A vertebroplastia percutânea (VP) consiste na injeção de polimetilmetacrilato (PMMA) no corpo vertebral para alívio da dor e estabilização vertebral, porém seu uso na região cervical é restrito. No intuito de avaliar a efetividade e a segurança da VP na região cervical (VPC), foram avaliados 75 pacientes que se submeteram à VPC (n=101) por doença maligna (n=69) ou hemangioma vertebral (n=6) no período de janeiro de 1994 a outubro de 2007. A VPC foi realizada por uma abordagem ântero-lateral guiada por fluoroscopia. A dor foi graduada por uma escala variando de 0 a 10. O seguimento clinico (período médio de 8,8 meses) foi obtido em 57 (76%) pacientes: 48 tiveram a VPC indicada para controle da dor e nove para estabilização vertebral. Os dados foram analisados de forma univariada e multivariada. A efetividade analgésica foi obtida em 37 (77,1%) dos 48 pacientes seguidos, tendo sido associada ao volume de cimento injetado (P=0,011) e ao preenchimento vertebral (P=0,007) na análise multivariada. A estabilidade vertebral foi observada em 55 (96,5%) dos 57 pacientes, não se correlacionando com as variáveis estudadas. A curva de ROC identificou o preenchimento vertebral como preditor da efetividade analgésica (P=0,008), sendo 50% o melhor ponto de corte para discriminar a maior probabilidade de efetividade analgésica (sensibilidade de 78,0% e especificidade de 62,5%). O extravasamento de cimento foi identificado em 83 (82,2%) das 101 vértebras tratadas não se correlacionando com as variáveis estudadas. As complicações clínicas foram detectadas em 13 (17,3 %) pacientes: complicações locais em 10 (13,3%) e sistêmicas em três (4%) pacientes. As complicações clínicas foram estatisticamente relacionadas à ruptura do muro posterior (P=0,026) e ao extravasamento de PMMA no plexo venoso transverso (P=0,023). A taxa de mortalidade e morbidade a longo termo foi de 1,3% (um paciente) e 1,3% (um paciente). Pode se inferir que a VPC é um procedimento efetivo e seguro, sem se negligenciar os riscos potenciais de complicações. O preenchimento vertebral e o volume de cimento foram associados à efetividade analgésica, mas não à estabilidade vertebral. O preenchimento vertebral teve o maior poder discriminatório da efetividade analgésica, tendo sido obtido com o ponto de corte de 50 % o melhor equilíbrio entre sensibilidade e especificidade para se determinar a efetividade analgésica / Percutaneous vertebroplasty (PV) consists of an injection of polymethylmethacrylate (PMMA) into the vertebral body for pain relief and spinal stabilization, however reports of PV in the cervical spine (CPV) are scarce in the literature. To evaluate the effectiveness and security of CPV, we evaluated 75 patients (mean age, 51.3 years) who underwent CPV (n=101) for malignancies (n=69) and vertebral hemangiomas (n=6) between January 1994 and October 2007. CPV was performed via an antero-lateral approach, using fluoroscopic guidance. Pain intensity was scored with a scale ranging from 0 to 10. Follow-up (mean time of 8.8 months) was avaible in 57 (76 %) patients: 48 of them had CPV indicated for pain control and nine for spinal stabilization. Data were analysed by means of univariate and multivariate analysis. Pain improvement was observed in 37 (77.1%) out of 48 followed patients and was correlated in multivariate analysis with cement volume (P=0.011) and with vertebral filling (P=0.007). Spinal stabilization was observed in 55 (96.5%) of 57 followed patients and was related with none of the evaluated variables. The ROC curve identified the vertebral filling as a good predictor of pain improvement (P=0.008). The best cut-off point to discriminate pain improvement was 50% of vertebral filling (78.0% sensitivity and 62.5% specificity). In 83 (82.2%) of the 101 treated vertebral levels, at least one type of PMMA leakage was found. None of the evaluated factors were related significantly to PMMA leakage. Clinical complications were detected in 13 (17.3%) patients: local complications in 10 (13.3%) patients and systemic clinical complications in three (4.0%) patients. Posterior wall disruption (P=0.026) and transverse venous PMMA leakage (P=0.023) were significantly associated with clinical complications. Long-term morbidity and mortality rate was 1.3% (one patient) and 1.3% (one patient). CPV is a safe and efficacious procedure, but the potential for local and systemic complications must be considered. Cement volume and vertebral filling were associated with pain improvement but not with spinal stability. Vertebral filling has a good performance to predict pain improvement and a cut-off of 50% of vertebral filing obtained the best compromise between sensitivity and specificity to discriminate pain improvement

Finally, the system of vascular interventional radiology simulator is discussed by integrating all presented techniques and designing a trackball mouse based hardware sensors. Training experiments demonstrate that the presented techniques benefit rapid development of realistic and interactive vascular interventional radiology simulators. / Fourth, in order to clearly visualize vascular networks and the placement of instruments while treating the lesion, a physics-based simulation for angiography procedure is presented based on navier-stokes equation and semi-lagrangian method. The multi-scale vessel grid is reconstructed for flow distribution, and point sprites based rendering is adopted to preserve real-time visualization of the procedure. The experiments demonstrate that our results are more realistic compared to previous methods and are closer to the real angiography procedure. / In order to build a high fidelity interventional simulator for physician training and surgery planning, accurate reconstruction of three dimensional vascular network, real-time simulation of angiographic medium propagation and physics-based simulation of interaction between surgical instruments and vessel wall are absolutely indispensable. Thus, first, a methodology for geometric vascular modeling is proposed. As the reconstructed models are essential for many subsequent applications such as deformable modeling and visualization, a series of methods are proposed based on the parallel transport frames in order to maintain high mesh quality of these models. An improved bifurcation modeling method and two novel trifurcation modeling methods are developed based on 3D Bezier curve segments in order to ensure the continuous surface transition at furcations. To solve the twisting problem caused by frame mismatch of two successive furcations, a frame blending scheme is implemented. A curvature based adaptive sampling scheme combined with a mesh quality guided frame tilting algorithm is developed to construct an evenly distributed, non-concave and self-intersection free surface mesh. In terms of surface mesh quality criteria, our methodology can generate vascular models with better mesh quality than previous methods. / Second, we extend our geometric modeling method for illustrative visualization of vasculature, which is an indispensable component in medical education and training. Illustration of vasculature accentuates depth perception and provides a specific manner to identify the branching pattern and topology of vascular structure, which is crucial for therapy planning and real surgery in order to give an effective treatment. With advanced GPU acceleration techniques including render to texture (RTT) , framebuffer object (FBO) and fast image convolution, a real-time visualization can be achieved. / Third, an interactive simulation of angioplasty procedure is reported. To achieve an efficient modeling of soft tissue deformation and virtual device mechanics, mass spring models are adopted to construct the deformable models of vessel wall and stent. By designing a quasi-equilateral triangular mesh model of blood vessel and stent, a linear spring coefficients setting method is adopted to achieve the same accuracy compared with finite element method. With the employment of Physics Processing Unit (PPU), a real-time simulation of the interaction between blood vessel wall and surgical device is developed for vascular interventional radiology simulation. / Vascular diseases have been the leading cause of death worldwide. Interventional procedures are an increasingly promising therapy for treating vascular diseases, which are usually done by a guidewire-catheter combination under the fluoroscopic guidance. However, due to the complicated vascular network, bending of surgical instruments and the risk of vessel injury, these techniques need to be performed by highly trained and experienced specialists. Virtual reality based training of these procedures offers high flexibility and cost effective alternative. Furthermore, it allows training evaluation and accelerates learning process without risk to patients, therefore has distinct advantages than traditional training methods on animals or cadavers. / Guo, Jixiang. / Advisers: Pheng-Ann Heng; Tien-Tsin Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 97-111). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

A vertebroplastia percutânea (VP) consiste na injeção de polimetilmetacrilato (PMMA) no corpo vertebral para alívio da dor e estabilização vertebral, porém seu uso na região cervical é restrito. No intuito de avaliar a efetividade e a segurança da VP na região cervical (VPC), foram avaliados 75 pacientes que se submeteram à VPC (n=101) por doença maligna (n=69) ou hemangioma vertebral (n=6) no período de janeiro de 1994 a outubro de 2007. A VPC foi realizada por uma abordagem ântero-lateral guiada por fluoroscopia. A dor foi graduada por uma escala variando de 0 a 10. O seguimento clinico (período médio de 8,8 meses) foi obtido em 57 (76%) pacientes: 48 tiveram a VPC indicada para controle da dor e nove para estabilização vertebral. Os dados foram analisados de forma univariada e multivariada. A efetividade analgésica foi obtida em 37 (77,1%) dos 48 pacientes seguidos, tendo sido associada ao volume de cimento injetado (P=0,011) e ao preenchimento vertebral (P=0,007) na análise multivariada. A estabilidade vertebral foi observada em 55 (96,5%) dos 57 pacientes, não se correlacionando com as variáveis estudadas. A curva de ROC identificou o preenchimento vertebral como preditor da efetividade analgésica (P=0,008), sendo 50% o melhor ponto de corte para discriminar a maior probabilidade de efetividade analgésica (sensibilidade de 78,0% e especificidade de 62,5%). O extravasamento de cimento foi identificado em 83 (82,2%) das 101 vértebras tratadas não se correlacionando com as variáveis estudadas. As complicações clínicas foram detectadas em 13 (17,3 %) pacientes: complicações locais em 10 (13,3%) e sistêmicas em três (4%) pacientes. As complicações clínicas foram estatisticamente relacionadas à ruptura do muro posterior (P=0,026) e ao extravasamento de PMMA no plexo venoso transverso (P=0,023). A taxa de mortalidade e morbidade a longo termo foi de 1,3% (um paciente) e 1,3% (um paciente). Pode se inferir que a VPC é um procedimento efetivo e seguro, sem se negligenciar os riscos potenciais de complicações. O preenchimento vertebral e o volume de cimento foram associados à efetividade analgésica, mas não à estabilidade vertebral. O preenchimento vertebral teve o maior poder discriminatório da efetividade analgésica, tendo sido obtido com o ponto de corte de 50 % o melhor equilíbrio entre sensibilidade e especificidade para se determinar a efetividade analgésica / Percutaneous vertebroplasty (PV) consists of an injection of polymethylmethacrylate (PMMA) into the vertebral body for pain relief and spinal stabilization, however reports of PV in the cervical spine (CPV) are scarce in the literature. To evaluate the effectiveness and security of CPV, we evaluated 75 patients (mean age, 51.3 years) who underwent CPV (n=101) for malignancies (n=69) and vertebral hemangiomas (n=6) between January 1994 and October 2007. CPV was performed via an antero-lateral approach, using fluoroscopic guidance. Pain intensity was scored with a scale ranging from 0 to 10. Follow-up (mean time of 8.8 months) was avaible in 57 (76 %) patients: 48 of them had CPV indicated for pain control and nine for spinal stabilization. Data were analysed by means of univariate and multivariate analysis. Pain improvement was observed in 37 (77.1%) out of 48 followed patients and was correlated in multivariate analysis with cement volume (P=0.011) and with vertebral filling (P=0.007). Spinal stabilization was observed in 55 (96.5%) of 57 followed patients and was related with none of the evaluated variables. The ROC curve identified the vertebral filling as a good predictor of pain improvement (P=0.008). The best cut-off point to discriminate pain improvement was 50% of vertebral filling (78.0% sensitivity and 62.5% specificity). In 83 (82.2%) of the 101 treated vertebral levels, at least one type of PMMA leakage was found. None of the evaluated factors were related significantly to PMMA leakage. Clinical complications were detected in 13 (17.3%) patients: local complications in 10 (13.3%) patients and systemic clinical complications in three (4.0%) patients. Posterior wall disruption (P=0.026) and transverse venous PMMA leakage (P=0.023) were significantly associated with clinical complications. Long-term morbidity and mortality rate was 1.3% (one patient) and 1.3% (one patient). CPV is a safe and efficacious procedure, but the potential for local and systemic complications must be considered. Cement volume and vertebral filling were associated with pain improvement but not with spinal stability. Vertebral filling has a good performance to predict pain improvement and a cut-off of 50% of vertebral filing obtained the best compromise between sensitivity and specificity to discriminate pain improvement

1 ABSTRACT PATIENTS' ATTITUDES TO PHARMACOTHERAPY OF OSTEOPOROSIS Author: Hana Theimerová Supervisor: Magda Vytřísalová Charles University in Prague, Faculty of Pharmacy in Hradec Králové, Department of Social and Clinical Pharmacy INTRODUCTION: Patients' attitudes to treatment might be affected by various factors. These may vary in different generations as well as in different populations. The patients' attitudes to the treatment along with the illness may affect decision concerning the beginning, interruption or end of the treatment. That implies that the interaction between these factors and attitudes to the treatment is comprehensive. AIMS: The study aim was to evaluate the patients' attitudes to the treatment of osteoporosis based on the perception of necessity and concerns of treatment with oral bisphosphonates (BIS). METHODS: Data for the analysis were obtained using an anonymous questionnaire in five outpatient centres in the Czech Republic from November 2012 to March 2013. The patients' opinions concerning the BIS treatment were identified (necessity vs. concerns) using the Czech version of the "Beliefs about Medicines Questionnaire Specific" (BMQ-CZ). RESULTS: A total of 363 patients were involved in the analysis (mean age 68.9 years). Patients were treated with once a week dosing forms of BIS -...

INVIDUAL MOVEMENT PROGRAM TO INFLUENCE FITNESS AND AFFECT BODY WEIGHT Aims: The main aim of this thesis is to influence the fitness assumptions and to affect the body weight of a chosen person on the basis of an applied intervention program. Particular aims involve creating the intervention program, its fulfillment and practical verification, confirmation of defined hypotheses, stating and particulary explaining the differences between measured dates before and after the intervention and formulating relevant conclusions and recommendations.. Methods: The research method used in the thesis was an experiment. Its basis was creation and especially application of the six months lasting training program and further testing in laboratory conditions before and after the intervention. Results: The controlled person fulfilled the training program without complications and in a full scale. The created interventional program involved aerobic activities (running), bodybuilding and other activities (fitbox, cycling, in-line skating, swimming) without adjusting nutrition habits or an eventual diet. The feed-back tests showed/proved that the condition assumptions of the controlled person distincively improved in all chosen function parameters. Requested weight reduction though was not achieved. Key words:...

A ocorrência do comportamento autolesivo logra índices significativos na população adolescente e pré-adolescente, tornando-se queixa frequentemente observada no contexto escolar e clínico, preocupando a todos os envolvidos. Na atualidade, a Organização Mundial da Saúde (OMS) a categoriza como um problema de saúde pública global, e, portanto, foco de atenção de políticas públicas e sociais prementes dada a gravidade e aumento do risco de tentativa de suicídio no futuro. No Brasil, as pesquisas realizadas ainda são incipientes quando comparadas com a produção internacional, ainda mais no que diz respeito à dinâmica psíquica do jovem que se autolesiona e meios de intervenção. Assim, considerando a perspectiva investigativa atribuída à Psicologia Clínica e a indissociabilidade entre prática e pesquisa, este trabalho buscou contribuir por meio da realização de um estudo de caso único com vistas à análise dos traços de personalidade de uma adolescente, estudante de uma escola pública do Estado de São Paulo, sem diagnóstico psiquiátrico e/ou em atendimento psicológico, além de investigar dados do funcionamento familiar e a relação de tal conduta com a sintomatologia depressiva e ansiosa. Para tanto, o método clínico-qualitativo de cariz psicanalítico foi empregado em consonância com o delineamento de estudo de casos único e o processo Psicodiagnóstico Compreensivo e Interventivo. O Psicodiagnóstico previamente esquematizado contemplou duas etapas: 1) primeira aplicação, que contabilizou sete atendimentos, e, 2) fase de follow-up, com três atendimentos. Em ambas as etapas, abarcou a realização de entrevistas com a responsável, entrevistas com a participante, aplicação do Questionário Desiderativo, Teste de Apercepção Temática Infantil - Figuras Humanas (CATH), Inventário de Depressão Infantil (CDI) e Inventário de Ansiedade de Beck (BAI). Os resultados do caso foram examinados individualmente, em cada etapa, e, posteriormente, em conjunto, com a comparação entre essas duas fases por meio da livre inspeção do material à luz das observações oferecidas pelos instrumentos projetivos e objetivos fundamentados na abordagem psicanalítica psicodinâmica. Assim, com base nos aportes winnicottianos, pode-se observar que, no caso analisado, a conduta autolesiva revelou uma dupla função: impedir o aniquilamento total do Eu, e, concomitantemente, comunicar ao ambiente sobre falhas nos cuidados em fases primitivas, reatualizados na adolescência, na tentativa de resgatar algo ofertado, porém percebido como perdido. Adicionalmente, integrando os achados iniciais com os obtidos na reavaliação de follow-up, a significativa remissão de aspectos dissociados da personalidade da participante e sintomas clínicos após o processo Psicodiagnóstico comporta correlações com o conceito winnicottiano de distúrbio psicossomático, recuperável após a presença de condições ambientais favoráveis, ou ainda com o trânsito da posição kleiniana esquizo-paranóide para a depressiva, denotando a retomada do processo de amadurecimento. Por fim, os dados obtidos permitem sintetizar sobre a importância do ambiente para a restauração do sentimento de confiança e de esperança no caso investigado, corroborando a teoria winnicottiana sobre a subordinação da saúde psíquica ao longo da vida aos cuidados iniciais recebidos / The occurrence of self-injurious behavior achieves significant rates in the adolescent and preadolescent population, becoming a frequent complaint in the school context, causing concern to all involved. Currently, the World Health Organization (WHO) categorizes it as a global public health problem, and therefore, focus attention on pressing public and social policies given the seriousness and increased risk of attempted suicide in the future. In Brazil, the research carried out is still incipient when compared to international production, especially with regard to the psychic dynamics of the self-injuring young person and means of intervention. Thus, considering the research perspective attributed to Clinical Psychology and the indissociability between practice and research, this work sought to contribute through the accomplishment of a single case study with a view to the investigation and analysis of the personality traits of a teenager, student of a school of the State of São Paulo and without psychiatric diagnosis, besides the family functioning and the relation of such conduct with the depressive and anxious symptomatology. The clinical-qualitative psychoanalytic method was used in consonance with the design of a single case study and the Comprehensive and Interventive Psychodiagnostic process. The psychodiagnosis previously planned included two stages: 1) the first application, which counted seven meetings, and 2) the follow-up phase, with three sessions. Interviews with the participant, interviews with the participant, application of the Desiderative Questionnaire, Child Thematic Apperception Test - Human Figures (CAT-H), Infant Depression Inventory (CDI) and Anxiety Inventory of Beck (BAI). The results of the case were examined individually at each stage and then together with the comparison between these two phases through the free inspection of the material in the light of the observations offered by the projective and objective instruments based on the psychoanalytic psychoanalytic approach. Thus, on the basis of Winnicott\'s contributions, it can be observed that, in the case analyzed, self-defeating behavior revealed a double function: to prevent the total annihilation of the ego, and, at the same time, to communicate to the environment about the failures in care, in an attempt to rescue something offered, but perceived as lost. Additionally, integrating the findings with those obtained in the follow-up reassessment, the significant remission of aspects dissociated from the participant\'s personality and clinical symptoms after the Psychodiagnostic process correlates with the winnicottian concept of psychosomatic disorder, recoverable after the presence of favorable environmental conditions , or with the transit from the kleinian position schizopanoid to the depressive, denoting the resumption of the maturation process. Finally, the data obtained allow us to synthesize the importance of the environment for the restoration of the feeling of trust and hope in the case investigated, corroborating the Winnicottian theory about the subordination of the psychic health throughout the life to the initial care received

Thesis advisor: Barabara Hazard / This randomized controlled trial (RCT) examined a discharge nursing intervention (DNI) aimed at promoting self-regulation of care for early discharge interventional cardiology patients. The purpose of this study was to compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and those who receive a DNI. The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at life style changes to reduce secondary events after treatment for CVD is needed to guide evidence based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or one to two days of the procedure. Cardiac disease is then managed as a chronic, but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: a) the burden of care shifts from the hospital setting to home, b) patients are discharged without extensive education about complications and disease management, c) the occurrence of secondary events and disease progression remain a valid threat, and d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions. 1. Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence? 2. Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction? 3. Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care? 4. Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by seven components of the IPQ-R: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations? Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred and fifty four patients were and randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI which included: 1) additional written information about taking medications, 2) a medication pocket card, 3) a list of 3 cardiac internet sites,and 4) a phone call, 24 hours post procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. Analyses on four outcome measures, medication adherence, use of urgent care, patient satisfaction, and illness perception, revealed one statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on one measure, the timeline (acute/chronic) component of illness perception (p = .006) indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant group differences found. This study provides support for nursing intervention research guided by self-regulation theory that examines the patient's perception of illness. Patients with cardiac disease who received the DNI were statistically more likely to acknowledge that their illness would last a long time. This awareness, may improve adherence to a prescribed regimen of medication and lifestyle modification. Nursing interventions guided by an understanding of patients' belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A embolização intra-arterial é rotineiramente utilizada na prática clinica como co-adjuvante pré-operatório ou controle de tumores, tratamento de malformações arteriovenosas e outras doenças vasculares. Em vários casos é realizada com uso de partículas de diferentes formas e composições. Um agente embolizante esférico e utilizado com bons resultados é o trisacryl (Embosphere®; BioSphere® Medical). Um novo agente embólico - polivinil acetato esférico cobertas com polivinil álcool (PVAc) foi desenvolvido recentemente no Brasil. Este trabalho tem objetivo de avaliar, após embolização renal, o grau de oclusão vascular, recanalização da luz vascular e a necrose da parede vascular provocados por partículas de PVAc, utilizando como parâmetro partículas de trisacryl. Setenta e nove fêmeas de coelhos do tipo albino New Zealand foram submetidas a cateterização arterial do rim direito; trinta e três animais foram embolizados com trisacryl, trinta e um com PVAc e quinze animais compuseram o grupo de simulação, tendo sido excluídos quatro animais (três trisacryl e um PVAc) devido a óbito precoce. Foram criados cinco subgrupos de seis animais, que foram sacrificados após 48 horas, 5 dias, 10 dias, 30 dias e 90 dias após a embolização. O grupo de simulação seguiu a mesma ordem temporal com três animais em cada grupo. As técnicas de coloração utilizadas foram os métodos de hematoxilina-eosina (HE) e tricrômico de Masson com observação por microscopia óptica. Os resultados mostraram diferença significativa entre o grau de oclusão vascular nos grupos de 5 dias e 10 dias e necrose no grupo de 48 horas em favor do grupo embolizado com PVAc, que apresentou reação tecidual adequada (redução volumétrica e isquemia) e menor grau de recanalização que o trisacryl / Intra-arterial embolization is often utilized in medical practice preoperatively as adjuvant in controlling tumors, treatment of arteriovenous malformations and other vascular diseases. Often times, particles of different forms and compositions are employed. trisacryl (Embosphere®; BioSphere® Medical), a spheric embolic agent, is nowadays used with very satisfactory results. However, a new embolic agent spheric polyvinyl alcohol-covered polivinyl acetate (PVAc)- has been developed in Brazil. This study evaluates the degree of vascular occlusion, vascular recanalization and the necrosis of vascular wall caused by PVAc particles, compared with trisacryl, after renal embolization. Seventy-nine female albine New Zealand rabbits underwent arterial catheterization of the right kidney; Thirty-three animals were embolized with trisacryl, thirty-one with PVAc and fifteen were kept as control group, four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed 48 hours, 5 days, 10 days, 30 days and 90 days after embolization. The control group was divided into subgroups of three animals, for the same period of time. Their kidneys were dyed with hematoxylin-eosin (HE) and Masson tricromic and examined using optic microscopy. The results showed a significant difference between the five-day and ten-day groups with regard to the degree of vascular occlusion, and the amount of necrosis in the forty-eight-hour group. Both findings favor the PVAc group, with adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than with trisacryl

La prévention des effets biologiques radio-induits en radiologie interventionnelle nécessite une estimation complète de l’exposition à la peau et aux organes du patient. Dans ce contexte, un logiciel permettant une reconstruction post-opératoire précise et rapide de la dosimétrie du patient par méthode Monte Carlo, a été développé. L’utilisation de techniques de réduction de variance et de navigation voxélisée avancées permet une amélioration significative du temps de calcul. Des fantômes anthropomorphes de dernière génération, couplés à la lecture des paramètres d’irradiation, permettent une prise en compte réaliste de l’anatomie du patient et de la géométrie de la machine. La précision de la modélisation Monte Carlo associée à un temps d’exécution réduit ainsi qu’à une complète automatisation rend cet outil particulièrement adapté à un calcul systématique en radiologie interventionnelle. / The prevention of the radio-induced biological effects in interventional radiology require a complete estimation of the patient skin and organs exposition. In this context, a software allowing a precise and fast postoperative reconstruction of the patient’s dosimetry using the Monte Carlo method was developed. The use of advanced methods of variance reduction and voxelized navigation allows a significant improvement in computing time. Last generation anthropomorphic phantoms, coupled with the reading of the irradiation parameters, allow to take realistic account of the patient's anatomy and the geometry of the machine. The precision of the Monte Carlo modelization associated with a reduced execution time as well as a complete automation makes this tool particularly suitable for a systematic calculation in interventional radiology.

BACKGROUND: Since the initial report on the negative effects of smoking by the Surgeon General's Advisory Committee, the components of cigarettes and tobacco smoke and the mechanisms by which these cause disease have been studied extensively. Despite the well-documented health consequences associated with tobacco use, nearly 70 million Americans over the age of 12 actively use tobacco products, with 57.5 million of these (22.1% of the U.S. population in this age range) actively smoking cigarettes. Understanding how nicotine addiction develops and reinforces itself is important context for understanding the high prevalence of quit interest among smokers and the high relapse rates associated with quit attempts. While the increased availability of different, clinically proven tobacco cessation aids should lower the barrier associated with tobacco abstinence, the prevalence of quit aid use still remains low among those attempting to quit smoking. This study examines quit interest in active smokers, the quit attempts attempted by current and former smokers, the prevalence of tobacco cessation aid use in these quit attempts, and the perceived efficacy of certain quit aids. METHODS: This study was conducted in the Emergency Departments of ten hospitals nationwide by the National Association of Research Associates Programs in 2012. This study utilized trained research staff to enroll non-emergent patients and visitors over the age of 18 years old, obtaining demographical information and a detailed history of tobacco use from the participant. This included such information as current tobacco use status, how many cigarettes were consumed during a typical day, how many times they had attempted to abstain from tobacco use in the past, if they had used any tobacco cessation aids during those quit attempts, and, if so, how effective they believed these aids were. Participants were also asked to rate their readiness to quit smoking and intent to quit smoking, markers this study used to analyze quit interest. RESULTS: Of those approached, 10,303 study participants were selected for inclusion in this study, reporting tobacco use for longer than one month at any point in their life. 50.5% reported current tobacco use, while 46.8% reported current abstention from smoking. A majority of active smokers expressed interest in initiating tobacco cessation, with 55.2% reporting they were ready to quit smoking, though a smaller majority (51.9%) of active smokers reported that they intended to quit smoking. Most smokers reported at least 1 quit attempt in the past, with 76.5% of former smokers reporting that they quit within 1 to 5 attempts. Only 30.7% of study participants reported ever using some form of tobacco cessation aid in previous quit attempts, with nicotine replacement therapy use being the most commonly reported, and with pharmacological interventions more commonly reported than counseling-based cessation interventions. A majority of participants who reported using nicotine replacement gum and lozenges (57.8% and 49.5%, respectfully) reported that they were not helpful in aiding their cessation attempts, with only 30.1% of gum and 38.7% of lozenge users reporting a positive effect. CONCLUSIONS: The results indicated that among active smokers, smokers that reported smoking less (only some days or fewer cigarettes per day) were more likely to express interest (readiness and intent) in initiating tobacco cessation than those that reported smoking more (every day or more cigarettes per day). Quit interest also appeared to be lowest in 18-25 year olds, with this age group also reporting the lowest proportion of quit attempts, a finding that differed from another national tobacco survey. The prevalence of quit aid use in our study was comparable to another national tobacco survey, but our findings for the prevalence of unassisted quit attempts did not coincide with results found in other studies. These results also indicated that cessation aid use increased with increased number of quit attempts. Though we found that former smokers were more likely to indicate that NRT products were helpful than active smokers were, we were unable to fully analyze the perceived effects of cessation aid use due to the loss of some of this data. In light of the limitations of this study, further study needs to be conducted to better understand the perceived effect of tobacco cessation aids and how this might differ from the efficacy values found in clinical trials. In order to make findings more comparable to other tobacco surveys, future studies should also be designed around clear and common definitions for active tobacco use and quit interest, and a focus on quit attempts should be modulated by some degree of recency (e.g., quit attempts made within the previous year or two years).