臂叢阻滯麻醉可以阻斷同側正中神經，尺神經，橈神經和肌皮神經，故其經常被用於上肢手術中麻醉和/或鎮痛。臂叢阻滯麻醉也可以阻滯同側交感神經，導致同側上肢血管擴張（動脈和靜脈）和血流增加。脈沖多普勒超聲技術可以檢測到這些局部的血流動力學變化。文獻回顧表明迄今為止發表的大部分報道片面地評估了臂叢阻滯麻醉後上肢的局部血流動力學變化缺乏全面而系統的研究，並且報道中關於脈沖多普勒超聲技術用於上肢局部血流動力學測量的可靠性和可重復性的數據也很有限。此外，上肢的局部血流動力學變化是否與測量的位置或者使用的臂叢阻滯麻醉技術有關尚且未知。 / 我假設脈沖多普勒超聲是壹種可靠的測量上肢血流動力學變化的方法，它可以系統地定量測定臂叢阻滯麻醉後上肢的局部血流動力學變化，確定這些變化在上肢不同部位的差異，以及確定不同臂叢阻滯麻醉技術後局部血流動力學變化的差異。以下的部分列舉了本博士課題中開展的壹系列研究來證實我的假設。 / 第壹，我們在12個健康年輕誌願者中（年齡21-34歲）用脈沖多普勒超聲在上肢肱動脈和指掌側總動脈進行血流動力學測量，評估其在觀察者內和觀察者間的差異性。兩個觀察者獨立進行了測量。測量的指標包括收縮期峰值血流速度（厘米/秒），舒張末期血流速度（厘米/秒），收縮期峰值血流速度和舒張末期血流速度比值，平均速度（厘米/秒），時均速度（厘米/秒），阻力指數，搏動指數，動脈直徑（厘米），和血流量（毫升/分鐘）。結果顯示脈沖多普勒超聲是壹種可靠的方法，可用來重復測量上肢的局部血流動力學參數（組內相關系數>0.9）. / 第二，我們在8個病人中（年齡24-70歲）系統地評估了超聲波引導下的腋路臂叢神經阻滯後同側肱動脈的局部血流動力學變化。結果表明臂叢神經阻滯後最早的變化是脈沖多普勒頻譜波形的變化，其波形由三相變為單相，舒張期血流曲線擡升。隨著時間推移，收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量均顯著增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。大部分變化發生在神經阻滯後5分鐘。在所有的局部血流動力學指標中，舒張末期血流速度表現出最顯著的變化（3.7倍），其增加超過收縮期峰值血流速度（1.5倍）和平均速度（2.8倍）。 / 第三，利用15個病人（年齡23-70歲），我們評估了超聲波引導下的鎖骨上臂叢神經阻滯後上肢近端動脈（肱動脈）和遠端動脈（指掌側總動脈）血流動力學變化的差異。臂叢神經阻滯之後，在能量多普勒圖像上，指掌側總動脈表現出更明顯的血管擴張。在脈沖多普勒頻譜波形中，兩個動脈均出現舒張早期的反流消失以及舒張期曲線擡升。另外，收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。這些指標的相對變化在指掌側總動脈比肱動脈更顯著。此研究中，4個病人出現對側手部溫度的增加，以此推測局部麻醉藥的雙側擴散。 / 第四，我們開展了壹項前瞻性隨機對照研究來比較腋路和鎖骨上臂叢神經阻滯引起的局部血流動力學變化的不同。兩組病人人口統計學資料類似。兩種臂叢神經阻滯技術均引起肱動脈和指掌側總動脈收縮期峰值血流速度，舒張末期血流速度，平均速度，時均速度，動脈直徑，和血流量的顯著增加，收縮期峰值血流速度和舒張末期血流速度比值，阻力指數，搏動指數顯著降低。跟腋窩方法相比，鎖骨上技術能夠引起肱動脈時均速度和血流量更顯著的增加。然而，在感覺神經阻滯起效方面，腋窩方法比鎖骨上方法更快。 / 總之，脈沖多普勒超聲可重復地測量肱動脈和指掌側總動脈的血流動力學參數及其變化。臂叢阻滯麻醉引起肱動脈和指掌側總動脈脈沖多普勒頻譜形態的變化，血流速度的增加和血流量的增加。這些局部血流動力學變化在指掌側總動脈中比肱動脈更顯著。鎖骨上臂叢神經阻滯比腋窩方法引起更顯著的局部血流動力學變化。臨床醫生可以利用上肢遠端動脈的局部血流動力學變化來評價臂叢阻滯麻醉的交感神經阻滯效應。麻醉醫師還可以根據這些發現為術後需要較好血流灌註的上肢血管手術選取臂叢神經阻滯方法。 / Brachial plexus block (BPB), which produces sensory and motor blockade of the ipsilateral median, ulnar, radial and musculocutaneous nerves, is frequently used for anesthesia and/or analgesia during surgical procedures of the upper extremity. BPB also produces ipsilateral sympathetic nerve blockade that is characterized by vasodilatation (venous and arterial), and an increase in blood flow to the ipsilateral upper extremity. Pulsed wave Doppler (PWD) ultrasound (US) has been used to evaluate these regional hemodynamic changes. A review of the literature shows that most published reports to date have only partially evaluated the regional hemodynamic changes in the upper extremity after a BPB. There are also limited data demonstrating that PWD US is a reliable or reproducible method of quantifying the regional hemodynamic changes in the upper extremity. Moreover, it is also not known whether the regional hemodynamic changes vary with the site of measurement or the technique of BPB used. / I hypothesized that PWD US is a reliable method for measuring regional hemodynamic parameters in the upper extremity. It can be used to comprehensively quantify the regional hemodynamic changes after a BPB and to determine the extent of these changes at different sites in the upper extremity and after different techniques for BPB. The following section outlines a series of studies that I undertook during this PhD project to corroborate my hypothesis. / Firstly, we sought to assess the intra-observer and inter-observer variability of measuring regional hemodynamic parameters, in the brachial and common palmar digital arteries of the upper extremity, using PWD US in 12 healthy young volunteers aged 21-34 yrs. The measurements were performed independently by two observers. Measured hemodynamic parameters included peak systolic velocity (PSV, cm/s), end diastolic velocity (EDV, cm/s), ratio of PSV and EDV (S/D), mean velocity (Vmean, cm/s), time-averaged mean velocity (TAVM, cm/s), resistance index (RI), pulsatility index (PI), the arterial diameter (d, cm), and blood flow (mL/min). The results showed that PWD US is a reliable and reproducible method of measuring regional hemodynamic parameters in the upper extremity (ICC>0.9). / Secondly, we comprehensively evaluated the regional hemodynamic changes in the ipsilateral brachial artery after an ultrasound guided (USG) axillary BPB in eight adult patients aged 24-70 yrs. Our results suggested that the earliest change after the BPB was a change in the morphology of the PWD spectral waveform from a triphasic to a monophasic waveform and an elevation in the diastolic blood flow velocity. Over time, there was also a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a decrease in S/D ratio, RI, and PI. Most of these changes were seen as early as 5 minutes after the block. The increase in EDV (3.7-fold) was the most notable change, and it was significantly greater than the increase in PSV (1.5-fold) and Vmean (2.8-fold). / Thirdly, the regional hemodynamic changes in the proximal (brachial artery) and distal (common palmar digital artery) artery of the upper extremity after an USG supraclavicular BPB was investigated in 15 adult patients aged 23-70 yrs. After the block, the common palmar digital artery showed more obvious vasodilatation on the power Doppler US scan. In the PWD spectral waveform, and in both arteries studied, the protodiastolic blood flow disappeared and there was an elevation of the diastolic curve. Also there was a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a significant reduction in S/D ratio, PI and RI in both arteries. Relative changes of these parameters were greater in the common palmar digital artery than in the brachial artery. In this study, bilateral spread of local anesthetic was observed in 4 patients, as evidenced by an increase of skin temperature on the contralateral hand. / Fourthly, a prospective and randomized study was conducted to compare the regional hemodynamic changes in the upper extremity after an axillary and supraclavicular BPB. The two study groups were similar with respect to demographic data. Both axillary and supraclavicular BPB caused a significant increase in PSV, EDV, Vmean, TAVM, d, and blood flow, and a significant reduction in S/D ratio, PI and RI in both the brachial and common palmar digital arteries. Compared with the axillary approach, the supraclavicular approach produced significantly greater increases in TAVM and blood flow in the brachial artery. However, the onset of sensory blockade was faster after the axillary BPB than with the supraclavicular BPB. / In conclusion, PWD US is a reliable and reproducible method for quantifying the regional hemodynamic parameters in both the brachial and common palmar digital arteries. BPB produces a change in the morphology of the PWD spectral waveform, arterial vasodilatation, an increase in blood flow velocity, and an increase in blood flow in both the ipsilateral brachial and common palmar digital arteries. These changes in regional hemodynamic parameters were more profound in the common palmar digital artery than in the brachial artery. Also these changes were more significant after a supraclavicular BPB than after an axillary BPB. These findings will allow clinicians to evaluate the sympathetic effect of a BPB using regional hemodynamic changes in the distal arteries of the upper extremity. These findings will also allow anesthesiologists to make an evidence-based choice on the techniques of BPB for vascular surgery of the upper extremity when good tissue perfusion is desirable postoperatively. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Jiawei. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 182-192). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / TABLE OF CONTENTS / ABSTRACT / 中文摘要 / STATEMENT OF WORK / ACKNOWLEDGMENTS / PUBLICATIONS AND PRESENTATIONS / LIST OF ABBREVIATIONS / LIST OF TABLES / LIST OF FIGURES / Chapter CHAPTER 1 --- Introduction / Chapter 1.1 --- Introduction / Chapter 1.2 --- Aims of the project / Chapter 1.3 --- Outline of the thesis / Chapter CHAPTER 2 --- Literature Review / Chapter 2.1 --- Introduction / Chapter 2.2 --- Why regional hemodynamic changes occur after a BPB / Chapter 2.2.1 --- Anatomy of the sympathetic nervous system in the upper extremity / Chapter 2.2.2 --- The anatomic relationship between the sympathetic nerves and the brachial plexus / Chapter 2.2.3 --- Sympathetic efferents to blood vessels in the upper extremity / Chapter 2.3 --- Methods used to measure regional hemodynamic changes / Chapter 2.3.1 --- Skin and muscle blood flow / Chapter 2.3.2 --- Regional hemodynamic measurements using PWD US / Chapter 2.3.2.1 --- Basics of Doppler ultrasound / Chapter 2.3.2.2 --- Principles of blood flow / Chapter 2.3.2.3 --- Spectral analysis of blood flow using PWD US / Chapter 2.4 --- Published data on regional hemodynamic changes after BPB / Chapter 2.4.1 --- Skin temperature / Chapter 2.4.2 --- Cutaneous and muscular blood flow / Chapter 2.4.3 --- Regional hemodynamic measurements on major arterial branches of the upper extremity / Chapter 2.5 --- Introduction of BPB / Chapter 2.5.1 --- Anatomy of the brachial plexus / Chapter 2.5.2 --- Techniques for performing BPB / Chapter 2.5.3 --- USG BPB / Chapter 2.5.3.1 --- History / Chapter 2.5.3.2 --- Advantages of ultrasound guidance for peripheral nerve blockade / Chapter CHAPTER 3 --- Methodology / Chapter 3.1 --- Introduction / Chapter 3.2 --- Patient preparations / Chapter 3.3 --- Regional hemodynamic measurement / Chapter 3.3.1 --- Ultrasound equipment / Chapter 3.3.2 --- Patient position / Chapter 3.3.3 --- Regional hemodynamic measurements using PWD US / Chapter 3.3.3.1 --- Optimizing settings for B-Mode US / Chapter 3.3.3.2 --- Optimizing settings for PWD US / Chapter 3.3.3.3 --- Measurement of regional hemodynamic parameters / Chapter 3.3.4 --- Measurement of diameter (d) and blood flow (Q) / Chapter 3.4 --- USG BPB / Chapter 3.4.1 --- USG axillary BPB / Chapter 3.4.1.1 --- Scout scan / Chapter 3.4.1.2 --- Aseptic precautions / Chapter 3.4.1.3 --- USG axillary BPB / Chapter 3.4.2 --- USG supraclavicular BPB / Chapter 3.4.2.1 --- Scout scan / Chapter 3.4.2.2 --- Aseptic precautions / Chapter 3.4.2.3 --- USG supraclavicular BPB / Chapter 3.5 --- Outcome data after the BPB / Chapter CHAPTER 4 --- Measurement of Regional Hemodynamic Parameters in the Upper Extremity Using Pulsed Wave Doppler Ultrasound: A Reliability Study / Chapter 4.1 --- Introduction / Chapter 4.2 --- Methods / Chapter 4.2.1 --- Subjects / Chapter 4.2.2 --- Study design / Chapter 4.2.3 --- Data acquisition / Chapter 4.2.4 --- Statistical analysis / Chapter 4.3 --- Results / Chapter 4.4 --- Discussion / Chapter 4.4.1 --- Summary of main findings / Chapter 4.4.2 --- Compared with previous studies / Chapter 4.4.3 --- Sources of measurement variability / Chapter 4.4.4 --- Explanation for the variation in the changes in various regional hemodynamic parameters / Chapter 4.5 --- Conclusion / Chapter CHAPTER 5 --- Regional Hemodynamic Changes after an Axillary BPB: A Pulsed Wave Doppler Ultrasound Study / Chapter 5.1 --- Introduction / Chapter 5.2 --- Methods / Chapter 5.2.1 --- Patient enrollment / Chapter 5.2.2 --- Patient preparation / Chapter 5.2.3 --- Measurement of baseline regional hemodynamic parameters / Chapter 5.2.4 --- USG axillary BPB / Chapter 5.2.5 --- Outcome data after the BPB / Chapter 5.2.6 --- Sensory and motor assessments after the BPB / Chapter 5.2.7 --- Statistical Analysis / Chapter 5.3 --- Results / Chapter 5.4 --- Discussion / Chapter 5.4.1 --- Summary of main findings / Chapter 5.4.2 --- Limitations / Chapter 5.4.3 --- Changes in PWD spectral waveform / Chapter 5.4.4 --- Changes in regional hemodynamic parameters / Chapter 5.4.5 --- Increase in skin temperature / Chapter 5.4.6 --- Effects of local anesthetic / Chapter 5.5 --- Conclusion / Chapter CHAPTER 6 --- Does a Supraclavicular Brachial Plexus Block Induce Comparable Hemodynamic Changes in the Proximal and Distal Arteries of the Upper Extremity? / Chapter 6.1 --- Introduction / Chapter 6.2 --- Methods / Chapter 6.2.1 --- Patient recruitment / Chapter 6.2.2 --- Patient preparation / Chapter 6.2.3 --- Measurement of baseline regional hemodynamic parameters, arterial diameter and blood flow / Chapter 6.2.4 --- USG supraclavicular BPB / Chapter 6.2.5 --- Outcome measurements after the BPB / Chapter 6.2.6 --- Statistical analysis / Chapter 6.3 --- Results / Chapter 6.4 --- Discussion / Chapter 6.4.1 --- Summary of the main findings / Chapter 6.4.2 --- Limitations / Chapter 6.4.3 --- Changes in the PWD spectral waveform / Chapter 6.4.4 --- Explanation of the differences in regional hemodynamic changes in the distal and proximal arteries after BPB / Chapter 6.4.5 --- Increase in skin temperature and its relation to blood flow / Chapter 6.4.6 --- Bilateral sympathetic effect after supraclavicular BPB / Chapter 6.4.7 --- Other findings of this study / Chapter 6.5 --- Conclusion / Chapter CHAPTER 7 --- Does a Supraclavicular Brachial Plexus Block Induce Greater Changes in Regional Hemodynamics than an Axillary Brachial Plexus Block? / Chapter 7.1 --- Introduction / Chapter 7.2 --- Methods / Chapter 7.2.1 --- Sample size estimation / Chapter 7.2.2 --- Exclusion criteria / Chapter 7.2.3 --- Randomized allocation / Chapter 7.2.4 --- Preparations before the ultrasound scan / Chapter 7.2.5 --- Measurement of baseline regional hemodynamic parameters, diameter and blood / Chapter 7.2.6 --- USG axillary and supraclavicular BPB / Chapter 7.2.7 --- Outcome measurements after the BPB / Chapter 7.2.8 --- Statistical analysis / Chapter 7.3 --- Results / Chapter 7.4 --- Discussion / Chapter 7.4.1 --- Summary of the main findings / Chapter 7.4.2 --- Limitations / Chapter 7.4.3 --- Change in the PWD spectral waveform / Chapter 7.4.4 --- Differences in regional hemodynamic changes between the 2 study groups / Chapter 7.4.5 --- Differences in sensory and motor blockade between the 2 study groups / Chapter 7.4.6 --- Changes in skin temperature / Chapter 7.5 --- Conclusion / Chapter CHAPTER 8 --- Summary and Conclusions / APPENDIX / REFERENCES

In this study I reviewed 28 patients with brachial plexus lesions caused by shoulder dislocation. As far as can be established, this is the largest series reviewed in the literature to date. Contrary to most other reports, the neurological lesions involved the supraclavicular as well as the infraclavicular brachial plexus. The only part of the supraclavicular brachial plexus affected was the suprascapular nerve, and this always recovered spontaneously. Isolated axillary nerve lesions were found to have the poorest prognosis for spontaneous nerve recovery. All lesions that showed no recovery after 3 - 5 months were explored and had either a graft or a neurolysis. This study discusses the combinations of nerve lesions, their recovery and the indications for surgical intervention. I also suggest a classification perhaps more clinically relevant than the anatomical classification of Leffert and Seddon (1965).

Denna studie fokuserar på interobservatörsvariabiliteten vid utvärdering av distaltryckmätning, en viktig diagnostisk undersökning vid bedömning av cirkulationeni nedre extremiteterna och upptäcka perifer arteriell sjukdom (PAD) [1]. LaserDoppler Flödesmätning (LDF) användes i klinisk fysiologi och nuklearmedicin i(SUS) Lund och Malmö, för att mäta blodtrycket i ankarna och stortår. Studiensyftade till att utforska överensstämmelsen i resultat mellan olika observatörer,vid distal tryckmätning. Det vill säga, studera om resultaten av distaltryckmätning varierar, med LDF-teknik, beroende på undersökare. Studie krävdeingen etiks ansökan eftersom metoden bestod av avidentifierad och insamladmaterial. Tretton medarbetare med olika erfarenhetsnivåer deltog, ochkvalitetsstudien inkluderade fem patientfall. Resultat visade hög överstämmelsemellan observatörer, vilket indikerar att yrkeserfarenhet inte hade betydandeinverkan på tillförlitligheten i distal tryckmätning. I studiens resultat visadesIntraclass Correlation Coefficient (ICC) för höger tå-index var 0,996, för vänstertå-index 0,987, för höger ankel-index 0,990 och för vänster ankel-index 0,997.Dessa höga ICC-värden indikerar att mätresultaten var mycket tillförlitliga, vilketvisar på en hög grad av överensstämmelse mellan olika observatörers resultat.Studien betonar vikten av standardiserade protokoll och metodbeskrivningar föratt minimera interobservatörsvariabilitet, och säkerställa noggranna diagnostiskametodik.

archives@tulane.edu / Background Ankle brachial index (ABI) is a noninvasive measure of subclinical cardiovascular disease (CVD) and atherosclerosis of the lower extremities. Low and high levels of ABI are associated with cardiovascular mortality and vascular calcification in dialysis chronic kidney disease (CKD) patients. However, the association of the spectrum of vascular calcification with low and high ABI is not well studied in pre-dialysis CKD patients. The purpose of this study is to investigate the association of both low and high ABI with the risk of vascular calcification in CKD patients. Methods We recruited 243 patients with pre-dialysis CKD from the great New Orleans area between 2010 and 2012. Our study used a cross-sectional design with ABI and CAC measured at the same visit. Continuous ABI measurements were taken and further classified into four categories : <=0.9 (low ABI) >0.9-<1.0 (borderline), 1.0-<1.4 (normal), >=1.4 (high). Level of vascular calcification were considered as the outcome and calculated by agatston score. Three categories of CAC is defined as: CAC agaston score=0, 0-100, >100. Three cumulative logit models were applied to the data. The first is an unadjusted univariate model, the second adjusts for baseline demographics, and the third adjusts for baseline demographics and covariates that are associated with CAC. Logistic regression methods were used to calculate the odds ratio of having a higher CAC score for CKD patients. Results We found a significant association between ABI and vascular calcification. All three models returned consistently significant result (p=0.0005, 0.0005, 0.0037, respectively) for the association between ABI and CAC. In addition, low ABI (ABI≤0.9) is also associated with an increased risk of CAC and severe CAC (OR=6.183, 95%CI(1.085, 35.228)). High ABI (>1.4) is also associated with an increase in CAC and severe CAC (OR=5.064, 95%CI (1.696, 15.122)). Borderline ABI (0.9<ABI<1.0) is not associated with an increase in CAC or severe CAC (OR=2.704, 95% CI (0.702, 10.418). Conclusion Compared to normal ABI level, low and high ABIs are both significantly associated with an increased risk of coronary artery calcification and severe coronary artery calcification in CKD patients. / 1 / Shuo Bai

Obstetric brachial plexus palsy, a traumatic birth palsy, results in the paralysis of the upper limb/s. The birth injury is treated at the Brachial Plexus Clinic at King Edward VIII th Hospital, where the Candidate forms part of the Rehabilitation Team. In keeping with worldwide trends, the focus of treatment was on rehabilitation of the upper limb/s. During the course of treatment of these patients, it was observed that the performance of these children varied from excellent to poor. This observation, has not been recorded previously, hence a Research study was initiated to invesitigate this aspect of performance. The study comprised thirty children, between the ages of four and seventeen, whose paralysis was assessed in the conventional pattern. In addition, the visual perceptual abilities of these children were assessed in a variety of batteries, catering for the wide age range. These were: Developmental Test of Visual Motor Integration (1989), Motor Free Perception Test (1972), Developmental Test of Visual Perception (2nd edition), Test of Visual Perceptual Skills - Upper and Lower levels ( Gardner), Jordan's Left-Right Reversal Test (1974), Clinical (Ayres) and General Observations. Although traditionally viewed as a physical disorder, the results of the study indicate that children with obstetric brachial plexus injury present with a significant incidence of below average performance, against the normal population, on most of the assessment batteries. No significant relationship could be established between the severity of the lesion and visual perceptual abilities, owing to the disproportionate numbers of children amongst the different lesions. Further research is required to support and consolidate the findings of this study. It is also recommended that Occupational therapists screen for visual perceptual deficits in such injuries, thus facilitating holistic patient management. / Thesis (M.O.T.)-Unversity of Durban-Westville, 1998.

In view of the lifelong impact of Obstetrical Brachial Plexus Palsies (OBPP), prevention of OBPP would be of great significance. Despite contemporary advances in antenatal planning and assessment, OBPP remains an unfortunate consequence after difficult childbirth. Permanent brachial plexus palsy is a leading cause of litigation related to birth trauma. Objectives: To determine the incidence of Obstetrical Brachial Plexus Palsy (OBPP), Cephalopelvic Disproportion (CPD) and macrosomia in KwaZulu-Natal. As well as to investigate the relationship between OBPP and CPD, and the relationship between OBPP and macrosomia. The study also aimed to determine whether antenatal risk factors could identify those prone to OBPP. Study design: This was a case control study that included all deliveries from 1997 to 2000 from four provincial hospitals (Addington, King Edward VIII, Prince Mshiyeni Memorial and RK Khan hospital). The outcome variable was OBPP. Results were analyzed using Statistical Program for Social Sciences (SPSS). Results: A total of 60 infants of 76 352 deliveries sustained OBPP. The incidence of OBPP was found to be 0.72 per 1000 deliveries. The incidence of CPD was found to be 33.5 per 1000 deliveries and the incidence of macrosomia was found to be 16.7 per 1000 deliveries. Race, Maternal height> 150 cm, gravida >3, parity >4, history of a previous big baby, normal vaginal delivery, delivery by a midwife, difficult labour, inadequate or doubtful pelvic capacity, birth weight of >3700 g and gestation period> 34 weeks were significant risk factors. Logistic regression analysis showed that race, parity> 4, normal vaginal delivery and gestation period> 35 weeks were the variables most associated with OBPP. Using linear regression model was obtained for the calculation of predictive risk scores. Conclusion: Using standard statistical formulae the probability of OBPP can be calculated in women with significant risk factors from the logistic regression formula. This would need to be validated and could provide a useful tool for screening for OBPP thus contributing to preventing this devastating complication of birth trauma. The risk assessment profile would contribute greatly to the prediction of OBPP and the subsequent prevention of this debilitating birth injury. / Thesis (M.Sc.)-University of Durban-Westville, 2002.

The rat model of cervical dorsal root injury mimics the avulsion of dorsal roots in humans following brachial plexus injury, a condition that leads to debilitating sensory disturbances and intractable neuropathic pain that is not amenable to repair. This injury disrupts sensory inputs from the dorsal roots to the spinal cord and the damaged axons do not regenerate across the PNS-CNS interface, the dorsal root entry zone. This thesis investigated the role of OECs for repairing DRI-associated neuropathic pain, which has never been previously explored. Chapter 2 of this thesis characterised two DRI models, a partial (2-root) or complete (4-root) deafferentation of the rat forepaw. The 2-root animals developed persistent allodynia and hyperalgesia, whereas in the 4-root DRI, in contrast, reduced sensation (desensitisation) was found within the affected forepaw. The degree of deficits on performing complex, skilled forepaw movements was proportional to the severity of DRI. Sensory control of forepaw movements was permanently abolishes in animals with 4-root DRI. With the goal of repairing DRI-associated neuropathic pain, the efficacy of genetically modified OECs that carry a novel GDNF construct was examined. These modified GDNF-OECs were able to produce GDNF in vitro, however, died rapidly and failed to yield long term GDNF expression after both acute and delayed transplantation into the DRI spinal cord. Unmodified plain OECs were then used. The results show that delayed transplantation of OECs attenuated the development of DRI-associated allodynia and hyperalgesia. Central reorganisations occurred within the dorsal horn following DRI, including reduction in the area of deep dorsal horn, permanent depletion of IB4-labeled axons and restoration of CGRP-labelled afferents in the denervated superficial laminae. The development of neuropathic pain is suggested to be mediated by the aberrant expansion of large myelinated VGLUT1-positive afferents into the superficial laminae, which normally receive nociceptive inputs. The effect of OECs on modulating nociception seems to be mediated by factors other than inhibition of afferent sprouting. In conclusion, the results in this thesis demonstrated the potential effect of OECs for modulating DRI-associated neuropathic pain. This finding could have clinical applicability for resistant pain sequelae resulting from neurotrauma.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

abstract: ABSTRACT Despite significant advancements in drug therapy, cardiovascular disease (CVD) is still the leading cause of death in the United States. Given this, research has begun to seek out alternative approaches to reduce CVD risk. One of these alternative approaches is Vitamin D supplementation. Current research has shown a link between Vitamin D status and CVD risk in both healthy and diseased populations. Among the possible mechanisms is a positive effect of Vitamin D on vascular endothelial function, which can be measured with noninvasive techniques such as flow-mediated dilation (FMD) of conduit vessels using high-resolution ultrasound. This dissertation is comprised of two studies. The first examines whether Vitamin D supplementation can improve FMD in older adults within a time period (two weeks) associated with peak increases in plasma Vitamin D concentrations after a single-dose supplementation. The second examines the effect of Vitamin D supplementation in people with Rheumatoid Arthritis (RA). The reason for looking at an RA population is that CVD is the leading cause of early mortality in people with RA. In the first study 29 Post-Menopausal Women received either 100,000 IU of Vitamin D3 or a Placebo. Their FMD was measured at baseline and 2 weeks after supplementation. After 2 weeks there was a significant increase in FMD in the Vitamin D group (6.19 + 4.87 % to 10.69 + 5.18 %) as compared to the Placebo group (p=.03). In the second study, 11 older adults with RA were given 100,000 IU of Vitamin D or a Placebo. At baseline and one month later their FMD was examined as well as plasma concentrations of Vitamin D and tumor necrosis factor-alpha; (TNF-alpha;). They also filled out a Quality of Life Questionnaire and underwent a submaximal exercise test on the treadmill for estimation of maximum oxygen uptake (VO2max). There was no significant change in FMD in Vitamin D group as compared to the Placebo group (p=.721). Additionally, there was no significant improvement in either plasma Vitamin D or TNF-alpha; in the Vitamin D group. There was however a significant improvement in predicted VO2max from the submaximal exercise test in the group receiving Vitamin D (p=.003). The results of these studies suggest that a single 100,000 IU dose of Vitamin D can enhance FMD within two week in older adults, but that a similar dose may not be sufficient to increase FMD or plasma Vitamin D levels in older adults with RA. A more aggressive supplementation regimen may be required in this patient population. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2012

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Objetivos: Avaliar a funÃÃo endotelial atravÃs da dilataÃÃo fluxo mediada em adolescentes e verificar se hà diferenÃa entre aquelas com antecedentes de gestaÃÃo normotensa ou com prÃ-eclÃmpsia (PE). Metodologia: Foram analisadas 99 adolescentes pÃs-parto (intervalo este que variou de dois meses a 11 meses pÃs-parto). Avaliou-se a dilataÃÃo fluxo mediada da artÃria braquial (DILA): apÃs repouso de cinco a dez minutos em decÃbito dorsal era verificada a pressÃo arterial no braÃo direito e realizada a medida da luz da artÃria braquial ao ultrassom. Essa medida era considerada a medida basal. Era, entÃo, realizada compressÃo do braÃo com o esfigmomanÃmetro por trÃs a cinco minutos com uma pressÃo que ultrapassasse em 30 mmHg a pressÃo sistÃlica. ApÃs a liberaÃÃo da compressÃo,era verificado o diÃmetro da luz arterial apÃs 30, 60, 90, 120 e 180 segundos em diÃstole no mesmo local da verificaÃÃo basal. Para cÃlculo da DILA, considerou-se a maior dilataÃÃo em porcentagem. Utilizou-se transdutor de alta frequÃncia (6 a 9 MHz). O ultrassonografista nÃo tinha conhecimento do resultado da gestaÃÃo no momento do exame. Verificou-se, retrospectivamente, o resultado da gestaÃÃo quanto a ausÃncia ou desenvolvimento de PE (leve ou grave). Considerou-se PE o aparecimento de pressÃo arterial maior ou igual a 140x90 mmHg apÃs 20 semanas de gestaÃÃo, associado à proteinÃria (uma cruz em duas verificaÃÃes ou duas cruzes em Ãnica verificaÃÃo, em amostra isolada ou 300 mg/dia em avaliaÃÃo de 24h). A normalidade da distribuiÃÃo dos dados foi avaliada pelos testes de Shapiro-Walk e Levene. Os grupos foram comparados pelos Testes de Kruskal-Wallis, T-Student e Mann-Whitney. Considerou-se p<0,05 como significante. Resultados: A idade variou de 13 a 18 anos (mÃdia 16,2  1,3). 76 gestaÃÃes foram consideradas normotensas, 23 prÃ-eclÃmpsias (11 PE leves e 12 graves). Verificou-se presenÃa de DILA > 10% em 75 pacientes e &#8804; 10% em 24 delas. Oito pacientes (8,1%) apresentaram DILA < 5%. Inicialmente, a populaÃÃo foi dividida em trÃs grupos: normotensa, PE leve e PE grave. NÃo houve diferenÃa estatÃstica entre os grupos quanto a idade (16,3 x 15,9 x 16,1, p = 0,615), tempo entre o parto e a avaliaÃÃo (6,8 x 6,2 x 6,7, p = 0,497), IMC (22,8 x 26,1 x 24,3 Kg/mÂ, p = 0,090) e pressÃo diastÃlica (70,3 x 73,6 x 73,4 mmHg, p = 0,181), ou DILA (16,8 x 16,5 x 11,4%, p = 0,085). A pressÃo sistÃlica foi estatisticamente diferente entre os grupos (108,8 x 117,2 x 110,8 mmHg, p = 0,005), [ a pressÃo arterial sistÃlica na PE leve foi maior do que nas normotensas (p = 0,003). NÃo houve diferenÃa entre PE leve e grave (p = 0,126) e entre PE grave e normotensa (p = 0,686)]. Quando foram comparadas somente os dois grupos PE x normotensas, o IMC apresentou-se estatisticamente diferente (p = 0,031). Nos antecedentes de prÃ-eclÃmpsia, o IMC foi maior ( 25,3 x 22,8 Kg/m ). ConclusÃes: NÃo hà diferenÃa na presenÃa de disfunÃÃo endotelial verificada pela dilataÃÃo fluxo mediada da artÃria braquial em adolescentes com antecedentes de gestaÃÃo normotensa ou prÃ-eclÃmpsia. As pacientes com antecedentes de PE apresentaram pressÃo arterial sistÃlica e IMC mais elevados do que as pacientes com gestaÃÃo previa normotens. / Aims : To evaluate the endothelial function by flow mediated dilation in adolescents and to observe if there is difference among those with a history of normotensive pregnancy or with prÃ-eclampsia ( PE ) . Methodology : A total of 99 adolescents after delivery ( this interval ranged from 2 to 11 months post partum ). It was evaluated the flow mediated dilation of brachial artery ( FMD), after resting from 5 to 10 minutes in a supine position, it was checked the blood pressure in the right arm and achieved the light measure of the brachial vessel to ultrasound. This measure was considered the baseline one. So, it was performed the compression of the arm with the sphygmomanometer about 3 to 5 minutes with a pressure that exceeded in 30 mmHg the systolic pressure. After the release of the compression, it was checked the diameter of the lumen after 30, 60, 90, 120, and 180 seconds in diastole in the same place of the basal verification . For FMD calculation, it was considered the biggest expansion in percentage. It was used a high-frequency transducer (6 to 9 MHz). The ultrasonographer did not know the result of the pregnancy at the moment of the exam. It was found retrospectively, the result of the pregnancy concerning to the absence or development of PE (mild or severe). PE was considered the appearing of arterial blood pressure greater or equal to 140 x 90 mmHg after 20 weeks of pregnancy associated with proteinuria (a cross in two checks or two crosses in only one in an isolated sample or 300 mg/day in 24-hour evaluation). The normal distribution of data was evaluated by Shapiro - Walk and Levene tests. The groups were compared through the test of Kruskal â Wallis, R- student and Mann â Whitney. It was considered p < 0, 05 as significant. Results: The age ranged from 13 to 18 years (mean 16,2  1,3 ). 76 pregnancies were considered normotensive, 23 preâeclampsia (11 mild and 12 severe PE). It was found the presence of FMD > 10 % in 75 patients and &#8804; 10% in just 24. Eight patients (8, 1%) presented FMD < 5%. First the population was divided in three groups: normotensive, mild and severe PE. There was no statistical difference between the groups in relation to age (16,3 x 15,9 x 16,1, p = 0,615), time between delivery and evaluation (6,8 x 6,2 x 6,7, p= 0, 497). IMC (22,8 x 26,1 x 24,3 Kg/mÂ, p = 0,090), diastolic blood pressure (70,3 x 73,6 x 73,4 mmHg, p = 0,181), or FMD (16,8 x 16,5 x 11,4%, p= 0,085). The systolic blood pressure was statistically different between the groups (108,8 x 117,2 x 110,8 mmHg, p = 0,005), systolic blood pressure in mild PE was higher than in normotensive (p = 0,003). There was no difference between mild and severe PE (p = 0,126) and between severe PE and normotensive (p = 0,686). When it was compared only two groups PE x normotensive, the Body Mass Index (BMI) was statistically different (p = 0,031). In the history of PE, the Body Mass Index (BMI) was higher (25,3 x 22,8 Kg /mÂ). Conclusion :There is no difference in the presence of endothelial disfunction observed by the flow mediated dilation of the brachial artery in adolescents with a history of normotensive pregnancy or PE. Patients with history of PE presented systolic blood pressure and BMI higher than women with prior gestational normotensive.