Baroreflex function and cardiovascular responses to lower body negative pressure during selective autonomic blockade were evaluated in endurance exercise trained (ET) and untrained (UT) men. Baroreflex function was evaluated using a progressive intravenous infusion of phenylephrine HCL (PE) to a maximum of 0.12 mg/min. Heart rate, arterial blood pressure, cardiac output and forearm blood flow were measured at each infusion rate of PE. The reduction in forearm blood flow and concomitant rise in forearm vascular resistance was the same for each subject group. However, the heart rate decreases per unit increase of systolic or mean blood pressure were significantly (P<.05) less in the ET subjects (0.91 ± 0.30 versus 1.62 ± 0.28 for UT). During progressive lower body negative pressure with no drug intervention, the ET subjects had a significantly (P<.05) greater fall in systolic blood pressure (33.8 ± 4.8 torr versus 16.7 ± 3.9 torr). However, the change in forearm blood flow or resistance was not significantly different between groups. Blockade of parasympathetic receptors with atropine (0.04 mg/kg) eliminated the differences in response to lower body negative pressure. Blockade of cardiac sympathetic receptors with metoprolol (0.02 mg/kg) did not affect the differences observed during the control test. It was concluded that the ET subjects were less effective in regulating blood pressure than the UT subjects, because of 1) an attenuated baroreflex sensitivity, and 2) parasympathetic-mediated depression of cardiac and vasoconstrictive responses to the hypotensive stress.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Trata-se de um estudo, cujo objetivo foi avaliar o processo ensino aprendizagem das manobras de ressuscitação cardiopulmonar (RCP) com uso do desfibrilador externo automático (DEA) realizadas por graduandos da área de saúde antes e depois de um curso teórico-prático, bem como nas suas etapas intermediárias. A amostra consistiu de 84 estudantes de Cursos de Graduação da área de saúde de uma Instituição de Ensino Superior da região Noroeste do Estado de São Paulo. Dois instrumentos de avaliação foram aplicados, um para Avaliação da HABILIDADE psicomotora caracterizada por um modelo padrão (check-list) composto de 30 itens e outro para Avaliação do CONHECIMENTO caracterizado por uma prova escrita composta de 40 questões objetivas. Ambas as avaliações contemplaram conteúdos referentes às manobras de RCP com uso do DEA e foram embasadas nas Diretrizes para RCP 2005 do International Liaison Committee on Resuscitation (ILCOR). Os resultados permitiram concluir que, após a Aula Teórica, na HABILIDADE houve melhora no número de acertos em 28 dos 30 itens e aumento da pontuação, de forma significativa, apenas o item 5, do Aspecto Preliminar atingiu o índice de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em 39 das 40 questões e aumento da nota, de forma significativa, as questões do Aspecto Preliminar 1, 2, 3, 4, 5, 8, 9, 20, 35; da Ventilação 6,14 ; das Compressões Cardíacas 24, 25, 27, 28 ; do Uso do DEA 23, 29, 31, 33, 34, 36, 37, 38; atingiram índices de acertos 90%. Após o Treinamento Prático, na HABILIDADE houve melhora no número de acertos em todos os 30 itens e aumento da pontuação, de forma significativa, os itens do Aspecto Compressões Cardíacas 14, 15, 16, 17, 18, 19, 20; atingiram índices de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em 12 das 40 questões, em apenas 04 de forma significativa, apenas a questão 27 do Aspecto Compressões Cardíacas atingiu o índice de acertos 90% e não houve alteração na nota. Após o Curso Teórico Prático (aula teórica e treinamento prático) na HABILIDADE houve melhora no número de acertos em todos os 30 itens e aumento da pontuação, de forma significativa, os itens do Aspecto Preliminar 1, 2, 3, 4, 5, 6, 7; da Abertura das Vias Aéreas 8, 9; da Ventilação 10, 13 ; Compressões Cardíacas 14, 15, 16, 17, 18, 19, 20 ; do Uso do DEA 23, 24, 25, 26, 27, 28, 29, 30 ; atingiram índices de acertos 90%; no CONHECIMENTO houve melhora no número de acertos em todas as 40 questões e aumento da nota, de forma significativa, as questões do Aspecto Preliminar 1, 3, 5, 9, 20; da Ventilação 6, 14, 15, 16; das Compressões Cardíacas 27 ; do Uso do DEA 23, 31, 32, 33, 34, atingiram índices de acertos 90%. / This study aims to evaluate the teaching-learning process of the cardiopulmonary resuscitation (CPR) maneuvers using the automatic external defibrillator (AED) performed by undergraduates in the health care field before and after a theoretical-practical course (theoretical classes and practical training), as well as in its intermediate stages. The sample was composed by 84 students of graduation courses in health care field of a Private Higher Education Institution in the Northwest region of the state of São Paulo. Two assessment tools were used, one for the evaluation of the ABILITY, characterized by a standard model (check-list) composed by 30 items and another for the evaluation of the KNOWLEDGE, characterized by a written test composed by 40 objective questions. Both evaluations consider contents referring to CPR maneuvers with the use of the AED; and they were based on the 2005 CPR Guidelines from the ILCOR (International Liaison Committee on Resuscitation). The results allowed to conclude that after Theoretical Classes, in ABILITY, there was improvement in the number of correct answers, 28 out of 30 items correctly, and a significant increase in the score, only the item number 5 of the Preliminary Aspect reached the success rate of > 90%; in KNOWLEDGE, there was also improvement in the number of correct answers, 39 out of 40 questions correctly, and the significant increase of the grade; the questions numbers 1, 2, 3, 4, 5, 8, 9, 20, 35 of the Preliminary Aspect, the numbers 6, 14 of the Ventilation, the numbers 24, 25, 27, 28 of the Cardiac Compression; the numbers 23, 29, 31, 33, 34, 36, 37, 38 of the AED use reached the success rate of 90%. After Practical Training, in ABILITY, there was improvement in the number of correct answers in all the 30 items and a significant increase in the score. The items numbers 14, 15, 16, 17, 18, 19, 20 of the Cardiac Compressions reached the success rates of > 90%; in KNOWLEDGE there was improvement in the number of correct answers in 12 out of 40 questions, only in 04 it was significant. Only question number 27 of the Cardiac Compressions reached the success rate of 90% and there was no alteration in the grade. After the Theoretical-practical Course (theoretical classes and practical training), in ABILITY, there was improvement in the number of correct answers in all the 30 items and significant increase of the score. The items numbers 1, 2, 3, 4, 5, 6, 7 of the Preliminary Aspect; the numbers 8 and 9 of the Airways Opening; the numbers 10 and 13 of the Ventilation; the numbers 14, 15, 16, 17, 18, 19, 20 of the Cardiac Compressions; the numbers 23, 24, 25, 26, 27, 28, 29, 30 of AED use reached the success rate of > 90%; and in KNOWLEDGE there was improvement in the number of correct answers in all the 40 questions and significant increase of the grade. The questions numbers 1, 3, 5, 9, 20 of the Preliminary Aspect, numbers 6, 14, 15, 16 of the Ventilation, number 27 of the Cardiac Compressions, numbers 23, 31, 32, 33, 34 of AED use reached the success rate of > 90%.

A segurança do paciente tornou-se indispensável para o sistema de saúde, portanto iniciativas vêm sendo implantadas, no decorrer dos anos, com vistas a reduzir os eventos adversos. A atuação do time de resposta rápida (TRR) consolida-se como estratégia para prover atendimento ao paciente que apresente sinais de deterioração clínica no setor de internação geral em hospitais. O serviço é formado por equipe multiprofissional capacitada para prestar tratamento intensivo ao paciente com quadro de deterioração clínica aguda no setor de internação, por meio de códigos (amarelo e azul) instituídos para seu acionamento, com vistas a reduzir a probabilidade de agravamento do quadro clínico ou risco de óbito imediato do paciente, durante o seu período de hospitalização. O estudo objetiva caracterizar as exigências críticas nos atendimentos emergenciais realizados por TRR, em um hospital público no estado do Paraná e um filantrópico no estado de São Paulo. Pesquisa descritiva, exploratória, qualitativa, com utilização da Técnica do Incidente Crítico como guia do processo metodológico, realizada por meio de entrevistas com 19 médicos, 20 fisioterapeutas e 23 enfermeiros. Os resultados encontrados foram agrupados em 89 incidentes críticos extraídos das entrevistas. A análise dos dados constou da identificação e do agrupamento de 220 comportamentos e 130 consequências. A partir das situações, comportamentos e consequências identificadas, destacam-se a necessidade da melhoria na via aferente do TRR (reconhecimento da deterioração clínica e acionamento do TRR na unidade), a capacitação dos profissionais das unidades de internação para exercer as habilidades técnicas iniciais necessárias frente ao atendimento de emergência até a chegada do TRR, a falha na interação entre os diversos profissionais durante o atendimento do código azul com prejuízo na sistematização do atendimento de emergência para reverter o quadro de parada cardiorrespiratória dos pacientes e os sentimentos e emoções negativas geradas nos profissionais como dificultadores dos atendimentos emergenciais em código azul. Em relação aos destaques positivos a partir das situações, comportamentos e consequências identificados, ressaltam-se o tempo de chegada do TRR na unidade para realizar o atendimento de emergência, a sistematização do atendimento de reanimação cardiopulmonar realizada pela equipe multiprofissional, o restabelecimento das funções vitais do paciente após o atendimento e a sua transferência após a finalização do atendimento da unidade de internação para um ambiente de cuidados intensivos. Como principais sugestões ao TRR, os entrevistados pontuaram a importância da capacitação de atendimento de emergência aos profissionais das unidades de internação, a necessidade de mantê-los atuando exclusivamente no TRR, o número adequado de profissionais no quarto durante o atendimento de emergência e a importância do registro em prontuário do paciente sobre a decisão de não reanimação frente aos cuidados paliativos. Destaca-se a expressiva frequência dos resultados positivos comparados aos negativos que permearam as situações, comportamentos e consequências decorrentes das entrevistas. Infere-se que mesmo ocorrendo dificuldades, enfrentadas por esses profissionais durante os atendimentos realizados aos pacientes que se tornam críticos nas enfermarias, predominaram os relatos positivos nas diversas categorias que legitimaram a importância da implantação desse serviço, como contribuição à qualidade e segurança dos que estão hospitalizados / Patient safety has become indispensable for the health system. Therefore, initiatives have been implemented over the years to reduce adverse events. The performance of the Rapid Response Team (RRT) has been consolidated as a strategy to provide care to patients who get in critical conditions at the general hospital admission unit. The service is constituted by a multiprofessional team with an approach in the intensive treatment of patients with signs of acute clinical deterioration in the inpatient unit, through codes established for its activation, in order to reduce the probability of worsening of the clinical condition or imminent death risk of the patient during the hospitalization period. The study aims to characterize the critical requirements in emergency care provided by the RRT at a public hospital in the state of Paraná and a philanthropic hospital in the state of São Paulo, Brazil. This is a descriptive, exploratory study with a qualitative approach, adopting the Critical Incident Technique to guide the methodological procedures, performed with 62 health professionals, being 19 physicians, 20 physiotherapists and 23 nurses. The results were grouped into 89 critical incidents extracted from the interviews. Data analysis consisted of the identification and grouping of 220 behaviors and 130 consequences. Based on the situations, behaviors and consequences identified, there is a need to improve the afferent pathway of RRT (recognition of clinical deterioration and activation of the RRT in the unit), the qualification of the professionals of the inpatient units to perform the necessary initial technical skills in the emergency response until the arrival of the RRT, the failure in the interaction among the different professionals during blue-code care with negative effects for the systematization of emergency care to revert the patients\' CPA and the negative feelings and emotions generated in the professionals as impediments to code-blue emergency care. Regarding the positive highlights from the situations, behaviors and consequences identified, the arrival time of the RRT in the unit to perform the emergency care, the systematization of the cardiopulmonary resuscitation service performed by the multiprofessional team, the restoration of the patient\'s vital functions after the care and transfer of the patient after the end of the care from the inpatient unit to an intensive care environment. As the main suggestions to the RRT, the interviewees pointed out the importance of emergency care training for the professionals of the inpatient units, the need to keep the professionals working exclusively in the RRT, the appropriate number of professionals in the room during emergency care and the importance of registering the patient\'s decision not to reanimate in the patient file in view of palliative care. The significant frequency of positive over negative results was highlighted, which permeated the situations, behaviors and consequences deriving from the interviews. It is inferred that, even though these professionals encountered difficulties during the visits to patients who became critical in the wards, the positive reports predominated in the various categories that legitimized the importance of implementing this service, as a contribution to the quality and safety of hospitalized patients

Este estudo objetivou desenvolver, implementar e avaliar uma estratégia de capacitação para trabalhadores de uma indústria metalúrgica do interior do Estado de Minas Gerais. Trata-se de uma pesquisa qualitativa estruturada a partir da Teoria da Aprendizagem Transformativa, que tem como elementos centrais: a experiência individual, a reflexão crítica, o diálogo, a orientação holística, a consciência do contexto e a prática autêntica. Como método estratégico de desenvolvimento optou- se pelo Círculo Epistemológico, sendo desenvolvido em três fases: 1a ) Investigação: realizada por meio de Grupos Focais para a identificação da percepção dos trabalhadores sobre seus riscos ocupacionais, acidentes mais frequentes e necessidades de aprendizado em relação a Primeiros Socorros; 2a ) Tematização: em que foi desenvolvida e implementada a capacitação em Suporte Básico de Vida; e 3a ) Proposição: na qual buscou-se as impressões dos participantes sobre a capacitação realizada e sinais da busca pela transformação do contexto vivido por meio da técnica do Círculo de Cultura. Participaram da capacitação 54 trabalhadores, os quais fazem parte da Brigada de Incêndio e são locados em diversos setores da empresa. Como resultados, obteve-se na 1a etapa as seguintes categorias: riscos, acidentes, melhorias na segurança, dificuldades e necessidades de capacitação em primeiros socorros. Os trabalhadores relataram a necessidade de capacitação relacionada ao atendimento a vítimas de Parada Cardiorrespiratória e, devido à importância deste tema, o mesmo foi priorizado na 2a etapa. Assim, a 2a etapa foi realizada com o tema \"Suporte Básico de Vida - Ressuscitação Cardiopulmonar e uso do Desfibrilador Externo Automático\". A capacitação, com carga horária de oito horas, contou com a participação intensa dos educandos, tendo sido utilizadas dinâmicas de grupo, práticas com manequins e estudos de casos. A 3a etapa aconteceu logo após o curso, dentro das oito horas, e os discursos foram categorizados da seguinte forma: a estratégia metodológica - percepção dos educandos, o que muda para os pesquisandos a partir desta capacitação e atitudes práticas que podem ser tomadas a partir desta capacitação. Este estudo mostrou que o diálogo e a reflexão crítica, num processo participativo de capacitação, podem facilitar mudanças de comportamento capazes de transformar a realidade do trabalho. Os trabalhadores referiram sentir-se mais seguros após a realização das práticas e das discussões grupais e relataram soluções viáveis e compatíveis com o seus contextos de vida e de trabalho. A percepção dos trabalhadores retrata que a aprendizagem transformativa pode provocar mudanças no comportamento individual e coletivo no contexto do trabalho, incluindo atitudes críticas e reflexivas em um sistema de referência mais amplo. Portanto, a aplicação dos conceitos da Teoria da Aprendizagem Transformativa em capacitações de trabalhadores pode contribuir para a transformação das práticas de trabalho / This study identified the perception of workers about occupational risks, experiences with accidents in the work environment and the need for habilitation in First Aid and, therefore, to develop, implement and evaluate a habilitation strategy for brigade workers in a metallurgy industry in the State of Minas Gerais. This is a structured qualitative research based on the Transformative Learning Theory, which has as central elements: individual experience, critical reflection, dialog, holistic orientation, context awareness and authentic experience. The Epistemological Circle was adopted and was developed in three stages: 1st) Investigation: done through Focus Groups for the identification of worker\'s perception about occupational risks, most frequent accidents, difficulties as brigade member and their learning needs on First Aid; 2nd) Thematization: in which habilitation in Basic Life Support was developed and implemented; and 3rd) Proposal: where participants\' impressions about the concluded habilitation. Fifty four workers took part in the course, all of them belonged to the Fire Brigade and were located in several sectors of the company. The main results obtained in the first stage, fell in the following categories: risks, accidents, improvements in security, difficulties and needs for habilitation in first aid. The workers reported the need for greater habilitation on emergency service for victims with cardiopulmonary arrest and, due to its importance, it was selected for the 2nd stage. Thus, this stage was done with the theme \"Basic Life Support - Cardiopulmonary Resuscitation and the use of an automated external defibrillator\". Habilitation, with a class load of eight hours, had intense participation of the workers, and group dynamics, practices with dummies and case studies were used. The 3rd stage was done immediately after the course, with the eight hours, and the discoursed were divided into the following categories: methodological strategy - perception by the participants, what changes for them after the habilitation and the practices that can be done afterwards. This study demonstrated that dialog and the critical reflection, in a participative habilitation process can enable behavior changes capable of transforming the work environment. The workers stated that they felt more secure after the practices and group discussions, and reported viable and compatible solutions with their life and work contexts. The workers perception portraits that transformative learning can bring changes in individual and collective behavior in the work context, including critical and reflexive attitudes in a broader reference system. Therefore, the application of concepts from Transformative Learning Theory in worker habilitation can contribute for the transformation of their work practices

O objetivo deste estudo foi desenvolver e avaliar um ambiente virtual de aprendizagem em reanimação cardiorrespiratória em Neonatologia. Consiste em um ambiente virtual de aprendizagem voltado ao ensino, atualização e capacitação de alunos de Graduação em Enfermagem. O estudo constituiu-se de uma pesquisa metodológica aplicada e de produção tecnológica. A metodologia para criação de ambientes virtuais de aprendizagem utilizou cinco fases: análise, desenho, desenvolvimento, avaliação e administração. O planejamento e o desenvolvimento do conteúdo e de todas as situações didáticas tiveram como base o design instrucional contextualizado, que propõe o desenho de atividades sistemáticas de ensino-aprendizagem em conformidade com o contexto, as necessidades e objetivos do aprendiz. Assim, o resultado foi a criação do ambiente virtual de aprendizagem denominado ENFNET. Este ambiente multimídia encontra-se hospedado no servidor da Escola de Enfermagem da Universidade de São Paulo e apresenta hipertextos, recursos de áudio, vídeo, imagens e simulação de casos clínicos. A avaliação do ENFNET foi realizada por alunos do Curso de Graduação em Enfermagem e por especialistas nas áreas de Informática, Educação, Neonatologia e Educação a Distância. Os especialistas em Informática avaliaram aspectos relacionados ao tempo de resposta, qualidade da interface, ferramentas e recursos utilizados no ambiente virtual de aprendizagem. Os alunos e demais especialistas avaliaram os seguintes elementos: aspectos educacionais, interface do ambiente e recursos didáticos. O ENFNET foi avaliado positivamente na maioria dos itens investigados e mostrou-se como uma estratégia importante para auxiliar na aprendizagem, no desenvolvimento de habilidades e na capacitação profissional em enfermagem. Concluiu-se que, a metodologia de desenvolvimento utilizada foi fundamental para criar um ambiente virtual de aprendizagem dinâmico que poderá propiciar a aprendizagem ativa, a experimentação e a vivência de situações reais do cotidiano da profissão, bem como a capacitação do aluno para exercitar a tomada de decisões e atitudes de liderança em situações de urgências neonatais, baseadas na simulação de casos reais, promovendo o saber fazer reflexivo com o uso das tecnologias da informática e da informação / The objective of this study was to develop and to evaluate a virtual environment of learning in the Attendance of Neonatal Cardiopulmonary Resuscitation directed toward education continued in nursing. It constituted an applied methodological research and a technological production. The methodology used to develop the virtual learning environment was composed by five phases: analysis, drawing, development, evaluation and administration. The planning and development of the content and all the didactic situations were based on contextualized instructional design, which considers the drawing of systematic activities about teaching and learning in compliance with the context, the necessities and objectives of the apprentice. Thus, the result was the creation of the virtual learning environment named ENFNET. This multimedia environment is hosted in the server of the Nursing School at the University of São Paulo and presents hypertexts, audio and video resources, images and clinical cases simulation. The ENFNET evaluation was done by pupils of the Graduation Course in Nursing and by specialists in areas Computer science, Education, Neonatologia and Distance Education areas. Computer science specialists evaluated aspects referring to reply time, interface quality and tools and resources used in the virtual learning environment. The evaluation carried through for the pupils and the other specialists corresponded to the following elements: educational aspects, environment interface and didactic resources. The ENFNET was positively evaluated in the majority of investigated items and revealed itself as an important strategy to assist in learning, the abilities development and the professional qualification of the user. In conclusion, the development methodology used was fundamental to create a dynamic virtual learning environmental that might be able to provide an active learning, experimentation and the existence of real urgency neonatal situations, starting from real cases simulation, promoting the reflexive know how to do with the use of computer and information technologies

Die Arbeit untersucht die Akute Phase Reaktion nach erfolgreicher kardiopulmonaler Reanimation. Untersuchungsgegenstand war der Verlauf unterschiedlicher Akute Phase Proteine und Procalcitonin in Abhängigkeit von verschiedenen klinischen Parametern. Ebenso wurde das Verhalten der Akute Phase Proteine bei gesunden Probanden unter kontrollierter systemischer Hypoxie untersucht, da die Hypoxie als Auslöser der Akute Phase Reaktion diskutiert wird. Außerdem wurde betrachtet, welche Parameter sich für die Diagnose einer nach der Reanimation auftretenden Ventilator-assoziierten Pneumonie eignen. In die Untersuchung wurden 33 reanimierte Patienten eingeschlossen sowie 7 Probanden, die sich freiwillig einer hypobaren Hypoxie ausgesetzt hatten. Die wesentlichen Resultate sind: 1) Die untersuchten Akute Phase Proteine verhalten sich nach kardiopulmonaler Reanimation wie dies in der Literatur für andere Genesen beschrieben ist. Das Procalcitonin zeigt gewisse Charakteristika eines Akute Phase Proteins, wobei die Daten eine abschließende Beurteilung nicht ermöglichen. 2) Die Konzentrationsänderungen der Akute Phase Proteine treten bei allen Patienten unabhängig von ihrem Krankheitsverlauf auf. Schlussfolgerung ist, dass nach kardiopulmonaler Reanimation unabhängig von der Ursache regelmäßig eine Akute Phase Reaktion auftritt. 3) Die Probanden zeigten unter hypobarer Hypoxie keine Akute Phase Reaktion, obwohl ein Anstieg der Erythropoetin-Konzentration eine Aktivierung der sauerstoffabhängigen Genexpression anzeigte. Der Sauerstoffmangel reicht deshalb zur Erklärung der Akute Phase Reaktion als alleinige Ursache nicht aus. 4) Der Verlauf der untersuchten Akute Phase Parameter bleibt von einer Ventilator-assoziierten Pneumonie als Komplikation unbeeinflusst. Das Procalcitonin zeigte hingegen bereits frühzeitig im Verlauf deutliche Unterschiede zwischen Patienten mit und ohne Ventilator-assoziierte Pneumonie. / The thesis paper studies the acute phase reaction after successful cardiopulmonary resuscitation. Focus were different acute phase proteins as well as procalcitonin in relation to different clinical parameters. Also the course of these acute phase proteins during hypobaric hypoxia in volunteers was studied, because hyoxia is being discussed as a potential cause of the acute phase reaction. Additionally it was determined, which parameters are suitable to diagnose a ventilator-associated pneumonia after resuscitation. The study included 33 resuscitated patients as well as 7 volunteers undergoing a hypobaric hypoxia. The main results are: 1) The acute phase proteins studied behave after cardiopulmonary resuscitation as described in the literature for other causes. Procalcitonin show certain aspects of an acute phase protein, however, the data do not permit a final judgment. 2) The changes in concentration of the acute phase proteins take place in all patients regardless of the case history. It can be concluded that after cardiopulmonary resuscitation always an acute phase reaction occurs. 3) The volunteers undergoing hypobaric hypoxia showed no acute phase reaction, even though a rise in erythropoetin concentration indicated an oxygen-dependent gene expression. The hypoxia alone therefore is not a sufficient explanation for the development of the acute phase reaction. 4) The course of the acute phase proteins studied is not influenced by a ventilator-associated pneumonia as complication. The course of procalcitonin, however, shows early significant differences between patients with and without ventilator-associated pneumonia.

Einleitung: Bei Langzeitüberlebenden nach OLT findet sich eine Reduktion der Diffusionskapazität ohne Veränderungen des Lungeninterstitiums (nachweisbar in der high resolution Computertomographie HR-CT) und eine Reduktion der Muskelmasse. Wir untersuchten daher den Pathomechanismus der Diffusionsstörung, den zeitlichen Verlauf der Diffusionskapazität und die Auswirkungen der Lungen- und Atemfunktion auf die kardiopulmonale Belastbarkeit. Methoden: Bei 38 Lebertransplantierten (67.7 Mon. nach OLT) wurden Diffusionskapazität, Membranfaktor, Kapillarvolumen, Atemantrieb, maximaler inspiratorischer Druck (PImax), die maximale O2-Aufnahme (VO2max) und Atemeffizienz bestimmt und ein HR-CT der Lunge sowie eine Echokardiographie durchgeführt. Ergebnisse: Diffusionsstörungen bestanden bei 21% der Patienten. Der Diffusionskoeffizient war gegenüber der Voruntersuchung um 4% angestiegen 4% (p / Introduction: In long-term survivors after OLT, a reduction of the diffusion capacity (TLCO) may be noticed in absence of interstitial pulmonary changes (as observed in high resolution computertomography HR-CT). Also a diminution of the body muscle mass may be seen together with an increase in body fat mass. We tried to identify the origin of the pulmonary diffusion impairment as an alteration of the membrane factor or the capillary volume. We analysed the progression of the impairment in the course time and the effects of cardiac and respiratory function on VO2max. Methods: In 38 patients (67.7 month after OLT) we determined TLCO, membrane factor, capillary volume, ventilatory drive, maximal inspiratory pressure (PImax), maximal O2-uptake on exercise and breathing efficiency. Also HR-CT and echocardiography have been performed. Results: Diffusion impairment has been found in 21% of the patients. In the course of 3 years the diffusion coefficient has increased by 4% (p

Seit vielen Jahren werden Glukokortikoide routinemäßig eingesetzt, um Zeichen der inflammatorischen Reaktion nach kardiochirurgischen Eingriffen unter extrakorporaler Zirkulation (EKZ) zu mildern. Glukokortikoide sind jedoch für ihre immunsuppressiven Wirkungen bekannt, und bisher blieben die möglichen Auswirkungen auf immunologische Funktionen weitgehend hypothetisch. Ziel der vorliegenden Studie war es daher, den Einfluss von Methylprednisolon (MP) und Tirilazad Mesylat (TM), einer antiinflammatorischen Substanz aus der Klasse der Aminosteroide auf immunologische Funktionen nach koronarchirurgischen Eingriffen mit EKZ zu untersuchen. 38 Patienten wurden randomisiert den Behandlungsgruppen Placebo (NaCl 0,9 %, n=13), MP (15 mg/ kg KG, n=12) und TM (10 mg/kg KG, n=13) zugeteilt. Die Verläufe der Plasmakonzentrationen von IL-6 und IL-10, der monozytären HLA-DR Expression und der ex vivo LPS-stimulierten TNF-alpha, IL-1RA, IFN-gamma und IL-12 Sekretion wurden bestimmt. Im Vergleich zu Placebo resultierte die Gabe von MP in geringeren postoperativen Plasmakonzentrationen von IL-6, aber einer deutlichen Erhöhung von IL-10. Die monozytäre HLA-DR Expression nahm postoperativ in allen Gruppen ab mit einer deutlichen Verstärkung durch MP. Die ex vivo stimulierte TNF-alpha Sekretion nahm postoperativ in allen Gruppen deutlich ab, ebenfalls mit einer deutlichen Verstärkung durch MP. Die IL-1RA Sekretion hingegen war zu keinem Zeitpunkt eingeschränkt. Die ex vivo stimulierte IFN-gamma und IL-12 war postoperativ in allen Gruppen stark vermindert ohne Einfluss einer medikamentösen Behandlung. Die Gabe von TM zeigte keinerlei Beeinflussung aller gemessenen Parameter im Vergleich zu Placebo. Nach koronarchirurgischen Eingriffen sind insbesondere monozytäre Funktionen stark eingeschränkt. Diese Suppression wird durch die Gabe von MP verstärkt, während die Gabe von TM nicht in einer zusätzlichen Immunsuppression resultiert. IL-10 scheint eine Schlüsselrolle bei der beobachteten monozytären Funktionseinschränkung einzunehmen. / Glucocorticoids have been routinely applied in cardiac surgery involving cardiopulmonary bypass (CPB) for many years in order to diminish inflammatory stress reactions. On the other hand glucocorticoids are well known for their immunosuppressive effects, and data on the consequences on immune function are scarce. Thus it was the aim of this trial to determine the influence of methylprednisolone (MP) and tirilazad mesylate (TM), an antiinflammatory drug of the class of aminosteroids, on immunological parameters after coronary surgery involving CPB. 38 patients were randomised to receive either placebo (NaCl 0.9 %, n=13), MP (15 mg/kg, n=12) or TM (10 mg/kg, n=13) treatment. Plasma concentrations of IL-6 and IL-10, monocyte surface expression of HLA-DR and the ex vivo endotoxin-stimulated secretion of TNF-alpha, IL-1RA, IFN-gamma und IL-12 were measured. Compared to placebo IL-6 concentrations were lower after MP treatment, whereas IL-10 levels were much higher. The rate of HLA-DR+-monocytes decreased in all groups with a significant aggravation by MP treatment. The ex vivo stimulated TNF-alpha secretion was postoperatively diminished in all groups, with again significantly lower values after MP treatment. IL-1RA secretion was not suppressed at any point. The ex vivo stimulated IFN-gamma and IL-12 secretion was strongly suppressed postoperatively regardless of the treatment. TM treatment resulted in no alterations of any parameter measured. It was demonstrated that especially monocyte functions are depressed after coronary surgery, and that MP treatment results in marked aggravation of this immunosuppression, whereas TM treatment shows no additional immunosuppressive effect. IL-10 seems to play a key role in the observed monocyte functional depression.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-07-13T12:02:18Z No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-18T12:59:17Z (GMT) No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) / Made available in DSpace on 2018-07-18T13:04:40Z (GMT). No. of bitstreams: 1 DAVID_PONCIANO_DE_SENA.pdf: 7136289 bytes, checksum: 63e5ded0ad929d80daf354b846f5dd28 (MD5) Previous issue date: 2018-04-12 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Aim of the Study: The purpose of this study was to develop and validate a serious game for mobile platforms comparing with a video-assisted self-learning method to assist in the teaching and learning process of cardiopulmonary resuscitation (CPR) maneuvers. In a traditional training, CPR is based on learning by doing using a simulated model with the assistance of an instructor. However, this model presents an overall higher cost and less accessibility, provoking the need for cheaper and more accessible alternative methods. Methods: Forty-five volunteer first-year medical students completed a written multiple choice and practical pretest about CPR maneuvers skills and were randomly allocated into two groups. During a period of 20 minutes, the video self-learning group with 22 students was exposed to a video-based training about CPR, while the video game group with 23 students used a serious game simulating a cardiac arrest scenario where the student should perform virtual CPR to keep playing the game. Each group then performed, a written multiple choice score and practical post-test on a CPR training model while being evaluated by three blinded emergency doctors based on 2015 AHA-BLS (American Heart Association - Basic Life Support) protocol. Both groups were also evaluated about how long they kept interested on each self-learning system. Results: The video group had superior performance as confirmed by a written multiple choice score 7.56+-0.21 against 6.51+-0,21 for a video game (p=0. 001) and practical scores 9.67+-0.21 against 8.40+-0,21 for a video game (p<0. 001). The video game group stayed longer using the method as confirmed by 18.57+- 0,66 minutes for video game group and 7.41+-0,43 for the video group (p<0. 001), demonstrating greater interest in the video game method. Conclusions: The group that used a video game as a self-training method in a short period of exposure had a lower performance than the video group in both the theoretical and practical tests regarding cardiorespiratory resuscitation. However, there was a clear preference for students to use games rather than videos as a form of self-training. / Objetivo do estudo: O objetivo deste estudo foi desenvolver e validar um jogo s?rio para plataformas m?veis em compara??o com um m?todo de autoaprendizagem assistido por v?deo para auxiliar no processo de ensino e aprendizagem das manobras de ressuscita??o cardiopulmonar (RCP). Em um treinamento tradicional, a RCP ? baseada no aprendizado pela pr?tica, utilizando um modelo simulado com a ajuda de um instrutor. No entanto, este modelo apresenta um custo global mais elevado e de menor acessibilidade, despertando a necessidade de m?todos alternativos mais baratos e pratic?veis. M?todos: Quarenta e cinco volunt?rios, estudantes de medicina do primeiro ano, completaram um pr?-teste de m?ltipla escolha escrito e um pr?-teste pr?tico sobre RCP e foram alocados aleatoriamente em dois grupos. Durante um per?odo de 20 minutos, o grupo de autoaprendizagem v?deo, composto por 22 alunos, foi exposto a um v?deo de treinamento sobre a RCP, enquanto o grupo videogame, composto por 23 estudantes, utilizou um jogo s?rio, simulando um cen?rio de parada card?aca, onde o aluno deveria executar uma RCP virtual para continuar jogando. Ao t?rmino do treinamento, cada grupo foi submetido a um p?s-teste escrito de m?ltipla escolha e um p?s-teste pr?tico em um modelo de treinamento de RCP, sendo avaliados de forma cegada, por tr?s m?dicos com experi?ncia em atendimento de emerg?ncia, com base no protocolo 2015 AHA-BLS (American Heart Association - Basic Life Support). Ambos os grupos tamb?m foram avaliados quanto a quantidade de tempo que eles permaneciam interessados em cada sistema de autoaprendizagem. Resultados: O grupo v?deo apresentou desempenho superior confirmado por uma maior pontua??o no teste escrito de m?ltipla escolha, 7.56 + -0.21 contra 6.51 + -0,21 para videogame (p = 0. 001) e pontua??o no teste de avalia??o pr?tica 9,67 + -0,21 contra 8,40 + -0,21 para videogame (p <0. 001). O grupo videogame permaneceu mais tempo utilizando o m?todo, 18,57 + - 0,66 minutos para o grupo videogame e 7,41 + -0,43 para o grupo v?deo (p <0. 001), demonstrando maior interesse no m?todo do videogame. Conclus?es: O grupo que usou o jogo s?rio (grupo videogame) como um m?todo de autotreinamento em um curto per?odo de exposi??o teve um desempenho pior do que o grupo v?deo nos testes te?ricos e pr?ticos em rela??o ? ressuscita??o cardiopulmonar. No entanto, houve uma clara prefer?ncia por parte dos alunos em utilizar jogos em rela??o aos v?deos como forma de autotreinamento.