Resumo: Um avanço significativo na tecnologia de aquisição de imagens médicas tem ocorrido nas últimas duas décadas, trazendo benefícios no estudo e no tratamento de patologias cerebrais. A integração de imagens de exames anatômicos e funcionais permite mapear regiões de ativação cerebral, importantes no planejamento neurocirúrgico e radioterápico. Este trabalho descreve uma plataforma flexível para a visualização de volumes multimodais, com ênfase na integração de informações funcionais e anatômicas, abrangendo modalidades tais como a ressonância magnética (MRI), a tomografia computadorizada (CT) e a ressonância magnética funcional (fMRI). Neste contexto, questões específicas são abordadas, a saber, a segmentação do cérebro e a atenuação das reentrâncias da superfície do córtex utilizando o algoritmo de fechamento morfológico. A integração e apresentação das imagens são feitas com base no algoritmo ray casting. Os resultados obtidos evidenciam contribuições importantes no desenvolvimento de ferramentas destinadas à visualização volumétrica multimodal.

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Made available in DSpace on 2014-06-11T19:33:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:04:14Z : No. of bitstreams: 1 cyrino_eg_dr_botfm.pdf: 1051308 bytes, checksum: 43dc82ef9643c7314b55af43fb4c9550 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Um movimento amplo vem se estruturando para responder à formação de um médico crítico, criativo, com responsabilidade, ético e mais humano e que participe ativamente na construção do Sistema Único de Saúde. Em 1998, docentes dos Departamentos de Pediatria e de Saúde Pública iniciaram a construção de novos cursos a serem ministrados ao terceiro ano de graduação médica. O objetivo desta investigação foi descrever os casos de inovação dos cursos de Semiologia Pediátrica e de Saúde Coletiva III para o desenvolvimento da proposta de reforma curricular da instituição. Foram escolhidos dois casos singulares: Saúde Coletiva III, com a participação de cinco disciplinas: Administração, Ciências Sociais, Epidemiologia, Ética e Nutrição em Saúde Publica, oferecido em 1999 e Semiologia Pediátrica ministrado em 2000. Para descrição e avaliação dos casos, utilizaram-se de métodos quantitativos e qualitativos. O de Saúde Coletiva III foi organizado sob três núcleos temáticos: Problemas em Saúde Publica; Nutrição em Saúde Publica; Planejamento em Saúde. O modelo de ensino centrou-se na problematização de situações concretas vivenciadas na prática da Saúde Publica, trabalhando-se em centros de saúde, serviços e organizações de saúde da região de Botucatu. O de Semiologia Pediátrica privilegiou a atenção integral à saúde da criança. O modelo de ensino centrou-se na aprendizagem baseada em problemas e no aprendizado prático da semiologia pediátrica em diferentes cenários, enfatizando-se o ensino em ambulatório. Nos dois casos privilegiou-se o trabalho em pequenos grupos, com a orientação docente. A avaliação foi uma preocupação constante, apresentando aspectos diferentes para os dois cursos. Os cursos estudados inovaram pelo esforço de Departamentos que tiveram autonomia e independência para formulá-los... / Many projects and changes have been under way to add to the formation of a critical, creative, responsible, ethical and caring doctor who would be strongly participative in the consolidation of SUS (Unified Health System). In 1998, faculty members of the Pediatrics and Public Health Departments of Botucatu Medical School started planning new courses for the third year of Medical School. This work describes the innovations in the courses of Pediatric Semiology and Collective Health III aiming the curricular reform in the institution. Two particular cases were chosen: Collective Health III with five disciplines: Administration, Social Sciences, Epidemiology, Ethics and Nutrition in Public Health taught in 1999 and Pediatric Semiology in 2000. Quantitative and qualitative methods were used to describe and evaluate the cases. Collective Health covered tree themes: Problems in Public Health, Nutrition in Public Health and Planning in Health. The teaching model was centered on the inquiry of real situations routinely experienced in Health Centers and other Health Services in Botucatu and surrounding areas. Pediatric Semiology focused on full assistance to children. The teaching model adopted was Problem Based Learning and practical teaching of Pediatric Semiology in different scenarios, mainly in the outpatient department. Group work under professor guidance was encouraged in both cases. Constant evaluation was strongly valued presenting different aspects in these two courses. The innovation came as a result of the effort made by the departments who had autonomy to carry it out. The main goal was to realize and utilize the strategies that could offer a student-centered approach which would allow for more independence to build and increase his knowledge. As to Pediatrics, the model adopted was Comprehensive Medicine focused on child assistance... (Complete abstract, click electronic access below)

Made available in DSpace on 2014-06-11T19:33:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2003Bitstream added on 2014-06-13T18:45:10Z : No. of bitstreams: 1 jyh_jh_dr_botfm.pdf: 304699 bytes, checksum: a9183964c41c2d53b184d032a97e949a (MD5) / A farmacologia continua sendo um dos instrumentos fundamentais da prática médica. Os fármacos são utilizados com finalidades terapêuticas e diagnósticas. Entretanto, o uso inadequado da farmacoterapia tem contribuído para as chamadas iatrogenias medicamentosas (IAME) que aumentam a morbidade e a mortalidade dos pacientes. Nos Estados Unidos da América, segundo alguns pesquisadores, as IAME chegam a acarretar mais de cem mil óbitos anuais, sendo considerada como a quarta causa de mortes naquele país. Assim, foi realizado um estudo para a avaliação do conhecimento farmacoterápico dos médicos e graduandos em medicina humana em várias regiões do país. Utilizou-se protocolo previamente elaborado que contém três blocos de questões, além da caracterização do participante (sexo, idade, ano de formatura, faculdade, especializações, residência médica e locais de atuação); o primeiro bloco tem o objetivo de avaliar a formação acadêmica em farmacologia; o segundo, as noções básicas desta matéria; e o terceiro, o conhecimento em farmacoterapia. A amostra deste estudo, 788 participantes, foi dividida em 4 grupos: internos (18,7%), residentes (22,0%), pós-graduação (10,2%) e médicos (49,1%). Independentemente do grupo, a avaliação revelou que a formação acadêmica em farmacologia foi inadequada para fornecer as bases para a farmacoterapia na prática profissional, a maioria não se preocupa em conhecer as propriedades farmacológicas das drogas e nem das possíveis interações medicamentosas antes de prescrevê-las. Muitos desconhecem a fotossensibilidade dos medicamentos comumente prescritos e alguns até acham que benzodiazepínicos e curares podem ser utilizados como analgésicos. Para a maioria não houve aula formal de prescrição médica, tampouco... / Pharmacology has been considered as the main basis of medical science and further is one of the fundamental tool for medical practice. Drugs are given for therapeutic and diagnostic purposes, however injudicious drug therapy may be harmful and bring about to drug iatrogenic illness which increase morbidity and mortality. According to some researchers, iatrogenic illness causes more than 100.000 deaths per year in the United States and may rank the fourth leading cause of death. With these considerations in mind, the objective of this study was to evaluate the pharmacotherapeutic knowledge of physicians and graduating medical students from several Brazilian States. An elaborated protocol was performed including personal data (sex, age, year of graduation in medical school, university, medical specialty, medical residence and jobs) and three blocks of questions. The objective in the first block was to evaluate the pharmacological academic training; in the second block was to evaluate the basic pharmacological knowledge and in the third block was to evaluate the pharmacotherapeutical knowledge. The search sampling with 788 participants was divided into 4 groups: interns (18,7%), residents (22,0%), postgraduates (10,2%) and physicians (49,1%). The study documented in all groups that pharmacological academic training was unsatisfactory to provide basic pharmacotherapy for professional practice and most of them do not take care about drug’s pharmacological properties neither its possible interactions before making a medical prescription. Most of participants ignored drug’s photosensitivity and some of them believed that Benzodiazepines and curares should be used as analgesics. The greater number had no formal class about how to elaborate medical prescriptions neither had notions of toxicology. These facts are risk-related... (Complete abstract click electronic access below)

Made available in DSpace on 2014-12-02T11:16:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-16Bitstream added on 2014-12-02T11:21:14Z : No. of bitstreams: 1 000609546.pdf: 1464260 bytes, checksum: 34305688869576b88d9034d68dc81109 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / As técnicas biomagnéticas vêm sendo empregadas com sucesso no estudo do trato gastrintestinal (TGI). Elas podem medir o campo magnético originado pela atividade elétrica dos órgãos, o campo de marcadores magnetizados ou a resposta de marcadores ou traçadores a um campo magnético de excitação. Este trabalho apresenta uma coletânea de instrumentações desenvolvidas para aplicações no trato gastrintestinal. Os equipamentos desenvolvidos utilizaram sensor anisotrópico magnetorresistivo (AMR) para medir campo magnético e conversores de tensão true rms-to-dc objetivando a redução de custo das técnicas que empregam excitação magnética alternada (AC). Foram desenvolvidos um método de localização magnética de sonda nasoenteral, uma solução para substituição dos amplificadores lock-in’s por conversores true rms, uma instrumentação com sensor AMR com um eixo de detecção para avaliar o trânsito faringiano, uma instrumentação com sensor AMR com três eixos de detecção para avaliar o trânsito esofagiano e uma instrumentação com 36 sensores que foi aplicada para obter imagens magnéticas de diferentes fantomas e para avaliar a atividade de contração gástrica em um modelo in vivo – ratos. As instrumentações foram avaliadas em testes in vitro e in vivo e apresentaram sensibilidade para o emprego no trato gastrintestinal. Os equipamentos desenvolvidos são de baixo custo, livre de radiação ionizante, portáteis e que possibilitam aplicações em gastroenterologia, farmacologia, farmacotécnica e na clínica médica. / Biomagnetic techniques have been employed successfully to study gastrointestinal (GI) tract. They are enable to measure the magnetic field of magnetized markers, the markers and tracers responses to applied magnetic field excitation, and the magnetic field occurred by GI electrical activity. This work presents some instrumentation developed to evaluate different parameters of GI tract. The equipment built uses anisotropic magnetoresistive (AMR) sensor to measure magnetic field and true rms-to-dc voltage converter in order to reduce the cost of techniques that employ alternate (AC) magnetic excitation. In this work were developed: a magnetic method for localization of enteral feeding tube, a solution to replace lock-in amplifier for true rms converter, an instrumentation using AMR sensor (one axis-sensing) to evaluate the pharyngeal transit time, another instrumentation using AMR sensor (three axis-sensing) to evaluate esophageal transit time and finally, a equipment consisted of 36 AMR sensors to evaluate the gastric motor activity from rats and in order to obtain magnetic images from different kinds of phantoms. All equipments were tested and showed sensitivity to be employed in GI studies. The equipments developed are low cost, radiation free, portable and enable to applications in gastroenterology, pharmacology, pharmaceutical and medical clinic.

The most successful antimicrobial agents in clinical use are of microbial origin and of these the greatest variety has been found in the genus Streptomyces. However, the resistance of the pathogenic microbes to the commonly used antibiotics is increasing as a result of the wide-spread and long-term use of these antibiotics. Therefore, understanding the strategies that bacteria use to become resistant is of crucial need. Streptomycetes are Gram positive bacteria, commonly found in soil and are known antibiotic-producers. The focus of this thesis was to underpin the mechanism of resistance to penicillin G in isolated strains of streptomycetes that exhibit elevated resistance to penicillin G and to characterise these organisms. Moreover, to investigate the interaction between penicillin G and PBPs in Streptomyces strains and investigate the relationship between growth rate and penicillin G resistance in Streptomyces in vitro. Ninety six Streptomycetes were isolated and characterized. Morphological examination and the16s rRNA sequences of these strains indicated that strains belong to the species Streptomyces. The MICs and MBCs for penicillin G for the isolated Streptomyces strains were measured by plate culture. Some strains showed growth up to 400 μg/ml with penicillin G, which indicate that the strains were highly resistant against penicillin G. Some strains were unable to grow at penicillin concentrations above 200μg/ml. Also, The MICs of penicillin G for isolated Streptomyces strains were measured using a novel OxoPlates® system in 96-well culture format employing Mueller-Hinton broth culture. The MICs of all strains ranged from 1-100 μg /ml. Results indicate that the sensitivity of Streptomyces strains of penicillin G is not directly related to β-lactamase production in the panel of isolates examined. There was no correlation between the MICs of penicillin G and the growth rate in these isolates. Likewise, there was no association between the position of beta-lactamase producing and non-beta-lactamase producing strains on the phylogenetic tree and their beta-lactamase xii activity. Beta-lactamase producing and non-producing strains refers to the same ancestral origin clade. Additionally, the comparative analysis of 16S rRNA gene sequence and phylogenetic relationship of strain (W43) revealed that the isolate clustered with (W76) Streptomyces lividans strain YLA0. Bocillin (a penicillin binding protein stain) staining in β-lactamase producing strains showed staining throughout the mycelia whereas in non β-lactamase producing strains staining only occurred in certain parts of the mycelia. Bocillin also revealed that in spores PBPs were located on both poles of the spores. Streptomyces coelicolor has the ability to grow at high concentrations of penicillin G up to 640 μg/ml in continuous culture. It also has the capacity to grow at very low amounts of dissolved oxygen in continuous culture. Significantly, there was a correlation between the growth rate of S. coelicolor and the resistant to penicillin G. S. Coelicolor was more sensitive to penicillin G at a high dilution rate. Furthermore, our strategy of using the Bug-Lab for monitoring the progress of S. Coelicolor 1147 in continuous culture, even at low concentrations of cells in real time was successful.

Background: SF processing has been firstly applied on the processing and storage of the rhizome of Dioscareapersimilis Prain et Burkill. in Wenxian country since 1900. Due to the simple, quick and low-cost characteristics of SF, it soon became a common postharvesting method for CMMs. However, recent studies showed that SF can either cause chemical changes to CMMs or affect human health. The awareness of identification of sulfur-fumigated CMMs is arisen. Comparing with chemical methods, FM is more simple and user-friendly to be established in authentication. Also, recent studies showed that different chemical profiles of CMMs can emit fluorescence differently. This research aimed to validate if FM was suitable for identification of sulfur-fumigated CMMs through using Codonopsis Radix and Ginseng Radix as examples. Method: 16 herbal samples were collected in different commercial market in different time, in which 6 of them was Codonopsis Radix and 8 of them was Ginseng Radix. Firstly, their chemical profiles of the samples were analyzed by UHPLC-QTOF-MS to make a chemical authentication. Then, their fluorescence characteristic were localized and captured on their transverse sections. Result: All the samples of Codonopsis Radix and 2 samples of Ginseng Radix were confirmed to be sulfur-fumigated as compounds sulfates or sulfites were detected. Investigated by fluorescence, herbal samples emitted blue and yellow fluorescence in different intensity under blue and green light filter. The fluorescence of groups of laticiferous tubes and resin canals were remarkable in Codonopsis Radix and Ginseng Radix respectively. Sulfur-fumigated samples showed similar characteristic to those raw samples. It was significant that samples of Codonopsis Radix emitted fluorescence differently even all of them were sulfur-fumigated. Conclusion: In the present study, samples with different growing condition, storage time and SF processing had some variation in their fluorescence characteristics. The result showed that fluorescence microscopy was not probable for identification of the sulfur-fumigated CMMs. The application of FM on the identification of sulfur-fumigated CMMs should be further investigated comprehensively. Key works: sulfur-fumigation; Codonopsis Radix; Ginseng Radix; authentication; fluorescence microscopy; UHPLC-QTOF-MS 背景：硫磺薰蒸中藥技術是在1900年由溫縣人民發明並最早記載於河南溫縣縣誌的。由於硫磺薰蒸技術擁有最高效，低成本，便於操控的優點，因此一直被藥農及中藥開發藥廠用於中藥防蟲及乾燥加工。但近年不少論文開始報道有關硫磺對中藥材的危害性，其中以硫磺薰蒸會影響中藥材內部的化學成分和藥理活性的報告最令人擔憂。礙於高效液相色譜法(HPLC)等化學檢測手段的複雜性，使用化學手段鑒別硫磺熏蒸藥材存在困難及難以普及。而近年實驗證明，中藥材裏不同的化學成分在熒光顯微鏡下會發放出不同熒光顔色。本研究以人參和黨參為例子，為應用熒光顯微鏡鑒別硫磺熏蒸中藥材，提供科學證據支持。 實驗方法：本研究採集了6個黨參及8個人參樣品進行分析。實驗首先以高效液相色譜-四極杆飛行時間串聯質譜(UHPLC-QTOF/MS)技術分析各樣品的化學成分用於鑒別樣品有否被硫磺熏蒸。然後各樣品先進行冷凍切割，並在熒光顯微鏡下進行橫切面觀察，從外到内觀察各特徵結構的熒光顔色，比較不同樣品的熒光差別。 結果：實驗結果顯示所有黨參樣品及2個白皮參樣品存在硫磺熏蒸后產生的硫酸鹽或亞硫酸鹽化合物，提示該樣品被硫磺熏蒸。所有樣品在熒光顯微鏡下都顯示不同程度的藍色及綠色熒光。儘管所有黨參樣品均被硫熏，但其顯示的熒光仍存在明顯差異，其中以樣品5和6最爲明顯。而被硫熏的人參樣品，其熒光則非常類似於非硫熏樣品。非硫熏的人參其熒光仍存在個體差異，其中2個樣品的熒光強度較其他為強及明顯。黨參内的乳管群及人參内的樹脂道，其熒光強度及顔色最爲突出。 結論：研究結果表明不同來源的樣品，其熒光特徵存在區別。熒光顯微鑑定技術不能有效鑒別市場上的黨參和人參是否經過硫磺熏蒸。熒光顯微鑑定硫磺熏蒸中藥方面的應用有待深入及系統探討。 關鍵詞：硫磺熏蒸；黨參；人參；熒光顯微鏡；中藥鑒別；高效液相色譜-四極杆飛行時間串聯質譜(UHPLC-QTOF/MS)

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Adverse drug reactions (ADRs) are a significant public health problem. This thesis examined the incidence and nature of adverse drug reactions following admission to hospital. An initial pilot study was conducted to develop methodology, which was then utilised in a study of 3695 patients. Approximately 15% of patients experienced an ADR following admission, of which one-third were serious Commonly used drugs such as opioids, diuretics and anticoagulants were the most frequent causes of ADRs. Bleeding, renal impairment and Clostridium difficile were the ADRs with the greatest impact on patient length of stay and thus should be key areas for intervention strategies. Adoption of methods used in the assessment of hospital patient safety incidents such as root-cause analysis may help in identifying underlying factors leading to ADRs as well highlighting the importance of ADRs to senior hospital managers.