Die Bestimmung des Sollgewichts von Dialysepatienten stellt einen Balanceakt zwi-schen Hyper- und Hypovolämie und damit zwischen ischämischen Ereignissen durch Hypotonie und kardiovaskulären Komplikationen dar. Derzeit wird es anhand gering sensitiver bzw. unspezifischer und meist subjektiver klinischer Methoden ermittelt. Die Bioimpedanzanalyse als objektives, nicht invasives und zeitsparendes Verfahren steht zunehmend im Mittelpunkt von Studien, die der Behandlung von Dialysepatienten gewidmet sind. In dieser Arbeit wird die Untersuchung von 40 Patienten mit den Bioimpedanzanalysatoren Body Composition Monitor von Fresenius und Nutriguard-M von Data Input sowie mit klinischen Methoden beschrieben. Der Body Composition Monitor errechnet die Überwässerung des Patienten im Rahmen der Messung. Für die Berechnung der Überwässerung aus vom Nutriguard-M gemessenen Daten wurde eigens eine Formel erstellt. Obgleich hohe absolute Unterschiede zwischen den mittels der Bioimpedanzanalysatoren und der klinisch bestimmten Werte für die Überwässerung beobachtet wurden, waren positive Korrelationen der durch Bioimpedanzsanalyse gemessenen Überwässerung mit klinischen Parametern, wie dem Durchmesser der V. cava inferior, der Ausprägung von Unterschenkelödemen und dem mittleren arteriellen Blutdruck zum Nadir der Dialyse feststellbar. Verglichen wurden die Geräte nicht nur auf der Ebene der gemessenen Überwässerung, sondern auch auf den Ebenen der Rohwerte und der Anteile der Körperkompartimente am Körpergewicht. Dabei zeigten sich in Abhängigkeit des Verarbeitungsgrades der durch die Geräte gemessenen bzw. berechneten Größen sowohl geringe als auch hohe Abweichungen. Diese Erkenntnisse relativieren die Euphorie über die Möglichkeit der Anwendung der BIA in der Dialysetherapie.

Submitted by Cláudio Spínola Najas (cnajas@gmail.com) on 2018-04-06T20:30:16Z No. of bitstreams: 1 TESE Nova corrigida 2018.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-06T20:47:06Z (GMT) No. of bitstreams: 1 najas_cs_dr_bot.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) / Made available in DSpace on 2018-04-06T20:47:06Z (GMT). No. of bitstreams: 1 najas_cs_dr_bot.pdf: 1836496 bytes, checksum: 5754878942303c31e60421d7ee692e04 (MD5) Previous issue date: 2017-08-28 / O infarto agudo do miocárdio (IAM) é responsável por grande número de hospitalizações e óbitos em todo o mundo. Nos últimos anos, outro fator que vem ganhando destaque na literatura como preditor de má evolução após o IAM é a remodelação ventricular. Na fase aguda do infarto, há desintegração do colágeno interfibrilar. A perda desse tecido de sustentação torna a região mais propensa à distensão e, consequentemente, mais susceptível às deformações, denominada de expansão do infarto. Na fase crônica estudos revelam que a reversão da dilatação, por outro lado, pode ocorrer entre 30 e 60% dos pacientes estando associada à melhora na evolução. Diversos estudos têm demonstrado que medicamentos ou procedimentos que modificam a remodelação ventricular, prevenindo ou retardando a dilatação cardíaca, estão associadas à melhor evolução dos pacientes como a remodelação cardíaca reversa. Outro fator importante é a força de preensão palmar no IAM, diversos estudos mostram que a força do músculo esquelético, se altera em associação com eventos cardíacos, já a composição corporal demonstra que em indivíduos portadores de maior peso magro, tem significativamente maior força que os indivíduos portadores de menor peso magro. No entanto os resultados demonstram a correlação entre peso magro e percentual de gordura pode indicar uma melhor ou pior condição para realizar o esforço isométrico de preensão manual. Objetivo: Avaliar a força da musculatura esquelética e a composição corporal como preditoras de remodelação ventricular, remodelação reversa e disfunção ventricular após o infarto agudo do miocárdio de parede anterior. Metodologia: A análise da força muscular esquelética foi obtida pela técnica de Handgrip, feita por meio de aparelho específico, Hand Dinamometer T-18. Todas as medidas realizadas na mão não dominante, com o paciente sentado, e o cotovelo apoiado na cama. Foi utilizado o método de impedância bioelétrica para a avaliação da composição corporal, principalmente quanto ao volume e percentual de água. Para a remodelação cardíaca, foi realizado o ecocardiograma para avaliar a parede anterior do ventrículo esquerdo. Todas as análises foram realizadas entre o 3º e 5º dia após o infarto. A estatística foi analisada por meio do teste do χ2, o teste t de Student, o teste de Mann-Whitney, considerando nível de significância adotado de 5% para todos os testes. Resultados: Em relação a força muscular e composição corporal, não foram detectadas diferenças significativas entre os grupos avaliados para remodelação cardíaca e disfunção com fração de ejeção ˂ 50% (p ˃ 0,05). Resultados semelhantes foram observados na remodelação cardíaca reversa que também não foram encontradas diferenças significativas para os parâmetros de força muscular e composição corporal (p ˃ 0,05). Para as análises de regressão multivariada, o percentual de massa magra mostrou-se como preditora para a remodelação cardíaca reversa quando ajustado por sexo, idade e enzimas CK-MB ( OR= 0,876; p= 0,019 ), assim como o percentual de gordura ajustados para as mesmas variáveis ( OR= 1,145; p= 0,027 ). / Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricular remodeling, reverse remodeling, and ventricular dysfunction after acute myocardial infarction of the anterior wall. Methodology: Analysis of skeletal muscle strength was obtained through the Handgrip technique, carried out by means of a specific device, the Hand Dinamometer T-18. All measurements were taken on the non-dominant hand, with the patient seated, and the elbow resting on the bed. The bioelectrical impedance method was used to evaluate body composition, principally regarding the volume and percentage of water. For cardiac remodeling, an echocardiogram was performed to evaluate the left ventricular anterior wall. All analyzes were performed between the 3rd and 5th day after the infarction. The statistics were analyzed using the χ2 test, the Student t test, and the Mann-Whitney test, considering a significance level of 5% for all tests. Results: Regarding muscle strength and body composition, no significant differences were detected between the evaluated groups for cardiac remodeling or dysfunction, with ejection fraction ˂ 50% (p ˃ 0.05). Similar results were observed in the reverse cardiac remodeling, also with no significant differences found for the parameters muscle strength and body composition (p ˃ 0.05). For the multivariate regression analyzes, the percentage of lean mass was shown to be a predictor for reverse cardiac remodeling when adjusted by sex, age, and CK-MB enzymes (OR = 0.876, p = 0.019), as well as the percentage of fat adjusted for the same variables (OR = 1.145, p = 0.027).

Orientador: Leonardo Antonio Mamede Zornoff / Resumo: O infarto agudo do miocárdio (IAM) é responsável por grande número de hospitalizações e óbitos em todo o mundo. Nos últimos anos, outro fator que vem ganhando destaque na literatura como preditor de má evolução após o IAM é a remodelação ventricular. Na fase aguda do infarto, há desintegração do colágeno interfibrilar. A perda desse tecido de sustentação torna a região mais propensa à distensão e, consequentemente, mais susceptível às deformações, denominada de expansão do infarto. Na fase crônica estudos revelam que a reversão da dilatação, por outro lado, pode ocorrer entre 30 e 60% dos pacientes estando associada à melhora na evolução. Diversos estudos têm demonstrado que medicamentos ou procedimentos que modificam a remodelação ventricular, prevenindo ou retardando a dilatação cardíaca, estão associadas à melhor evolução dos pacientes como a remodelação cardíaca reversa. Outro fator importante é a força de preensão palmar no IAM, diversos estudos mostram que a força do músculo esquelético, se altera em associação com eventos cardíacos, já a composição corporal demonstra que em indivíduos portadores de maior peso magro, tem significativamente maior força que os indivíduos portadores de menor peso magro. No entanto os resultados demonstram a correlação entre peso magro e percentual de gordura pode indicar uma melhor ou pior condição para realizar o esforço isométrico de preensão manual. Objetivo: Avaliar a força da musculatura esquelética e a composição corporal como predit... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Abstract: Acute myocardial infarction (AMI) is responsible for large numbers of hospitalizations and deaths worldwide. In recent years, another factor that has been gaining prominence in the literature as a predictor of poor evolution after AMI is ventricular remodeling. In the acute phase of infarction, there is disintegration of the interfibrillar collagen. The loss of this supporting tissue makes the region more prone to distention and, consequently, more susceptible to deformation, termed infarct expansion. On the other hand, in the chronic phase, studies reveal that the reversal of dilation can occur in between 30 and 60% of patients, being associated with improvement in evolution. Several studies have shown that medications or procedures that modify ventricular remodeling, preventing or delaying cardiac dilatation, such as reverse cardiac remodeling, are associated with better evolution of patients. Another important factor in AMI is the palmar grip strength; several studies show that skeletal muscle strength changes in association with cardiac events, whereas body composition demonstrates that individuals with higher lean weight present significantly greater strength than individuals with lower lean weight. However, results demonstrate that the correlation between lean weight and fat percentage may indicate a better or worse condition to perform the isometric handgrip effort. Objective: To evaluate skeletal muscle strength and body composition as predictors of ventricu... (Complete abstract click electronic access below) / Doutor

abstract: Bioimpedance measurements have been long used for monitoring tissue ischemia and blood flow. This research employs implantable microelectronic devices to measure impedance chronically as a potential way to monitor the progress of peripheral vascular disease (PVD). Ultrasonically powered implantable microdevices previously developed for the purposes of neuroelectric vasodilation for therapeutic treatment of PVD were found to also allow a secondary function of tissue bioimpedance monitoring. Having no structural differences between devices used for neurostimulation and impedance measurements, there is a potential for double functionality and closed loop control of the neurostimulation performed by these types of microimplants. The proposed technique involves actuation of the implantable microdevices using a frequency-swept amplitude modulated continuous waveform ultrasound and remote monitoring of induced tissue current. The design has been investigated using simulations, ex vivo testing, and preliminary animal experiments. Obtained results have demonstrated the ability of ultrasonically powered neurostimulators to be sensitive to the impedance changes of tissue surrounding the device and wirelessly report impedance spectra. Present work suggests the potential feasibility of wireless tissue impedance measurements for PVD applications as a complement to neurostimulation. / Dissertation/Thesis / Masters Thesis Bioengineering 2015

The aim of my Ph.D. thesis is to summarize my research on the development of multimateiral multifunctional fibers for bio-related application, mainly in the fields of neural interfacing and bioimpedance sensing. Understanding the cytoarchitecture and wiring of the brain requires improved methods to record and stimulate large groups of neurons with cellular specificity. This requires the development of improved miniaturized neural interfaces that integrate into brain tissue without altering its properties. Despite the advancement of the existing neural interface technologies such as microwires, silicon-based multielectrode arrays, and electrode arrays with flexible substrates, the physical properties of these devices limit their access to one, small brain region with single implantation. Beyond neural interfacing, extracting molecular information is crucial for understanding many neurological diseases and disorders. The most adapted methods are fast scan cyclic voltammetry and microdialysis. However, both have some limitations such as offline sensing or lack of selectivity. Furthermore, by concentrating optical fields at the nanoscale, plasmonic nanostructures can serve as optical nanoantennas to achieve ultrasensitive bio-/chemical sensing. But due to the limitation of the sensing mechanism, it is hard to perform the plasmonic sensing in live animals. Moreover, the relatively poor electrical performance of the electrode materials that can be utilized in the thermal drawing process limits the function of the fiber in other types of biomedical application, such as deep brain stimulation and electrochemical sensing. For example, the large inherent electrical resistance of the electrode material will significantly interference the electrical impedance result while the main purpose of this kind of study is to explore the frequency-dependent electrical properties of the tested subjects. To overcome above difficulties This thesis introduces broad application of multimaterial multiplexed fibers in biomedical areas. I first describe the development and application of spatially expandable multifunctional fiber-based probes for mapping and modulating brain activities across distant regions in the deep brain (Chapter 2). Secondly, I present the flexible nano-optoelectrodes integrated multifunctional fiber probes that can have hybrid optical-electrical sensing multimodalities, including optical refractive-index sensing, surface-enhanced Raman spectroscopy, and electrophysiological recording (Chapter 3). Thirdly, I demonstrate that hollow multifunctional fibers enable in-line impedimetric sensing of bioink composition and exhibit selectivity for real-time classification of cell type, viability, and state of differentiation during bioprinting (Chapter 4). The same device allows for local delivery of immune checkpoint blockade antibodies and for monitoring of clinical outcomes by tumor impedance measurement over the course of weeks with the photodynamic therapy option to enhance anti-tumor immunity and prolong intratumoral drug retention (Chapter 5). An overview future work has been summarized (Chapter 6). / Doctor of Philosophy / Electrode technology has played an indispensable role in neuroscience community since the first employment of insulated tungsten wire in cat brain in 1950s. The electrophysiological signal acquired from or the electrical current delivered to the brain tissue using the implanted electrode, has permitted us to understand the functional networks in the brain and treat neurological diseases. Over the past decades, significant progress has been made in developing miniaturized electrical neural interfaces. The development of optogenetics involving genetically-modified neurons that express light-sensitive proteins (opsins) has provided a powerful tool for modulating the neuronal activity to be switched on or off using light at a particular wavelength. Leveraging the thermal drawing process (TDP) from optical fiber industry for producing conventional silica fibers, multifunctional fiber-based neural probes have recently been developed, allowing for simultaneous optical stimulation, electrical recording, and drug delivery in vivo. However, the interfacing sites in these fiber-based neural probes have been restricted to a single location (at the fiber tip) so far, making the broad application of these probes unfeasible. Beyond neural interfacing, extracting molecular information is crucial for understanding many neurological diseases and disorders. The most adapted methods are fast scan cyclic voltammetry and microdialysis. However, both have some limitations such as offline sensing or lack of selectivity. Furthermore, by concentrating optical fields at the nanoscale, plasmonic nanostructures can serve as optical nanoantennas to achieve ultrasensitive bio-/chemical sensing. But due to the limitation of the sensing mechanism, it is hard to perform the plasmonic sensing in live animals. To overcome these limitations, we first developed a platform that provides three-dimensional coverage of brain tissue through multifunctional polymer fiber-based neural probes capable of interfacing simultaneously with neurons in multiple sites (Chapter 2). In a later study, we demonstrate that conductive nanoantenna arrays can be integrated with microelectrodes on the tip of multifunctional fiber probes as nano-optoelectrodes to enable optical bio-/chemical spectroscopy as well as to improve electrophysiology recording (Chapter 3). Besides, inspired by a convergence fiber drawing method, we have also managed to incorporate copper wires inside multifunctional fibers with a hollow channel in the center, in favor of high electrical conductivity. This technology developed here holds great promise for electrochemical impedance sensing of the tested media without the interference from the utilized electrodes' high resistance. Hence, by exploiting the functional fibers and the superior electrical performance, the copper-electrode-based fiber has been used for in vitro bioink bioimpedance sensing during 3D printing process (Chapter 4) and in vivo tumor impedance monitoring and drug delivery (Chapter 5). In summary, my research produces unique platforms for fundamental research studies as well as the readily translational application for human subjects. Given the scalable, straightforward, and versatile fabrication method, the multifunctional fibers delivered by our team would pave the way for new engineered tools for broad biomedical community.

Title: Comparison of body composition of soccer players according to their players' post Objectives: The main objective of this work is to determine the body composition of soccer players according to their post and to compare these data with the results of similar testing taken in foreign countries. Methods: 45 players participated in the testing in total. The machine of bioelectrical impedance BIA 2000 M was used for the detection of the body composition and the gained data were further proceeded in the programme NUTRI 4. The observed parameters were a percentage of body fat, an absolute amount of fat mass, fat-free and intracellular tissue. For the process of the statistic data (arithmetic average, BMI, standard deviation, tables and graphs) the programme Microsoft Excel 2007 was used. Results: The players of both Czech clubs have a typical body composition for top athletes. It was found out that the goalkeepers have the highest percentage of body fat out of all measured players. Defenders were proved to have the least percentage of body fat among all the measured players. Keywords: Soccer, player posts, body composition, bio impedance

Introdução: O conjunto de alterações de composição corporal e metabólicas encontrada em pacientes soropositivos para HIV é denominado de síndrome da lipodistrofia O ponto central da síndrome são as alterações da composição corporal que envolve a lipoatrofia em membros e face e/ou lipohipertrofia abdominal e dorso cervical. Até o momento, nesse grupo a determinação de gordura por segmento corporal pode ser obtida por métodos como a absorciometria dos raios X de dupla energia (DXA), mas não por medidas antropométricas e de bioimpedância elétrica (BIA), que seriam mais viáveis na prática clínica. Objetivos: Elaborar equações por regressão linear para estimativa de gordura em cada segmento (braço, perna e tronco) considerando variáveis antropométricas e de BIA segmentar e propor pontos de corte para classificar a lipodistrofia em pacientes soropositivos para HIV em terapia antirretroviral de alta potência (TARV). Métodos: Foram aferidas circunferências (braço, cintura, quadril, coxa, panturrilha), pregas cutâneas (bíceps, tríceps, subescapular, suprailíaca) e realizados exames de BIA segmentar e DXA em 100 pacientes soropositivos para HIV do sexo masculino. A partir destas variáveis foram elaboradas equações para estimativa de gordura por segmentos (braço, perna e tronco). Para propor pontos de corte foram utilizadas as curvas ROC utilizando o exame clínico para identificação da sensibilidade e especificidade. Resultados: Foram elaboradas 2 modelos para braço e tronco utilizando apenas medidas antropométricas e 2 modelos para a perna utilizando variáveis de BIA e antropométricas. Os coeficientes de determinações para os modelos de braço, tronco, pernas foram: 0.66 e 0.66; 0.76 e 0.75; 0.5 e 0.45, respectivamente. As razões propostas foram: circunferência da cintura pela circunferência da coxa (CC/CCo), circunferência da cintura pela da panturrilha (CC/CPant) e razão tronco braço (RTB). Os melhores pontos de corte observados para CC/CCo, RTB e para o índice já proposto na literatura fat mass ratio (FMR) foram de 1,74; 2,08 e 1,26, respectivamente. Conclusões: As equações e razões antropométricas podem ser utilizados para auxiliar no diagnóstico de lipodistrofia com a finalidade de contribuir para um diagnóstico mais acurado e precoce possibilitando intervenções e até prevenindo maiores alterações da composição corporal. / Background: The changes in body composition and metabolic parameters, found in HIV seropositive is called lipodystrophy syndrome. The central point of the syndrome are changes in body composition that involves the face and limb lipoatrophy and / or abdominal back neck lipohypertrophy. Until now, in this group of individual, the determination of fat per body segment can be obtained by methods such as X-ray absorptiometry dual energy absorptiometry (DXA), but not by anthropometric measurements and bioelectrical impedance analysis (BIA), which would be more feasible in practice clinic. Objectives: Develop equations, using linear regression, to estimate fat in each segment (arm, leg and trunk) considering anthropometric variables and segmental BIA and propose cutoff points for classifying lipodystrophy in HIV seropositive patients on highly active antiretroviral therapy (HAART). Methods: We measured circumferences (arm, waist, hip, thigh, calf), skinfolds (biceps, triceps, subscapular, suprailiac) and conducted examinations of segmental BIA and DXA in 100 HIV seropositive men. From these variables were developed equations to estimate fat segments (arm, leg and trunk). To propose cutoffs were used ROC curves using clinical examination to identify the sensitivity and specificity. Results: We developed two models for arm and trunk using only anthropometric measurements and two models for leg using BIA and anthropometric variables. The coefficients of determination for models of arm, trunk and leg were 0.66 and 0.66, 0.76 and 0.75, 0.5 and 0.45, respectively. The proposed reasons were: waist circumference by the circumference of the thigh (WC / CTh), waist circumference by the calf (WC / Cca) and trunk arm ratio (TAR). The best cutoff points observed for WC/CTh , TAR and the index already proposed in the literature fat mass ratio (FMR) were 1.74, 2.08 and 1.26, respectively. Conclusions: The anthropometric reasons and the equations can be used to aid in the diagnosis of lipodystrophy in order to contribute to a more accurate diagnosis and early intervention and to prevent possible major changes in body composition.

No intervalo de valores de frequência de poucos kHz até 1 MHz, nomeado às vezes como região de dispersão ?, as estruturas das células são o principal determinante da impedância do tecido. Esse é o fundamento básico da Espectroscopia da Bioimpedância Elétrica - EBE, a qual tem importância significativa como ferramenta de diagnóstico do câncer de colo no útero - CCU. A EBE consiste na medição de impedância elétrica do tecido cervical para diferentes valores de frequência. A diferença do comportamento no valor da impedância na frequência entre o tecido normal e o cancerígeno é usada para detectar o nível de neoplasia. Um bloco importante do Sistema EBE é o bloco gerador de sinal, o qual está composto principalmente de: a) Oscilador Controlado Numericamente - NCO, b) Conversor Digital - Analógico - DAC e c) Fonte de Corrente Controlada por Tensão - VCCS. O Objetivo do presente trabalho foi o projeto dos blocos principais do Gerador de Sinal para aplicação da Espectroscopia da Bioimpedância Elétrica na Detecção do Câncer no colo do Útero. O Gerador de Sinal é composto de: Oscilador Controlado Numericamente baseado no algoritmo de CORDIC, Conversor Digital - Analógico de 10 bits e Fonte de Corrente Controlada por Tensão. É apresentado o projeto do Oscilador Controlado Numericamente (NCO) de 10 bits baseado na arquitetura iterativa do CORDIC e otimizado em termos da área. O NCO foi implementado na Tecnologia CMOS do Processo da TSMC 180 nm por meio do FREE MINI@SIC IMEC-TSMC 2015. As especificações do projeto foram obtidas dos requerimentos da aplicação da Espectroscopia da Bioimpedância Elétrica - EBE na detecção do Câncer no Colo do Útero - CCU. A arquitetura proposta é composta fundamentalmente de: seletor de frequência de 5 bits, gerador do valor angular, bloco de pré-rotação, unidade aritmética do CORDIC, Unidade de Controle e tabela de busca da referência para arco-tangente. A área do núcleo para este componente foi de 133µmx133µm, ou seja, 0,017689 mm². Foi configurado para gerar 32 valores de frequência de sinais sinusoidais no intervalo de valores de frequência de 100 Hz até 1 MHz com um erro máximo de 0,00623% entre os valores de frequência obtidos da simulação e os resultados experimentais. O Conversor Digital - Analógico foi projetado no nível do esquemático numa arquitetura Current-Steering Segmentada 6-4 com valores de DNL<0,1 LSB e INL<0,2 LSB obtidos na análise de corners. O circuito VCCS foi projetado, simulado e fabricado em Tecnologia CMOS da TSMC 130 nm com polarização de 1,3 V. A Fonte de Corrente de Howland proposta foi baseada no amplificador operacional auto polarizado complementar de cascode dobrado (SB-CFC). De acordo com os requerimentos do padrão internacional IEC:60601-1 o valor pico da corrente sinusoidal foi ajustado em 10 µA. De acordo com aplicação da EBE para a CCD, as especificações do SB-CFC-AO foram calculadas para obter uma corrente sinusoidal na faixa de frequência de 100 Hz até 1 MHz com impedância de saída maior do que 1 MOhm a 1 MHz de frequência. Foram executadas simulações post-layout e os principais resultados foram: 10±0,0035 µA para a amplitude na corrente de saída na faixa de frequência especificada com 5 kOhm de resistência de carga, valores de impedância de saída maiores do 1,6 MOhm a 1 MHz; variações na amplitude da corrente de saída menores do que 0,4% para impedância de carga de 10 Ohm até 5 kOhm. O resultado experimental em termos de não-linearidade apresentou o máximo de 2% da plena escala. De acordo com os resultados obtidos, o desempenho do VCCS é adequado para aplicações da EBE na CCD. / In the frequency range of a few kHz to 1 MHz, sometimes referred to as the ? dispersion region, cell structures are the main determinant of tissue impedance. That is a basic fundamental of Electrical Bio-Impedance Spectroscopy - EBS, which has a significant importance as a diagnostic tool for Cervical Cancer Detection - CCD. EBS consists in the measurements of Electrical Impedance of cervical tissue at different values of frequency. The difference of behavior of impedance value in the frequency of normal tissue and cancerous tissue is used to detect the level of neoplasia. An important block of EBS System is the block signal generator, which is mainly composed of: a) Numerically Controlled Oscillator - NCO, b) Digital to Analog Converter - DAC and c) Voltage Controlled Current Source - VCCS. The aims of this work was to design the main blocks of a Signal Generator for Electrical Bio-Impedance Spectroscopy applied to Cervical Cancer Detection. The signal generator is composed by: CORDIC-Based Numerically Controlled Oscillator, 10-bits Digital-to-Analog Converter and Voltage Controlled Current Source - VCCS. A 10-bit Numerically Controlled Oscillator (NCO) based on the iterative architecture of COordinate Rotation DIgital Computer (CORDIC) optimized in terms of area is presented. The NCO was implemented in a TSMC CMOS 180 nm technology process on the FREE MINI@SIC IMEC-TSMC. The design specifications were obtained from the requirements for application of Electrical Bio-Impedance Spectroscopy (EBS) to Cervical Cancer Detection (CCD). The proposed architecture is basically composed by: 5-bit frequency selector, angle generator, pre-rotator block, CORDIC Arithmetic Unit, Control Unit and lookup table for arctangent reference. The area of this IC for the CORE circuit was 133µm X 133µm, i.e. 0,017689 mm². It was configured in order to generate 32 different frequencies for output sinusoidal signals in the frequency range of 100Hz up to 1MHz with maximum error of 0,00623% in frequency values obtained of comparison of theoretical and experimental results. The 10 bits DAC was implemented in a 6-to-4 Current Steering Segmented architecture with DNL<0,1 LSB and INL<0,2LSB obtained from corners analysis. The circuit VCCS was designed, simulated and fabricated in TSMC 130 nm CMOS technology at 1.3V power supply. The proposed Howland Current Source is based on Self-Biased Complementary Folded Cascode (SB-CFC) Operational Amplifier (OA). Complying with the requirements for medical electrical equipment of international standard ABNT-NBR-IEC-60601-1 the sinusoidal current peak amplitude was settled at 10 µA. In accordance with the requirements of the EBS for CCD, the specifications for the SB-CFC-OA were calculated to meet the 100 Hz to 1 MHz frequency range for the sinusoidal output current and the output impedance higher than 1 MOhm at 1 MHz frequency. Post-layout simulations were run and the main results were: 10 ± 0.0335 µA for the output current peak amplitude over the specified frequency range and with 5 kOhm load impedance; values above 1.6 MOhm output impedance @ 1 MHz; nominal current amplitude variations lower than 0.4% for load impedances in the range of 10 Ohm up to 5 kOhm. And the experimental result for maximum non-linearity was 2% of full scale. From these results, the performance of the VCCS is adequate for EBS-CCD applications.

Introdução: A associação entre tuberculose (TB) e desnutrição é bem reconhecida: a TB pode levar à desnutrição e a desnutrição pode predispor à TB. Levando-se em consideração o risco de mortalidade devido à desnutrição em pacientes com TB e as inúmeras limitações dos estudos realizados até hoje, é necessário realizar uma avaliação nutricional mais completa e precoce com o objetivo de identificar os indivíduos em risco nutricional. Objetivos: Avaliar o estado nutricional dos pacientes hospitalizados com TB, coinfectados ou não pelo vírus da imunodeficiência humana (HIV). Métodos: Estudo de prevalência com coleta de dados prospectiva. Foram incluídos pacientes com diagnóstico confirmado de TB. Foram utilizados os seguintes métodos para avaliação nutricional: índice de massa corporal (IMC), dobras cutâneas, bioimpedância, circunferência do braço (CB), circunferência muscular do braço (CMB), questionário de frequência alimentar, ferramenta de triagem de desnutrição (MST), avaliação subjetiva global (ASG) e dosagens de hemoglobina, transferrina, proteína C reativa, albumina e linfócitos. Resultados: Foram incluídos 92 pacientes no estudo. Considerando o IMC, 37% dos pacientes avaliados apresentavam critérios para risco nutricional. O percentual de gordura corporal foi baixo em 31,5% dos pacientes. Além disso, mais da metade dos indivíduos estudados apresentou critérios para desnutrição conforme a CB, CMB, dobra cutânea tricipital, ASG, MST ou parâmetros laboratoriais. Com relação aos nutrientes da dieta, em pacientes HIV positivos a ingestão de selênio foi significativamente menor do que nos pacientes HIV negativos. Também foram encontradas correlações positivas entre o IMC e a quantidade de zinco e magnésio da dieta. Conclusões: Identificamos uma prevalência elevada de desnutrição em pacientes com TB pulmonar internados em um hospital terciário, independente do método utilizado para avaliação do estado nutricional. / Introduction: The association between tuberculosis (TB) and malnutrition is well recognized: TB can lead to malnutrition and malnutrition can predispose to TB. Taking into account the risk of mortality due to malnutrition in patients with TB and the numerous limitations of the studies conducted to date, it is necessary to conduct a more thorough and early nutritional assessment in order to identify individuals at nutritional risk. Objectives: To assess the nutritional status of hospitalized patients with TB, co-infected or not by the human immunodeficiency virus (HIV). Methods: Prevalence study with prospective data collection. Patients with confirmed diagnosis of TB. The following methods of nutritional assessment were used: body mass index (BMI), skinfold thickness, bioelectrical impedance, arm circumference (AC), arm muscle circumference (AMC), food frequency questionnaire, malnutrition screening tool (MST), subjective global assessment (SGA) and serum levels of hemoglobin, transferrin, C-reactive protein, albumin and lymphocytes. Results: We included 92 patients in the study. Considering the BMI, 37% of the patients met the criteria for nutritional risk. The body fat percentage was low in 31.5% of patients. In addition, more than half of the subjects met criteria for malnutrition according to AC, AMC, triceps skinfold thickness, SGA, MST or laboratory parameters. Regarding the components of diet, selenium intake among HIV-positive patients was significantly lower than in HIV-negative patients. It was also found positive correlations between the BMI and the amount of dietary zinc and magnesium. Conclusions: We identified a high prevalence of malnutrition in patients with pulmonary TB admitted in a tertiary hospital, regardless of the method used to assess nutritional status.

In recent years, due to the combination of technological advances in the fields ofmeasurement instrumentation, communications, home-health care and textile-technology thedevelopment of medical devices has shifted towards applications of personal healthcare.There are well known the available solutions for heart rate monitoring successfully providedby Polar and Numetrex. Furthermore new monitoring applications are also investigated. Amongthese non-invasive monitoring applications, it is possible to find several ones enable bymeasurements of Electrical Bioimpedance.Analog Devices has developed the AD5933 Impedance Network Analyzer which facilitatesto a large extent the design and implementation of Electrical Bioimpedance Spectrometers in amuch reduced space. Such small size allows the development of a fully wearable bioimpedancemeasurement.With the development of a Electrical Bioimpedance-enable wearable medical device in focusfor personal healthcare monitoring, in this project, the issue of power management has beentargeted and a battery-driven Electrical Bioimpedance Spectrometer based in the AD5933 hasbeen implemented. The resulting system has the possibility to operate with a Li-Po battery with apower autonomy over 17 hours.