction. In order to reduce exposition time to AF in an animal model, has used a hydrogel of N-isopropylacrylamide (NIPAAm) copolymerized with acrylic acid (Aac), which undergoes rapid swelling in the amniotic fluid. The hydrogel was used to coat the bowel hernia until pregnance is completed. Gastroschisis was induced in the fetuses of female Sprague-Dawley rats by partial evisceration of the bowel through a right paramedian opening of the abdominal wall in day 18,5 of pregnancy. The fetuses were separated in four groups: control (C), gastroschisis alone (G), gastroschisis + coating of the bowel hernia with fibrin adhesive -Beriplast® (GA) and gastroschisis + coating of the bowel hernia with fibrin adhesive topped by a piece of adhered dry hydrogel (GAH). Animals were harvested by cesarean section at day 21.5 of pregnancy and the hydrogel was carefully removed. Fetuses and intestinal tract were weighed and morphometric analysis was performed. Results showed that the hydrogel weight was 34X heavier than its dry weight; its electric charge and also the AF charge were negative and there was no damage to serosa layer of the intestine exposed. Comparison of the C and GAH groups with G and GA showed that the bowel weight, diameter, the layers and wall thickness was significantly reduced in C and GAH compared to G and GA. Thus, application of the hydrogel bound onto the fibrin adhesive was shown to provide an effective protection of the herniated bowel, with a significant reduction of inflammation in gastroschisis. / Mestrado / Pesquisa Experimental / Mestre em Cirurgia