Introduction: Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Material and methods: We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. Results: We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3–4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR– = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71–0.87). In contrast, in those with HFrEF with CKD stages 3–4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR– = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69–0.86). All LRs and DOR were statistically significant. Conclusions: BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3–4, with moderate discriminatory diagnostic ability. / Revisión por pares

abstract: Heart failure is a major worldwide health concern and is the leading cause of hospitalization among elderly Americans. Approximately 50% of those diagnosed with heart failure have heart failure with preserved ejection fraction (HFPEF). HFPEF presents a therapeutic dilemma because pharmacological strategies that are effective for the treatment of heart failure and reduced ejection fraction have failed to show benefit in HFPEF. Long term moderate intensity exercise programs have been shown to improve diastolic function in patients HFPEF. High intensity interval training (HIIT) has been shown to improve diastolic function in patients with heart failure and reduced ejection fraction. However, the effects of high intensity interval training in patients with HFPEF are unknown. Fourteen patients with HFPEF were randomized to either: (1) a novel program of high-intensity aerobic interval training (n = 8), or (2) a commonly prescribed program of moderate-intensity (MOD) aerobic exercise training (n = 6). Before and after four weeks of exercise training, patients underwent a treadmill graded exercise test for the determination of peak oxygen uptake (VO2peak), a brachial artery reactivity test for assessment of endothelium-dependent flow-mediated dilation (BAFMD), aortic pulse wave velocity assessment as an index of vascular stiffness and two-dimensional echocardiography for assessment of left ventricular diastolic and systolic function. I hypothesized that (1) high-intensity aerobic interval training would result in superior improvements in FMD, aortic pulse wave velocity, VO2peak, diastolic function and, (2) changes in these parameters would be correlated with changes in VO2peak. The principal findings of the study were that a one month long high intensity interval training program resulted in significant improvements in diastolic function as measured by two-dimensional echocardiography [pre diastolic dysfunction (DD) grade - 2.13 + 0.4 vs. post DD grade - 1.25 + 0.7, p = 0.03]. The left atrial volume index was reduced in the HIIT group compared to MOD ( - 4.4 + 6.2 ml/m2 vs. 5.8 + 10.7 ml/m2, p = 0.02). Early mitral flow (E) improved in the HIIT group (pre - 0.93 + 0.2 m/s vs. post - 0.78 + 0.3 m/s, p = 0.03). A significant inverse correlation was observed between change in BAFMD and change in diastolic dysfunction grade (r = - 0.585, p = 0.028) when all the data were pooled. HIIT appears to be a time-efficient and safe strategy for improving diastolic function in patients with heart failure and preserved ejection fraction. These data may have implications for cardiovascular risk reduction in this population. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2012

Made available in DSpace on 2016-05-02T13:54:22Z (GMT). No. of bitstreams: 1 AlanAndradeMesquita-dissertacao.pdf: 164106 bytes, checksum: 3b73915b95c788017b359efc06ba110b (MD5) Previous issue date: 2012-06-20 / The objective of this study was to evaluate whether oxytocin, before and after milking, influences the efficiency of milk ejection, and consequently increased production and changes in milk composition. The experiment was conducted at the Federal Institute of Education, Science and Technology in Southern Minas Gerais - Machado Campus in the cattle industry, using 39 animals, divided into 13 blocks, each with three animals listed from "1" to "13". The division of animals was based on the sequence of individual production, so that block "1" was composed by the three most productive animals and block "13" by three animals of lower production. For each block, the animals were randomly assigned to treatments 1, 2 and 3. One (T1) animal did not receive oxytocin, representing the control treatment. It received only normal saline 0.5 ml, in the entire teat during the 60 days of the experiment. In two treatment (T2), all the animals received milking oxytocin at a concentration of 10 IU, total 0.5 ml, before the start of milking, during the 60 days period. In treatment three (T3), the animals received oxytocin at the end of milking at a concentration of 10 IU, total of 0.5ml, and were milked again. Such activities were performed during the 60 days of the experiment. To measure the production of cow s milk meters were used and sampling was performed every 15 days, totaling four weighing and sampling procedures. After measured the production of all animals were, measured samples were collected and sent for analysis. The variables analyzed were the acidity of the milk and quantified of the composition of fat, lactose and protein. The results were submitted to ANOVA and subsequently the comparison of means test, which was statistically significant at 5%. According to the results oxytocin did not influence milk production, the average percentage of fat, lactose and milk protein, but enabled moderation of declining production in the lactation curve and may decrease the effect of the fall in the percentage of protein in milk. / O objetivo deste trabalho foi avaliar se a ocitocina, antes e após a ordenha, influencia a eficiência da ejeção do leite e consequentemente o aumento da produção e mudanças na composição do leite. O experimento foi realizado no Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais - Câmpus Machado, no setor de bovinocultura, utilizando 39 animais, divididos em 13 blocos, cada um com três animais enumerados de 1 a 13 , e foi utilizado na divisão dos animais, uma sequência de produção individual. Assim, o bloco 1 foi composto pelos três animais mais produtivos, e o bloco 13 , pelos três animais de menor produção. Em cada bloco os animais foram sorteados para os tratamentos 1, 2 e 3, sendo que no tratamento um (T1) os animais não receberam ocitocina, representando o tratamento controle, apenas recebendo 0,5ml de soro fisiológico, em todas as ordenhas, durante os 60 dias do experimento. No tratamento dois (T2) os animais receberam ocitocina em todas as ordenhas, na concentração de 10 UI, no total de 0,5 ml, antes do início da ordenha, durante os 60 dias do experimento. No tratamento três (T3) os animais, receberam ocitocina no final de ordenha, na concentração de 10 UI, no total de 0,5 ml e foram reordenhados, atividades essas realizadas durante os 60 dias do experimento. Para aferir a produção das vacas, foram usados medidores de leite, e as colheitas de amostras foram realizadas a cada 15 dias, totalizando quatro procedimentos de pesar e amostrar. Após aferido a produção de todos os animais, as amostras foram coletadas e encaminhadas para as análises. As variáveis analisadas foram a acidez do leite, e após a determinação da acidez, quantificou-se a composição de gordura, lactose e proteína. Os resultados foram submetidos à análise de variância e posteriormente, ao teste de comparação de médias, com diferença estatística significativa de 5%. De acordo com os resultados, a ocitocina não influência a produção leiteira, nas médias de porcentagem de gordura, lactose e proteína do leite, mas possibilita a moderação da queda de produção na curva de lactação e pode diminuir o efeito da queda da porcentagem de proteína na lactação.

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The thesis is focused on the small UAV’s rescue system design. The thesis is divided into related sections reflecting the design process. The first part deals with general problems of parachute equipment. Another part is evaluating critical situations in manual and autonomous control of the airplane. The deceleration device is based on this critical situations as well as the calculated structure loading. Next is the description and evaluation of experiments to verify the performance of modern parachutes. The thesis also includes a simplified proposal ejection mechanism designed in 3D software and documentation of the of model aircraft construction for testing and predicting behaviour in autonomous flight mode.

Introduktion: Vid ekokardiografi används ultraljudsvågor med frekvens över 20 000Hz. Ultraljudssändare med piezoelektriska kristaller används för att generera ljudvågor som skickas ut i kroppen, reflekteras och sedan återvänder till kristallerna för att skapa en ultraljudsbild. Ejektionsfraktionen uttrycker hur stor del av den diastoliska volymen som pumpas ut i kroppen under systole och är en viktig parameter vid bedömning av den globala systoliska funktionen. Den rekommenderade metoden Simpsons biplan jämförs med Philips automatiska funktion a2Dq, som utgår ifrån speckle tracking principen, för bedömning av ejektionsfraktionen. Material och metod: 32 hjärtfriska testpersoner mellan 20–43 år inkluderades i tvärsnittsstudien. Apikala 4- och 2-kammarbilder insamlades ifrån testpersonerna och användes för beräkning av ejektionsfraktionen. Den manuella metoden Simpsons biplan grundas på operatörens utlinjering av endokardiet. Den automatiska funktionen a2Dq utgår ifrån 53 hjärtmodeller och placerar en region of interest automatiskt. Den semiautomatiska funktionen används genom att operatören modifierar region of interest men inte längden av vänsterkammaren. Resultat: Resultatet visade att det inte förelåg någon signifikant skillnad i mätvärdena av ejektionsfraktionen mellan de tre mätprinciperna. Den semiautomatiska och manuella metoden som är operatörsberoende hade likvärdiga mätresultat. Den automatiska funktionen erhöll totalt 6 mätvärden som hamnade utanför normalgränserna. Diskussion: Automatiska funktioner för bedömning av ejektionsfraktionen utvecklas snabbt och kräver utvärderingar. Automatiska mätningar har påvisats vara fördelaktiga då de inte är så tidskrävande som den manuella Simsons biplanmetoden. Tidsaspekten framhävs i de flesta studier dock på bekostnad av säkra mätresultat. Observationerna i denna studie påvisar att den automatiska funktionen inte är säker nog för användning. Konklusion: Enligt observationer ifrån denna studien rekommenderas att den automatiska funktionen ifrån Philips inte används. / Introduction: Ultrasound are soundwaves with frequencies above 20 000Hz. Piezoelectric crystals are used to generate sound waves that can be transmitted into the tissue and reflected back to the crystals to obtain an ultrasound image. The ejection fraction expresses how much blood the left ventricle pumps out with each contraction and is an important parameter for assessment of the hearts global systolic function. The recommended method Simpson´s biplane to assess ejection fraction is compared with Philips automatic function a2Dq, which is based on the principle of speckle tracking. Material and method: The study population included 32 tests subjects with age between 20-43 years old. The test subjects had no records of earlier heart pathologies. Apical 4- and 2-chamber images were collected for the purpose to measure the ejection fraction. The manual method Simpson´s biplane is based on the sonographers manual tracking of the endocardial border. The automatic function a2Dq is based on 53 heart models with different anatomy and physiology and applies a region of interest automatically along the endocardial border. The semi-automatic function allows the sonographer to adjust the region of interest but not the length of the chamber. Result: The result showed that there was no significant difference in the measured values of ejection fraction between the three different techniques. The semi-automatic and Simpson´s biplane method showed equivalent results. The automatic function showed a wide variance of measurements which resulted with a total of 6 measurement ended up below the normal values for ejection fraction. Discussion: Automatic functions for assessing the ejection fraction rapidly develops and requires validations. Automatic functions have shown to be advantageous as the are not as time-consuming as the manual Simpson´s biplane method. In most studies, however, the time aspect is emphasized at the expense of correct measurements results. The observations in this study show that the automatically function a2Dq from Philips are not providing correct measurements. Conclusion: According to observations in this study, it´s recommended that the automatic function from Philips shouldn’t be used.

Background: Heart Failure (HF) is a frequent cause of mortality and recurrent hospitalization. Although HF databases are assembled based on left ventricular (LV) ejection fraction, patients without LV ejection fraction determination are not further analyzed. Objective: The purpose of this study is to characterize patient attributes and outcomes in this group-HF with unknown Ejection Fraction (HFunEF). Methods: We queried the electronic medical record from a community-based university practice for patients with a HF diagnosis. We included patients with >60 days follow-up and had interpretable Doppler-echocardiograms. We recorded demographic, Doppler-echocardiographic, and outcome variables (up to 2083 days). Results: There were 820 patients: 269 with HF with preserved Ejection Fraction (HFpEF), 364 with HF with reduced Ejection Fraction (HFrEF), of which 231 had a LV ejection fraction=40-49% and 133 had a LV ejection fraction<40%, and 187 with HFunEF. As compared to patients with HFunEF, HFpEF patients were younger, had a higher coronary disease and hyperlipidemia prevalence. Patients with HFrEF had more prevalent coronary disease, myocardial infarction, and hyperlipidemia. Patients with HFunEF were more likely to be seen by non-cardiology providers. All-cause mortality (ACM) was greater in HFunEF patients than patients with HFpEF (Hazard Ratio (HR)=1.60 (1.16-2.29), p=0.004). Furthermore, HF readmission rates were lower in HFunEF as compared to HFpEF (HR=0.33 (0.27-0.54), p<0.0001) and HFrEF (HR=0.30 (0.028-0.50), p<0.0001). Conclusion: Patients with HFunEF have greater ACM and lower HF re-admission than other HF phenotypes. Adherence to core measures, including LV ejection fraction assessment, may improve outcomes in this cohort of patients.

Gross' emotion regulation model, Porges' polyvagal theory, and other existing research suggest that regulation of emotions, tactics used to handle conflict, and certain physiological processes that occur within the autonomic nervous system (ANS) in response to stress are significantly related, especially in relational contexts. However, despite their pervasiveness and negative impacts, there is a noticeable lack of research on predictors of violent, aggressive, or abusive conflict tactics in couples. In the current study, the predictive role of emotion regulation in relation to conflict tactics was examined, in addition to the role of respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as mediators for these variables. Thirty-eight participants (19 couples) completed self-report measures of emotion regulation and conflict tactics, and RSA and PEP were measured during a three-minute baseline and 20-minute conflict discussion. Results showed no significant relationships between emotion regulation and conflict tactics, and no significant relationships between these variables and RSA or PEP were found. These findings may suggest that other variables aside from measures of ANS activity better explain the relationship between emotional and behavioral regulation skills, though additional research is necessary to confirm these findings. Clinical implications of this research point to the exploration of other contributors to violence and aggression aside from poor emotion regulation as it was measured in this study. Future research may benefit from investigating the impact of other variables such as sleep and exercise on ANS reactivity in relation to the use of maladaptive conflict tactics in married couples.

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