Por padronização aceita internacionalmente, posiciona-se o sensor distal de pH-metria esofágica a 5 cm acima da borda superior do esfíncter inferior do esôfago, identificado por manometria esofágica. Porém, vários autores sugerem técnicas alternativas de posicionamento que prescindem da manometria; dentre essas, destaca-se a da viragem do pH. Esse tema é controverso: alguns autores consideram a técnica da viragem confiável, outros afirmam que não é. Considerando-se a polêmica existente e o pequeno número de trabalhos prospectivos com amostra e metodologia adequadas, idealizamos o presente estudo, que tem por objetivos avaliar a adequação do posicionamento do sensor distal de pH-metria baseado na técnica da viragem, analisando-se a presença, o grau e o tipo de erro de posicionamento que tal técnica proporciona e a influência da posição adotada pelo paciente durante a manobra. Foram estudados, de modo prospectivo, 1031 pacientes encaminhados para realização de pH-metria esofágica. Durante entrevista clínica, foram registrados os dados demográficos e as queixas clínicas apresentadas. Todos pacientes foram submetidos à manometria esofágica para localização do esfíncter inferior do esôfago e à técnica da viragem do pH, que consiste na introdução do sensor de pH-metria na câmara gástrica e na tração gradual do mesmo até que o pH vire para níveis superiores a 4. A identificação do ponto de viragem foi realizada de dois modos distintos, caracterizando dois grupos de estudo: com o paciente sentado (Grupo I - 450 pacientes) e em decúbito dorsal horizontal (Grupo II - 581 pacientes). Após a identificação do ponto de viragem, o sensor distal de pH-metria era posicionado na posição padronizada, baseada na localização manométrica do esfíncter. Registrava-se onde seria posicionado o sensor de pH se fosse adotada a técnica da viragem. Para avaliação da adequação do posicionamento, considerou-se que o erro é representado pela diferença (em centímetros) entre a localização padronizada e a localização que seria adotada caso fosse empregada a técnica da viragem. Considerou-se que o erro seria grosseiro se fosse maior que 2 cm. Analisou-se também o tipo de erro mais freqüente: se acima ou abaixo da posição padronizada. Observou-se que se fosse adotada a técnica da viragem, haveria erro no posicionamento do sensor em 945 pacientes (91,6%). Quanto ao grau de erro, haveria erro grosseiro em 597 (63,2%) casos. Em relação ao tipo de erro, o sensor seria posicionado abaixo do local padronizado em 857 (90,7%) pacientes. Em relação à interferência da posição adotada pelo paciente durante a técnica da viragem, observou-se que não houve diferença significante entre os grupos de estudo, em nenhum dos parâmetros analisados. Conclui-se que: 1. o posicionamento do sensor distal de pH-metria pela técnica da viragem não é confiável; 2. a técnica da viragem proporciona margem de erro expressiva; 3. o tipo de erro mais comum que tal modalidade técnica proporciona é o posicionamento mais distal do sensor, que pode superestimar a ocorrência de refluxo; 4. não há influência da posição adotada pelo paciente durante a realização da técnica da viragem do pH, na eficiência do método / By internationally accepted standardization, the esophageal pH-meter distal sensor is positioned 5 cm above the superior border of the esophagus lower sphincter, identified by esophageal manometry. However, several authors suggest alternative positioning techniques that leave out the manometry; among such techniques, the pH step-up is the one to be pointed out. This subject is controversial; some publications state that the step-up technique is not reliable while some others consider it reliable. Considering the existent controversy and the small number of prospective works with suitable sample and methodology, we have idealized the present study, that aims the evaluation of the suitability of the pH-meter distal sensor positioning based on the step-up technique, by analyzing the presence, the degree and the type of the error of positioning that such technique provides and the influence of the position adopted by the patient during the procedure. 1031 patients conducted to the esophageal pH-meter procedure were studied in a prospective way. During the clinical interview, the demographic data and the presented clinical complaints were registered. All the patients were submitted to both esophageal manometry in order to localize the esophagus lower sphincter and the pH step-up technique, that consists of the introduction of the pH-meter sensor in the gastric chamber and in the sensors gradual traction until the pH steps up to levels over 4. The step-up point was identified by two distinct ways, characterizing two study groups: with the setting patient (Group I - 450 patients) and in supine position (Group I I- 581 patients). After the step-up point identification, the pH-meter distal sensor was placed in the standard position, based on the sphincter manometric placement. It was registered where the pH sensor would be positioned if the step-up technique were adopted. To evaluate the positioning suitability, the error was considered to be represented by the difference (in centimeters) between the suitable placement (manometry) and the one that would be adopted in case the step-up technique were adopted. The positioning error was considered rough if it were larger than 2 cm. The most frequent type of error was also analyzed: if above or below the standard position. It was observed that if the step-up technique were adopted, there would be error in the sensor positioning in 945 patients (91.6%). In terms of error degree, there would be a rough error in 597 (63.2%) cases. Concerning the type of error, the sensor would be positioned below the standard place in 857 (90.7%) patients. As to the interference of the position adopted by the patient during the step-up technique, it was observed that there was no significant difference among the groups of study, in any of the analyzed parameters. It was concluded that: 1. the positioning of the pH-meter distal sensor by the step-up technique is not reliable; 2. the step-up technique provides expressive error margin; 3. the most common type of error that such technique mode provides is the placement of the sensor below the standard positioning, which may overestimate the reflux occurrence; 4. there is no influence in the position adopted by the patient during the pH step-up technique procedure, in terms of method efficiency

INTRODUÇÃO: No método piggyback de transplante de fígado (Tx), o pinçamento da veia cava inferior (VCI) do receptor é apenas parcial, permitindo a manutenção do retorno venoso durante a fase anepática sem a necessidade de utilização de desvio veno-venoso. A essa vantagem, contrapõe-se uma maior incidência de obstrução da drenagem venosa do enxerto, complicação que está relacionada com o tipo de reconstrução empregado. A implantação da VCI do enxerto no óstio das veias hepáticas média e esquerda (ME) do receptor tem sido evitada devido a uma maior freqüência de bloqueio venoso. Essa incidência diminui quando são empregadas a anastomose látero-lateral (LL) ou a implantação da VCI do enxerto no óstio das veias hepáticas direita, média e esquerda (DME) do receptor. Entretanto, essas reconstruções reduzem a eficiência do retorno venoso na fase anepática do Tx devido à constrição mais pronunciada da VCI durante o pinçamento necessário para a confecção da anastomose. A alternativa de utilizar o óstio formado pelas veias hepáticas direita e média (DM) pode propiciar uma constrição menor da VCI. Entretanto, esse benefício só se justifica se a via de efluxo venoso obtida não apresentar restrições anatômicas. O objetivo deste trabalho é comparar a congruência do perímetro da VCI com o perímetro das bocas anastomóticas e dos óstios de drenagem na VCI, obtidos por meio da utilização das modalidades DM e DME para a reconstrução do efluxo venoso no Tx piggyback. MÉTODO: Foram estudados prospectivamente 16 cadáveres frescos. Após a hepatectomia total, realizou-se o estudo morfométrico da confluência hepatocaval aferindo-se o perímetro da VCI (PVCI) e, nas reconstruções DM e DME, o perímetro das bocas anastomóticas (PDM e PDME) e dos óstios de desembocadura na VCI (PoDM e PoDME). Foram obtidas imagens digitalizadas de todos os perímetros. As medidas foram realizadas por meio do programa analisador de imagens KS300. A análise estatística foi realizada por meio de análise de variância (ANOVA) para medidas repetidas. Utilizou-se um nível de significância de 5%. RESULTADO: Foram estudados 11 casos do sexo masculino (68,8%). A média de idade foi de 63,7 ± 15,7 anos (40 a 83 anos). Foram obtidos dados completos para todas as variáveis, exceto para o PoDME. Os valores de PDME (137,2 ± 24,3 mm; p<0,001), PDM (123,2 ± 20,1 mm; p=0,003) e PoDM (116,6 ± 17,5 mm; p=0,027) foram significantemente maiores do que o PVCI (107,9 ± 18,8 mm). Os valores de PDME foram significantemente maiores que os de PDM (p=0,004) e PoDM (p=0,001). CONCLUSÃO: A via de efluxo venoso da modalidade DM apresenta um perímetro maior que o da VCI tanto no ponto de anastomose quanto no óstio de desembocadura na VCI, não determinando restrições anatômicas para o efluxo venoso do enxerto hepático. Em comparação com a modalidade DME, a modalidade DM apresenta perímetro mais congruente com o da VCI. / INTRODUCTION: In piggyback liver transplantation (LT), partial clamping of the recipient inferior vena cava (IVC) preserves the venous return of the lower extremities during the anhepatic phase precluding the use of venovenous bypass. The incidence of hepatic venous outflow obstruction after piggyback LT varies according to the type of venous reconstruction. Anastomosis between the cranial portion of the graft IVC and common stump of the middle and left hepatic veins (ME) of the recipient has been avoided due to a higher frequency of hepatic venous outflow obstruction. This incidence decreases when a cavo-caval side-to-side anastomosis (SS) or the ostium of the three main hepatic veins of the recipient (RML) are used. On the other hand, venous return is reduced in these modalities due to a more pronounced constriction during the IVC clamping. The use of the ostium formed by the right and middle hepatic veins (RM) may limit IVC constriction. However, this benefit is only justified if a hepatic venous outflow tract with no anatomical restrictions can be obtained. The aim of this study is to compare the congruence of the IVC perimeter with the perimeter of the venous outflow tract at the anastomotic site and also its opening into the IVC both in the RM and RML modalities. METHODS: Sixteen fresh human cadavers were prospectively studied. After total hepatectomy, a morphometric study of the hepatocaval confluence was done by measuring the perimeter of the IVC (IVCP) and, in RM and RML reconstructions, the perimeter of the venous outflow tract at the anastomotic site (RMP and RMLP) and at its opening into the IVC (RMoP and RMLoP). Digital images of all perimeters were obtained. The measurements were accomplished utilizing the KS300 image analysis software. The statistical analysis was performed using analysis of variance (ANOVA) for repeated measures. Statistical significance was established when the p value was less than 0.05. RESULTS: Examinations were performed in 11 men and 5 women with a mean age of 63.7 ± 15.7 years (40 to 83 years). Complete data were obtained for all the variables except for RMLoP. The mean RMLP (137.2 ± 24.3 mm; p<0.001), RMP (123.2 ± 20.1 mm; p=0.003) and RMoP (116.6 ± 17.5 mm; p=0.027) values were significantly larger than IVCP (107.9 ± 18.8 mm). RMLP values were significantly larger than RMP (p=0.004) and RMoP (p=0.001). CONCLUSION: In RM reconstruction, the venous outflow tract presents a larger perimeter than IVC both at the anastomotic site and at the opening into IVC. In comparison to RML, the RM modality presents a more congruent perimeter with the IVC.

Cette thèse se veut une étude comparative des médias dans trois différents pays (les États-Unis, la France et la Corée du Sud). Partant des rapports industriels et des recherches universitaires réalisés dans les différents pays, ce travail compare à la fois la presse traditionnelle et sa version internet. Notre questionnement porte sur le dispositif de publication internet/papier. Nous illustrons ainsi l’écosystème actuel de la presse et ce, dans le cadre du développement des versions internet des sites des titres de presse. Il s’agit d’examiner le potentiel des versions web de la presse à garantir une meilleure contextualisation de l’actualité à l’aide de technologies de l’internet. La recherche se déroule en quatre étapes. Nous avons en effet mené successivement une analyse des marchés des médias, un examen morphologique de la presse, enfin nous avons réalisé une analyse de contenu et étudié les facteurs de contextualisation. Malgré les différences remarquées dans les marchés des médias des trois pays de notre corpus, la tendance vers le déclin de la presse traditionnelle est partagée. L’observation portée sur les morphologies des journaux nous a permis de comparer les ressemblances nationales et de distinguer les différences dans les offres journalistiques. Notre analyse de contenu présente les principales formes d’écriture utilisées par les éditeurs sur internet, notamment la pratique de l’hypertexte et du multimédia. L’analyse qualitative sur l’arborescence des liens et sur la nature de la contextualisation nous a autorisé à identifier de nombreuses carences dans la manière dont les éditeurs de presse exploitent leurs sites web. Ceci nous permet donc de penser que la mobilisation de la technologie par la presse sera optimale lorsque le travail journalistique assurera le traitement essentiel de l’information. / This study compares the morphology and content formats of the traditional newspapers and their web sites in three different countries (United States, France and South Korea). It explores how the online environment changes content format from the traditional newspaper format. By focusing on the diversity of market environments within a common framework, this research proposes different types of analysis to illustrate today’s newspaper in a continually changing environment. Chapter 2 focuses on the observation of the environments of the three countries, which influence the traditional and online newspaper sectors. The thesis highlights that, despite the difference in the newspaper industry in the three countries, the traditional model of journalism suffers continued decline of revenue and audience in all three. Chapter 3 studies the morphology of the newspapers and their web sites and notes national similarities, centering on daily newspapers. The research design is completed by content analysis. Chapter 4 analyzes the content forms between the newspapers and their web sites, especially the hyperlink practice and the presence of multimedia content. Chapter 5 is devoted to contextualization capacity of Internet news by analyzing hyperlinks’ trajectory, as proposed by selected newspapers and news-sites. However, the study also showed that the traditional newspapers’ web sites still fall short in using this potential. The utility of the technology for newspapers will only be fulfilled if the journalism resources ensure the essential treatment of information.

I denna uppsats undersöks hur spelares beteende i virtuella miljöer skiljer sig när modern HMD VR-teknik används jämfört med traditionell bildskärm i 2D. Genom att utveckla en spelprototyp i 3D med förstapersonsperspektiv i pusselgenren där spelarens mål är att finna objekt i olika rum har en komparativ studie genomförts. Spelprototypen skapades med hjälp av metoden prototyputveckling. En alfaversion testades innan den slutgiltiga versionen gjordes klart.   Två grupper med 7 personer i vardera har utfört testet. Ena gruppen använde HMD VR-glasögonen Oculus Rift DK2 medan den andra använde traditionell bildskärm i 2D. Styrning skedde med tangentbord och mus. En dataloggning kördes i bakgrunden av varje användartest som samlade in information om spelarens positions- och rotationsdata. Denna data analyserades sedan och jämfördes mellan grupperna.   Sammanfattningsvis utgörs ingen stark skillnad mellan dom två grupperna. Den största skillnaden är i hur mycket mark som har täckts av spelarna. I gruppen som spelade med VR-glasögon stod spelarna still mer och gick inte runt och utforskade lika mycket. Men dom var cirka 5 sekunder snabbare i genomsnitt. Gruppen som spelade utan VR-glasögon tittade upp och ner något mer men som mest skiljde det sig endast 5 grader. / In this thesis the behaviours of players in virtual environments using modern HMD VR technology and traditional 2D monitors is studied and compared. By developing a game prototype in 3D using a first-person perspective and placing it in the puzzle genre by having the players goal being that they must find an object in different rooms a comparative study has been carried out. The game prototype was developed by using prototyping and an alpha version was tested before the final version was completed.   Two groups of 7 in each one has performed the test. One group used the HMD VR headset Oculus Rift DK2 and the other one used a traditional 2D monitor. Mouse and keyboard was used for controls. A data logging ran in the background of every test and collected information on the players positional and rotational data. The data was analysed and then compared between the two groups.   In conclusion, there is no strong difference between the two groups. The biggest difference was in how much ground the players covered. The group who played in VR didn’t walk around and explored as much and instead was more stationary. But they were around 5 seconds faster in average. The group who played without VR looked up and down a bit more but the difference was never more than just 5 degrees.

Magister Legum - LLM / This thesis will examine the effects of divorce on the benefit payable to a member of a retirement fund, where divorce has occurred before the member has reached retirement age. In particular, parametric (that is, piecemeal) amendments to the relevant legislation will be analysed in order to outline the development of the legislation relating to divorce and the consequent distribution of assets (including retirement savings). The previous and current legal position in South Africa relating to divorce and retirement savings will be set out and critically analysed to determine whether the current position can be regarded as an improvement upon the previous legal position, or whether other and/or new problems in this area have been created. Parametric amendments to relevant legislation have thus far been the subject of many cases in our courts and adjudicative tribunals. A systemic overhaul of a particular area of law is a useful tool in providing legal certainty and clarifying the laws applicable to that area. This thesis will therefore argue in favour of a systemic overhaul of the legislation applicable to the allocation of retirement benefits at divorce, as opposed to the ineffectual parametric (i.e. piecemeal) amendments that have been implemented thus far. An essential aspect of this study is a comparative study of South African legal principles relating to retirement benefits and divorce with the legal principles of this subject in the United Kingdom (UK). / South Africa

There is a growing concerns about reconstructing youth policy in many parts of the world in reflection to the issue on youth. Especially, in the post industrialized countries such as Sweden and Japan, young people's participation became one of the prioritized theme of national youth policy. Despite the implementation of youth policy and local practices in regards to youth participation in both of the countries, there is a clear difference in young people's notion and behavior in participation into society. The paper attempted to answer a question: what is the factor that shapes young people's different notion on participation? This qualitative study had investigated modern national youth policy documents in Sweden and Japan with focus on youth participation. Thematic contents analysis was employed as a methodology of this research in order to conduct comparative analysis. To grab context of youth participation in the respective countries, key concepts: youth participation and youth policy as well as historical development of youth policy in each countries were described. Analysis with self-organized framework found that the two countries shares several commonalities in youth policy such as rights perspectives, cross sectorial approach, social inclusion of risky young people and promotion of independence. However, policies in reality for participation of young people are implemented in differently, which reflects different recognition on youth participation in the contexts of the respective countries.

To respect climate change goals, reinforced by COP21 in Paris, an overhaul of the energy system in EU countries will be necessary and this will involve a major deployment of low-carbon technology (Stern 2006). Although the relative roles of green new ventures and incumbent firms in the dissemination of environmental innovation remain unclear (Hall, Daneke et al. 2010), entrepreneurship shows promise as a response to environmental prob-lems (Anderson 1998, Schaltegger 2002, Hart, Milstein 1999). Since green new ventures are free from the innovatory constraints faced by incumbent firms (York, Venkataraman 2010, Hockerts, Wüstenhagen 2010), they are in a position to disrupt existing unsustaina-ble markets. Designing and implementing an energy policy with an “entrepreneurial fla-vour” (Wüstenhagen, Wuebker 2011) could be advantageous in achieving a successful sus-tainable transformation of the energy system. This thesis examines how entrepreneurs per-ceive energy policy in three advanced EU countries using a case study approach, with each country constituting a case. Data sources comprised policy documents, interviews with entrepreneurs and key staff in new ventures, and field notes from practitioner conferences. At this critical point at which direct support for renewables is being withdrawn, it is argued that efforts must be made to retain this entrepreneurial force in the energy market. This thesis reflects on the degree to which the market-creating support mechanisms are being withdrawn. If entrepreneurship is to thrive in a post-support context, there must be consid-eration as to how to better integrate decentralised renewables into the energy market, espe-cially in relation to how they can compete effectively with conventional technologies, namely nuclear and gas. In addition to alternative strategies to incentivise adoption of re-newable energy technologies beyond early adopter consumer categories (Rogers 1995), building greater public consent to sustainability policies is crucial to the continued success of energy entrepreneurship. Geopolitical factors surrounding energy security may rein-force the case for continuing to support entrepreneurship in the renewable power sector.

Uppsatsen består av en komparativ studie gjord genom kritisk närläsning av två separata läromedel, Svenska impulser 3 (2013) och Svenska 3 – Helt enkelt (2015). Jämförelsen utgår från hur läromedlen konkretiserar det centrala innehållet och kunskapskraven som berör litteraturundervisning i kursen Svenska 3, och om de samverkar med didaktisk forskning och om de har ett formativt förhållningssätt. Att konkretisera det centrala innehållets roll och kunskapskraven har, sedan den nya kursplanen Gy11 släpptes, varit ett fortsatt dilemma. Det förklaras genom undersökningar från Skolverket. Resultatet visar att Svenska 3:s litteratursegment har konkretiserats på olika vis, trots att de utgått från samma centrala innehåll och kunskapskrav. Förutom konkretiseringen synliggörs också att de aktuella läromedlen förhåller sig till utvalda delar av Skolverkets didaktiska forskning och att läromedlen har ett formativt förhållningssätt. Likheterna och skillnaderna är också många i analysexemplen, något uppsatsen belyser. / The essay consists of a comparative study brought on by a critical close reading of two separate teaching aids, Svenska impulser 3 (2013) and Svenska 3 – Helt enkelt (2015). The comparison emanates from how the two teaching aids define the core content and knowledge requirements about literary studies in the upper secondary school course Swedish 3, and how they conspires with research in didactics and whether they have a formative approach or not. To define the core content’s role and to define the knowledge requirements has, since the new curriculum and syllabus Gy11 was released, been problematic. That is explained through enquiries made by Skolverket. The result shows that Svenska 3’s part about literary studies have been defined differently in the teaching aids, even though they transpire from the same core content and knowledge requirements. The teaching aids also relate to chosen parts of Skolverket’s research in didactics and they have a formative approach according to the analysis. The similarities and differences are plenty in the two examples, which the essay highlights.

O objetivo da reperfusão mecânica ou medicamentosa em pacientes com infarto agudo do miocárdio (IAM) é a restauração do fluxo sangüíneo na artéria relacionada ao infarto, a fim de limitar a necrose miocelular e preservar a função contrátil, que são os maiores preditores de sobrevida após o IAM. Entretanto, seu sucesso é indicado pela reperfusão nos capilares miocárdicos e não pela recanalização da artéria relacionada ao infarto. A ecocardiografia com perfusão miocárdica em tempo real pode ser usada para avaliar a perfusão nos capilares miocárdicos e estimar o tamanho do infarto em vários estudos experimentais. O objetivo deste estudo foi determinar a área do miocárdio infartado e sua extensão transmural pela ecocardiografia com perfusão miocárdica em tempo real, em pacientes hospitalizados nos primeiros dias após primo infarto agudo do miocárdio, tendo como padrão de referência a ressonância magnética de perfusão. Prospectivamente, foram estudados 20 pacientes (12 homens), com idade média de 64,2 ± 13,3, dentro de 12 horas de reperfusão mecânica ou medicamentosa. Os exames de ecocardiografia e ressonância magnética foram realizados do segundo ao quinto dia de infarto. O contraste \"PESDA (perfluorocarbon-exposed sonicated dextrose albumin)\" foi administrado em veia periférica, na dose de 0,1ml/Kg, em infusão contínua. A análise ecocardiográfica foi feita por uma análise qualitativa (visual) denominada escala de cinza e por uma análise quantitativa, chamada imagem paramétrica. A área de infarto média foi de 3,03 ± 2,77 cm2 para a escala de cinza (r=0,97), de 3,36 ± 2,82 cm2 para a imagem paramétrica (r= 0,99) e de 3,42 ± 2,80 cm2 para a ressonância magnética. O porcentual médio da área de infarto pela ecocardiografia em escala de cinza foi de 15,22% ± 14,84% (r= 0,97), pela imagem paramétrica foi de 16,46% ± 14,41% (r= 0,99) e pela ressonância magnética foi de 16,76% ± 14,48%. A extensão transmural do infarto em cada segmento infartado pela escala de cinza,apresentou uma correlação menor (r=0,77) em relação à imagem paramétrica (r=0,93). Em conclusão, este estudo mostrou uma excelente correlação entre ecocardiografia com perfusão miocárdica em tempo real (sobretudo pela imagem paramétrica) e ressonância magnética nas medidas da área de infarto e seu porcentual, assim como na determinação de sua extensão transmural em pacientes internados por infarto agudo do miocárdio / The aim of mechanical or pharmacological reperfusion in patients with AMI is to restore blood flow through the infarct related artery in order to limit myocellular necrosis and ultimately preserve myocardial contractile function, which is still the most powerful predictor of survival after acute myocardial infarction. The success of reperfusion, however, is indicated by perfusion of myocardial capillaries rather than simply patency of the infarct related artery. Myocardial contrast echocardiography (MCE) can be used to assess myocardial capillary perfusion and ultimately the infarct size in animals. The aim of this study was to determine by MCE the transmural extent and infarct size using magnetic resonance imaging (MRI) as a gold standard. We prospectively studied 20 patients (12 men; mean age 64.2 ± 13.3) admitted for a first acute myocardial infarction, within 12 hours after mechanical or pharmacological reperfusion. The MCE and MRI were performed between the 3rd and 5th day of acute myocardial infarction (AMI). A suspension of 0.1 ml/kg of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) ultrasound contrast agent was administered as a continuous infusion. The interpretation of perfusion images by MCE was assessed by qualitative analysis (visual- VIS) and a quantitative one called parametric image (PI). The average infarct area showed by VIS was 3.03 ± 2.77 cm 2, by PI was 3.36 ± 2.82 cm 2 and by MRI was 3.42± 2.80cm 2. The average percentage of infarct area by VIS was 15.22% ± 14.84%, by PI was 16.46% ± 14.41% and by MRI was 16.76% ± 14.48%. The transmural extent was calculated in each infarcted segment by VIS, with a worse correlation (r=0,77) than PI (r=0,93). In conclusion, this study showed that MCE, in special PI, correlates well with MRI in detecting infarct size, percentage of infarct size and transmural extent in patients with acute myocardial infarction

INTRODUÇÃO: Com a evolução da terapêutica para a Síndrome da Imunodeficiência Adquirida e o conseqüente aumento da sobrevida, um número crescente de crianças e adolescentes passou a conviver com a infecção pelo vírus da imunodeficiência humana (VIH). Paralelamente, aumentou a prevalência de complicações da doença sendo que as cardiovasculares são as mais graves. O presente estudo teve por objetivo determinar a prevalência das alterações cardiovasculares em crianças e adolescentes soropositivas, comparando com soronegativas e a sua relação com variáveis sócio-demográficas e clínicas. MÉTODOS: Estudo observacional, transversal, do tipo caso-controle de 83 crianças e adolescentes soropositivas do ambulatório de infectologia do Hospital Infantil Joana de Gusmão (Florianópolis, Santa Catarina) comparada a 83 crianças e adolescentes soronegativas e aparentemente saudáveis. Foi aplicado questionário estruturado, foram realizados pesquisa em prontuários, exame físico e antropométrico, eletrocardiografia, radiografia de tórax, ecocardiografia e ultra-sonografia carotídea e foi coletado sangue para análises. Foram realizadas análises univariadas e bivariadas para determinação de diferenças entre os grupos e multivariadas por regressão logística, pelo método anterógrado condicional, para os desfechos VIH+, disfunção de ventrículo esquerdo e aumento da espessura médio-intimal carotídea. RESULTADOS: Alterações cardiovasculares foram encontradas em 88% das crianças e adolescentes soropositivos sendo que 31% delas apresentaram mais de duas alterações. Todas as crianças e adolescentes soropositivas apresentaram ao menos um fator ou marcador de risco para aterosclerose, sendo que 68% delas apresentaram mais de dois destes fatores. Após a análise multivariada, a condição VIH+ apresentou associação positiva com tempo de aceleração pulmonar diminuído [razão de chance (RC): 23,9(2,8-204,6), p = 0,004], espessamento médio-intimal [RC: 13,1(3,9-43,5), p < 0,001], proteína C reativa elevada [RC: 11,5(2,8-47,6), p = 0,001] e negativa com excesso de ingestão de gorduras saturadas [0,2(0,1-0,5), p = 0,001]. O espessamento médio-intimal associou-se positivamente com o uso de estavudina [RC: 18,9(2,5-145,6), p = 0,005], aumento da relação átrio esquerdo/aorta [RC: 15,6(1,6-154,6), p = 0,019], aumento de prega suprailíaca [RC: 7,9(1,5-41,9), p = 0,015], taquipnéia [RC: 5,9(1,2-29,3), p = 0,031], níveis elevados de linfócito T CD8+ [RC: 5,7(1,1-28,3), p = 0,033], baixos níveis de linfócito T CD4+ [RC: 5,5(1,2-24,6), p = 0,025]. Por outro lado, associou-se negativamente com níveis elevados de colesterol total [RC: 0,22(0,1-0,8), p = 0,025] e zênite de linfócito T CD8+ [RC: 0,1(0,1-0,5), p = 0,007]. A disfunção de ventrículo esquerdo associou-se positivamente à carga viral detectável [RC: 18,6(3,1-111,6), p = 0,001], ingestão de bebida alcoólica [RC: 10,7(1,7-66,5), p = 0,011], baixo peso ao nascimento [RC: 5,6(1,2-24,7), p = 0,025] e negativamente a veias proeminentes de membros superiores [RC: 0,15(0,03-0,7), p < 0,001]. CONCLUSÕES: Na amostra estudada, as crianças e adolescentes apresentaram altas prevalências de anormalidades cardiovasculares, assim como de fatores de risco para aterosclerose. Estas alterações encontradas, em especial as relacionadas a alterações vasculares precoces da aterosclerose, por sua forte associação com pior prognóstico cardiovascular, indicam a necessidade imediata de formulação de estratégias para seu controle / INTRODUCTION: The Highly Active Anti-Retroviral Therapy employed to acquired immunodeficiency syndrome treatment has increased survival rate of children and adolescents living with human immunodeficiency virus (HIV). The new concerns in this population are infection-related or drug-related complications, and the higher risk complications may be determined by cardiovascular involvement. This study aimed to determine cardiovascular abnormalities prevalence in HIV-infected children and adolescents, and associations among these abnormalities and socio-cultural and clinical variables and cardiovascular risk factors, when compared to HIV-negative children and adolescents. METHODS: An observational, cross-sectional, case-control study was carried out, comparing 83 HIV-infected children and adolescents from an outpatient ambulatory of infectology at Joana de Gusmão Childrens Hospital (Florianopolis, Santa Catarina State) and 83 healthy children from a cardiologic triage outpatient ambulatory, at the same hospital, without any cardiovascular structural abnormality. A questionnaire, research of clinical records, physical examination, anthropometry, electrocardiography, chest X-ray, echocardiography and carotid ultrasound examination were performed and fasting blood sample were collected. Student t, chi-square, Mann-Whitney and Fischer exact tests were performed for univariate and bivariate analysis. For the multivariate analysis, a logistic regression was applied by forward conditional method, to the outcomes HIV-positive, left ventricular dysfunction and thicken intima-media complex. RESULTS: Cardiac abnormalities were found in 88% of the HIV-infected children and adolescents, and in 31% of them there were more than 2 abnormalities. Atherosclerotic risk factors were found in all HIV-infected children and adolescents, and in 68% of them there were more than to risk factors. After multivariate analysis, HIV-infection were positively associated with low pulmonary artery systolic acceleration time [odds ratio (OR): 23.9(2.8-204.6), p = 0.004], thicken carotid intima-media complex [OR: 13.1(3.9- 3.9-43.5), p < 0.001], high C-reactive protein levels [OR: 11.5(2.8-47.6), p = 0.001] and negative association with excessive ingestion of saturated fat [OR: 0.2(0.1-0.5), p = 0.001]. The presence of thicken intima-media complex were positively associated with stavudine use [OR: 18.9(2.5-145.6), p = 0.005], high left atrium/aorta relation [OR: 15.6(1.6-154.6), p = 0.019], high suprailiac skinfold thickness [OR: 7.9(1.5-41.9), 0.015], tachypnea [5.9(1.2-29.3), p = 0.031], high CD8+ T cells count [OR: 5.7(1.1- 28.3), p = 0.033], low CD4+ T cells count [OR: 5.5(1.2-24.6), p = 0.025], and negatively associated with total cholesterol [OR: 0.22(0.1-0.8), 0.1-0.8), p = 0.025] and zenith of CD8+ T cells [OR: 0.1(0.1-0.5), p = 0.025]. Left ventricular dysfunction had a positive association with detectable HIV viral load [OR: OR: 18.6(3.1-111.6), p = 0.001], alcohol ingestion [OR: 10.7(1.7-66.5), p = 0.011], and low birthweight [OR: 5.6(1.2-24.7), p = 0.025] and a negative association with arms prominent veins [OR: 0.15(0.1-0.7), p < 0.001]. CONCLUSIONS: In this sample, we found high prevalence of cardiovascular abnormalities and atherosclerotic risk factors. These abnormalities, especially early cardiovascular markers of atherosclerosis, because are related to a poor cardiovascular prognosis, pointed that there is an urgent necessity to implement preventive strategies to control cardiovascular events in this population, in the next decades