Orientador : Marcos Antonio Tambascia / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-01T16:33:18Z (GMT). No. of bitstreams: 1 GelonezeNeto_Bruno_D.pdf: 17945718 bytes, checksum: be1b29f1fb065e61a830d7b3f6bba826 (MD5) Previous issue date: 2001 / Resumo: A obesidade é um estado de resistência à insulina por excelência, e as morbidades metabólicas associadas compõem a chamada síndrome de resistência à insulina. Estas morbidades estão sensivelmente aumentadas na obesidade mórbida. O impacto da perda de peso na restauração da boa forma metabólica tem sido observado em séries clínicas em pacientes morbidamente obesos, mas os tratamentos conservadores têm sido ineficazes quanto à manutenção da perda de peso. A cirurgia bariátrica é o método mais radical para o tratamento da obesidade, sendo reservada para os casos de índice de massa corporal maior que 40 Kglm2, ou maior que 35 Kglm2 quando associado à co-morbidades significativas. A cirurgia antiobesidade leva a melhora de parâmetros metabólicos, em especial no diabetes tipo 2. No entanto, existem poucos estudos sobre o impacto da cirurgia sobre a resistência à insulina nestes pacientes. Além disso, não existem estudos pós-cirúrgicos correlacionando os achados clínicos de melhora metabólica com o aumento da ação insulínica.A partir do interesse em estudar a sensibilidade insulínica após a perda maciça de peso, nós realizamos prospectivamente em cinco diferentes momentos durante um ano de seguimento pós-cirúrgico, dois diferentes testes para avaliação da resistência à insulina: o teste de tolerância à insulina (Kitt) e o modelo homeostático da glicose (Homahomeostasis model assessement). Nós pudemos observar um paralelismo da melhora da resistência à insulina e dos parâmetros metabólicos (homeostasia da glicose e perfil lipídico), além do comportamento da leptina, em uma série de pacientes com tolerância normal à glicose, intolerância a carboidratos e diabetes. A maior contribuição do presente estudo foi estabelecer as correlações entre a melhora da condição metabólica, especialmente reversão do diabetes e da dislipidemia, e a redução da resistência à insulina. Além disso, observamos que o principal determinante da leptinemia foi à variação de peso e não a mudança da sensibilidade insulínica. Concluindo, a cirurgia bariátrica constitui-se num método eficiente para restaurar certos distúrbios metabólicos da obesidade mórbida, e o mecanismo determinante desta condição é a melhora da sensibilidade à insulina / Abstract: Obesity is an insulin resistance state par excellence, and the metabolic co-morbidity is part of a multifaceted syndrome called the insulin resistance syndrome. The morbidity in severely obese subjects has increased dramatically. The impact of weight loss in the restoration of metabolic fitness has been detected in many clinical series of severely obese patients, but conservative methods in treating class li obesity have been unsuccessful in securing significant weight loss as well as its maintenance. Bariatric surgery is the most radical treatment for obesity, generally being recommended for class li obesity or class II with severe co-morbidity. Data on bariatric surgery have shown improvement in metabolic parameters and particularly in glycemic control in Type 2 diabetic patients. Rowever, little data is available in regard to insulin resistance in severely obese patients. Moreover there are no studies correlating the metabolic improvement and changes in insulin sensibility afier surgery. As we were interested in studying the insulin sensitivity when morbidly obese patients loose massive amounts of weight, we assessed insulin resistance performing an insulin tolerance test (Kitt) and homeostasis model assessment (Roma) prospectively in a surgical series of patients while observing the correlation between amelioration in insulin resistance (Kitt) in parallel with improvement of the metabolic parameters (glucose homeostasis and lipid profile) and changes in leptin levels over a range of glucose tolerance from normal to diabetes. The most relevant contribution of this study was to establish the relationship between improvement in metabolic condition with reduction in insulin resistance, especially reversion of diabetes and dyslipidemia. Furthermore, we could observe that body mass index was the main determinant of the circulating leptin concentration, not depending on insulin action variation. In conclusion, bariatric surgery is an efficient method in restoring metabolic derangement associated with severe obesity, and the main determinant of this condition was the improvement in insulin sensibility / Doutorado / Endoclinologia / Doutor em Clínica Médica

Orientadores: Ilka de Fatima Santana Ferreira Boin, Luis Alberto Magna / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T18:22:16Z (GMT). No. of bitstreams: 1 Silva_AureaMariaOliveirada_M.pdf: 16990041 bytes, checksum: fd3d7bf699510d36cefe245c1f3e6f5c (MD5) Previous issue date: 2003 / Resumo: A obesidade mórbida tem como um dos fatores de co-morbidade as complicações respiratório, principalmente pelo fator restritivo da caixa torácica e pelo acúmulo adiposo em vias aéreas superiores. Por esse motivo existe sempre a indicação de perda de peso para evitar a morte súbita. Um dos tratamentos preconiza dos para essa perda de peso rápido é a cirurgia bariátrica, com várias técnicas e derivações. A fisioterapia pré e pós-operatória de cirurgia abdominal do andar superior se torna necessária para se evitar. complicações respiratórias, sendo de vital importância uma boa anamnese para se verificar a maior probabilidade dessas complicações. Dentro deste contexto, a verificação na melhora respiratória deste paciente obeso frente a uma perda significativa de peso, tornou-se o objetivo deste trabalho. Foram coletados dados de 50 pacientes obesos em pré e pós-operatório de cirurgia bariátrica do Hospital das Clínicas da Unicamp, no período entre março de 2000 a março de 2002, tendo sido realizadas avaliações respiratórias com espirometria, gasometria arterial, manovacuometria, incentivador da respiração, ausculta pulmonar e anamnese. A pesquisa aconteceu em quatro momentos: pré-operatório, primeiro dia,de pósoperatório, décimo-quarto dia de pós-operatório e trigésimo dia de pós-operatório. Os dados obtidos foram estudados estatisticamente nos pacientes que compareceram nas avaliações solicitadas. Os resultados das avaliações efetuadas não mostraram diferença estatisticamente significante quando comparadas nos diversos momentos do estudo, não havendo, nesse período, complicações respiratórias pós-operatórias / Abstract: Respiratory difficulty is an important co-morbidity factor in morbid obesity, due to the restriction caused by the chest wall and the increase of adipose tissue in the upper airway tract. In order to avoid sudden death of obese patients, weight 1055is recommended, and bariatric surgery is one of the procedures used to achieve this objective. Pre and postoperative chest physiotherapy of upper abdominal surgery becomes necessary in order to avoid sudden death. Therefore a well-done anamnese before surgery is imperative to verify greater probabilities of these complications. The main objective of this research was to verify the respiratory condition of obese patients after a significant weight 1055. A prospective study was carried out on 50 obese patients in Hospital das Clínicas at the University of Campinas between March/2000 and March/2002. Respiratory data were collected in four moments; before surgery, on the first postoperative day, the fourteenth postoperative day and the thirtieth postoperative day. The endpoints analyzed were the following; spirometry, arterial gasometry, mano-vacuometry, incentive spirometry, pulmonary auscultation and anamnese. The results taken from the evaluations did not show any difference when compared to any moments of the study. No difference was found in any of the endpoints between the different moments of the study. Perhaps, a longer follow-up or a more intense exercise protocol might have been necessary to find significant differences in the results / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Made available in DSpace on 2016-04-28T20:39:27Z (GMT). No. of bitstreams: 1 Renata Koyama.pdf: 559703 bytes, checksum: 36cd84714ba255ce5a188f60fb0624f0 (MD5) Previous issue date: 2007-05-14 / The person with morbid obesity has serious health problems , due to it may occur organic diseases, adverses psychosocial mainly caused by the affected personal mobility. The day-by-day of a morbid obese person is very difficult, due to the lack of mobility, activities like to take shower, to get dressed, to tie the shoes, to walk from a place to another ( because it´s breathtaking ), to enter in a vehicle, to go upstairs and to sit in unapropriated chairs, become hard. This way, the bariatric surgery arises as an invasive and extreme treatment, resulting in loss of weigth in a short period of time, modifying quickly the physical structure causing psychological and social changes to the person; and the mobility of the person after some months of the surgery can be modified. The objective of this work in a phenomenonlogic focus is to identify the meaning of mobility for obeses patients after the bariatric surgery, faced with the fast corporal change; being important the psychological treatment after the surgery and the relation of mobility in this context, to contribute with more information about the difficulties the patients go through. The results that were found about the meaning of mobility three months after bariatric surgery are: joy, happiness, victory, they felt like another person and better than before, the most important thing in life and all / A pessoa portadora de obesidade mórbida possui sérios problemas de saúde, pois dela decorrem doenças orgânicas e psicossociais adversos que em grande parte advém de sua mobilidade pessoal prejudicada. O dia-a-dia da pessoa obesa mórbida é muito difícil, pois entre as dificuldades de sua mobilidade estão o tomar banho, vestir-se, amarrar os sapatos, deslocar-se de um lugar ao outro devido a falta de ar, entrar num veículo, subir escadas, sentar-se nas cadeiras de ambientes sociais que são pequenas e frágeis, entre outros. Dessa forma, a cirurgia bariátrica surge como um tratamento invasivo e radical, tendo um resultado de emagrecimento em curto espaço de tempo, modificando rapidamente a estrutura física que conseqüentemente acarreta mudanças psicológicas e sociais na pessoa; e a mobilidade da pessoa após alguns meses da cirurgia exige reorganização radical. O presente trabalho sob o enfoque fenomenológico, procura identificar o significado da mobilidade para pacientes obesos, após a cirurgia bariátrica, face a rápida mudança corporal; sendo importante no tratamento pós cirúrgico o acompanhamento psicológico e a relação da mobilidade neste contexto, para que venha contribuir com mais informações sobre as dificuldades por que passam esses pacientes. Os resultados encontrados sobre o significado da mobilidade nos três meses pós-cirúrgico bariátrico foram: alegria, felicidade, vitória, ser outra pessoa, bem melhor que antes, a coisa mais importante na vida e tudo

[pt] Este trabalho resulta de um estudo onde se objetivou investigar o que é a obesidade mórbida para além do seu visível acúmulo de gordura. Por um lado, inserida em uma cultura com características muito específicas, como beleza, corpo trabalhado, agilidade, hedonismo e autonomia, nossa hipótese foi de que a obesidade mórbida é paradigmática nessa sociedade, pois é seu adoecimento por excelência na medida em que se relaciona diretamente com tais características. Paralelamente, a partir do referencial da psicanálise, buscamos entender o laço mortífero entre o grande obeso e a comida, com a hipótese de que o obeso mórbido é um sujeito que não sabe lidar com a falta radical que lhe constitui: comer é preencher essa falta. Para tanto, desenhamos um estudo que desse conta da complexidade de seu objeto sem perder a riqueza da subjetividade envolvida, uma abordagem que se aprofundasse nos significados das ações e relações humanas, um lado não perceptível e não captável em equações e estatísticas. Contamos também com a experiência tida em um hospital público, na qual coletamos as falas que serviram de guia desde o início do estudo, provocando a teoria em seu alcance explicativo e sendo utilizadas como vinhetas clínicas ao longo do trabalho. O modo como temos lidado com a obesidade mórbida requer uma análise acurada, caso contrário teremos uma forma de controle do homem e seu corpo e uma subjetividade que, uma vez amordaçada, se torna ainda mais obscura e difícil de manejar. / [en] All solid things are blown to vapor in me refers to a work that had the objective of investigating morbid obesity beyond mere accumulation of fat. The hypothesis is that obesity is paradigmatic of a hedonistic society that valorize the body and its autonomy, because it is the sickening par excellence of this society in a way that it relates directly to these characteristics. Taking as a reference the psychoanalytic theory, this work was also an attempt to understand the deadly connection between obesity and food, hypothesizing that the obese is an individual who is not able to cope with the radical lack that constitute his/her being. Thus, the methodology should cover the complexity of the object as well as the wealth of the subjectivity involved, approaching deeply the meanings of human actions and relationships, which are not easily perceived in equations and statistics. Statements from patients of a public hospital were used as a guide and also as a clinical vignette, which brought consistency to the theory. It is necessary to analyze accurately the way morbid obesity has been dealt; otherwise, society will have a means of controlling man and his body, and if this obese subjectivity is silenced, it will become more obscure and harder to handle.

Made available in DSpace on 2016-04-28T20:40:12Z (GMT). No. of bitstreams: 1 Maria Bernadete de Lourdes Brito Costa.pdf: 787971 bytes, checksum: 5b03b34c88f3e19a060209bb4d7cd013 (MD5) Previous issue date: 2009-10-02 / Obesity is growing among the population in general, a fact which brings serious consequences to a person s physical and mental health. As it is considered a public health problem in Brazil, Bariatric Surgery has been revealing itself as a useful tool in the treatment of morbid obesity. Many studies have shown that excess weight tends to diminish life expectancy and leads to a predisposition for morbidity, the reduction of motor activities, tiredness, a worsening of the quality of life and a rise in problems related to the human psyche. The purpose of this study is to observe and reflect on the psychological effects of the short, focal, group psychotherapy, with a Jungian orientation in morbid obese patients, with periodic eating compulsion disturbance, after bariatric surgery. This treatment will help them in the maintenance of the surgery gains, in other words, weight maintenance, and awareness concerning eating, the body, and periodic eating compulsion, offering a better life quality and also more satisfactory. Six morbid obese patients, just after bariatric surgery, with periodic eating compulsion disturbances took part in the research. They answered the Semi-Structured, Brief interview, (MINI - INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW) and the Scale of Periodic Eating Compulsion (SPEC ECAP), before and after the twelve sessions of group focal psychotherapy, on the themes already proposed. The session was carried out in the attendance room in the Outpatient s department of the Teaching and Research Foundation in Uberaba, an organ linked to the Federal University of the Triângulo Mineiro. The twelve psychotherapy sessions were taped, transcribed and analysed through the test, which verified the words which were most frequently used in the sentences of the patients discourse. The patients development during the proposed therapy was analyzed and shown in graphs. The MINI test showed some small differences which do not interfere in the life experiences of the patients, and does not show any psychiatric disturbance of any intensity which would alter their lives, becoming prejudicial to them. The SPEC (ECAP) showed tendencies to eating compulsion which can be controlled and do not interfere in re-education. The patients propose to continue the treatment after the research. The results show how the psychological part of the participants works after bariatric surgery and the twelve psychotherapy sessions, highlighting changes in the life quality, as well as making life more healthy and satisfactory. It was confirmed that all the participants became aware of the need to love themselves better. It was a rewarding and totally new situation confirmed after Bariatric Surgery / A obesidade vem aumentando na população em geral, o que traz sérias conseqüências para a saúde física e mental do indivíduo. Por ela ser considerada um problema de saúde pública no Brasil, a Cirurgia Bariátrica vêm se mostrando uma ferramenta eficaz no tratamento da obesidade mórbida. Muitos estudos têm demonstrado que o excesso de peso tende a diminuir a expectativa de vida e predispõem a morbidade, a redução das atividades motoras, fadigas, piora da qualidade de vida e aumento de problemas da psique humana. O objetivo deste estudo é observar e refletir sobre os efeitos psicológicos da interferência psicoterapêutica grupal breve, focal e de orientação junguiana, em pacientes obesas mórbidas, com transtorno da compulsão alimentar periódica, pós-cirurgia bariátrica. Tal tratamento poderá auxiliá-las na manutenção dos ganhos cirúrgicos, isto é, manutenção de peso, e na conscientização da alimentação, do corpo e da compulsão alimentar periódica, proporcionando-lhes uma melhor qualidade de vida e mais satisfatória. Participaram da pesquisa seis pacientes obesas mórbidas, pós- cirurgia bariátrica, com o transtorno da compulsão alimentar periódica, que responderam a Entrevista Breve Semi-Estruturada (MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW) e a Escala da Compulsão Alimentar Periódica ( ECAP), antes e depois das doze sessões de psicoterapia grupal focal, com os temas já propostos. A sessão foi realizada na sala de atendimentos do ambulatório da Fundação de Ensino e Pesquisa de Uberaba, órgão ligado à Universidade Federal do Triângulo Mineiro. As doze sessões de psicoterapia foram gravadas, transcritas e analisadas mediante o teste, que verificou as palavras mais freqüentes nas frases do discurso das pacientes. Foi analisada e mostrada em gráfico a evolução das pacientes durante o trabalho proposto. O teste MINI apresentou pequenas diferenças que não interferem nas experiências de vida das pacientes e não demonstra nenhum transtorno psiquiátrico de maior intensidade que altere suas vidas, prejudicando-as. O teste ECAP apresentou tendências de compulsão alimentar que podem ser controladas e não interferem na reeducação. As pacientes se propõem a continuar o tratamento depois da pesquisa. Os resultados mostram o modo de funcionamento psicológico das participantes após a CB e as doze sessões de psicoterapia, assinalando mudanças na qualidade de vida, além de torná-la mais saudável e satisfatória. Constatou-se que todas as participantes se conscientizaram da necessidade de gostarem mais de si mesmas; uma situação gratificante e inteiramente nova obtida depois da CB

<p dir="ltr">Reflectance spectroscopy has been increasingly used in forestry due to its ability to rapidly, efficiently, and non-destructively detect tree stress, enabling timely and cost-effective forest management decisions. This dissertation synthesizes three studies and five experiments to understand and improve our ability to use spectral data to estimate a variety of foliar physiochemical traits and identify spectral responses in multi-stress environments, thus, advancing our understanding and application of hyperspectral data in forest management.</p><p dir="ltr">The first study seeks to refine the hyperspectral approach to monitoring tree stress by selecting optimal wavelength ranges to enhance the estimation of foliar traits, such as CO₂ assimilation rate, specific leaf area, leaf water content, and concentrations of foliar nitrogen, sugars, and gallic acid. The study revealed that model performance varied significantly across the different wavelength ranges tested and consistently, including longer wavelength regions improved trait estimation for all traits modeled. This research also established a framework for discovering novel or previously unknown absorption features associated with functional traits, thereby laying the groundwork for expanded spectral applications. This advancement enables the estimation of diverse foliar traits and facilitates detailed stress detection in trees.</p><p dir="ltr">The second study focuses on assessing the effectiveness of hyperspectral data in estimating foliar functional trait responses to various biotic and abiotic stressors and to differentiate those stressors in black walnut (<i>Juglans nigra </i>L.) and red oak (<i>Quercus rubra</i> L.) seedlings. We demonstrated that spectral data can reliably estimate a wide range of foliar traits, highlighting its potential as a surrogate for reference data in understanding plant responses to stress. This research revealed that spectral leaf predictions can effectively provide stress-specific insights into tree physiochemical responses to biotic and abiotic stressors.</p><p dir="ltr">The third study explores the application of hyperspectral reflectance to identify drought-induced foliar responses in black walnut seedlings during their initial field establishment. Chemometric models developed from greenhouse experiments were applied to spectral data collected in the field to assess their transferability and accuracy in predicting various leaf traits under drought stress. Using only spectral data, we demonstrated that seedlings show distinct spectral responses to past and ongoing drought stress, with varying degrees depending on seed provenances. This research aims to provide practical insights for utilizing spectral analysis in real-world conditions and understanding the challenges of using spectral tools in the field.</p><p dir="ltr">Collectively, this dissertation demonstrates the robust potential of hyperspectral reflectance technology in advancing the monitoring of tree health. By optimizing spectral range selection, reliably estimating tree foliar traits under stress conditions, differentiating various stressors in controlled environments, and effectively detecting current and past drought stress in field conditions, this research offers valuable insights for improving forest health monitoring and management strategies in response to environmental challenges.</p>

<p>Eastern black walnut (<i>Juglans nigra</i> L.) ranks among the most highly valued timber species in the central hardwood forest and across the world. This valuable tree fills a critical role in native ecosystems as a mast bearing pioneer on mesic sites. Along with other <i>Juglans</i> spp. (Juglandaceae), <i>J. nigra</i> is threatened by thousand cankers disease (TCD), an insect-vectored disease first described in 2009. TCD is caused by the bark beetle <i>Pityophthorus juglandis</i> Blackman (Corthylini) and the phytopathogenic fungus <i>Geosmithia morbida</i> Kol. Free. Ut. & Tiss. (Bionectriaceae). Together, the <i>P. juglandis</i>-<i>G. morbida</i> complex has expanded from its historical range in southwest North America throughout the western United States (U.S.) and Europe. This range expansion has led to widespread mortality among naïve hosts <i>J. nigra</i> and <i>J. regia</i> planted outside their native distributions.</p> <p> The severity of TCD was previously observed to be highest in urban and plantation environments and outside of the host native range. Therefore, the objective of this work was to provide information on biotic and abiotic environmental factors that influence the severity and impact of TCD across the native and non-native range of <i>J. nigra</i> and across different climatic and management regimes. This knowledge would enable a better assessment of the risk posed by TCD and a basis for developing management activities that impart resilience to natural systems. Through a series of greenhouse-, laboratory- and field-based experiments, environmental factors that affect the pathogenicity and/or survival of <i>G. morbida</i> in <i>J. nigra</i> were identified, with a focus on the microbiome, climate, and opportunistic pathogens. A number of potentially important interactions among host, vector, pathogen and the rest of the holobiont of TCD were characterized. The <i>holobiont</i> is defined as the whole multitrophic community of organisms—including <i>J. nigra</i>, microinvertebrates, fungi and bacteria—that interact with one another and with the host.</p> <p>Our findings indicate that interactions among host, vector, pathogen, secondary pathogens, novel microbial communities, and novel abiotic environments modulate the severity of TCD in native, non-native, and managed and unmanaged contexts. Prevailing climatic conditions favor reproduction and spread of <i>G. morbida</i> in the western United States due to the effect of wood moisture content on fungal competition. The microbiome of soils, roots, and stems of trees and seedlings grown outside the host native range harbor distinct, lower-diversity communities of bacteria and fungi compared to the native range, including different communities of beneficial or pathogenic functional groups of fungi. The pathogen <i>G. morbida</i> was also associated with a distinct community of microbes in stems compared to <i>G. morbida</i>-negative trees. The soil microbiome from intensively-managed plantations facilitated positive feedback between <i>G. morbida</i> and a disease-promomting endophytic <i>Fusarium solani</i> species complex sp. in roots of <i>J. nigra</i> seedlings. Finally, the nematode species <i>Bursaphelenchus juglandis</i> associated with <i>P. juglandis</i> synergizes with <i>G. morbida</i> to cause foliar symptoms in seedlings in a shadehouse; conversely, experiments and observations indicated that the nematode species <i>Panagrolaimus</i> sp. and cf. <i>Ektaphelenchus</i> sp. could suppress WTB populations and/or TCD outbreaks.</p> <p>In conclusion, the composition, function, and interactions within the <i>P. juglandis</i> and <i>J. nigra</i> holobiont play important roles in the TCD pathosystem. Managers and conservationists should be aware that novel associations outside the host native range, or in monocultures, intensive nursery production, and urban and low-humidity environments may favor progression of the disease through the effects of associated phytobiomes, nematodes, and climatic conditions on disease etiology. Trees in higher diversity, less intensively managed growing environments within their native range may be more resilient to disease. Moreover, expatriated, susceptible host species (<i>i.e.</i>, <i>J. nigra</i>) growing in environments that are favorable to novel pests or pest complexes (<i>i.e.</i>, the western U.S.) may provide connectivity between emergent forest health threats (<i>i.e.</i>, TCD) and native host populations (<i>i.e.</i>, <i>J. nigra</i> in its native range).</p>