INTRODUÇÃO: A hipertensão renovascular (HRV) decorrente da estenose de artéria renal (EAR) é uma patologia potencialmente curável, mas os benefícios da revascularização não são alcançados por todos porque selecionar pacientes com base nos critérios clínicos ou angiográficos pode não ser suficiente para se obter o sucesso clínico. Existe um grande interesse em se desenvolver exames para detectar a presença de EAR e avaliar seu significado funcional. OBJETIVOS: avaliar se a redução da Taxa de Filtração Glomerular (TFG) medida com EDTA-51Cr após o uso de captopril consegue diferenciar pacientes hipertensos com EAR daqueles sem estenose da artéria e avaliar se existe correlação entre as variações da TFG e a evolução de pacientes submetidos a diferentes tratamentos. MÉTODOS: Foram estudados 41 pacientes com hipertensão arterial de difícil controle que foram divididos em dois grupos: GP: 21 pacientes com EAR e GH: 20 pacientes sem EAR. Os pacientes foram submetidos à medida de TFG com EDTA-51Cr pré e após a administração do captopril. Os pacientes do GP realizaram simultaneamente cintilografia com DMSA-99mTc para avaliação da função renal diferencial. Os pacientes com estenose de artéria renal foram subdivididos de acordo com o tratamento recebido: clínico (GP-CL) ou por intervenção (GP-I). As medidas das TFGs antes e após o captopril foram comparadas entre os grupos. Foi também, investigado se a relação pré/pós captopril tinha correlação com a resposta clínica dos pacientes. RESULTADOS: a média da TFG (ml/min./1,73m2) no total de pacientes estudados, foi de 56,7±26,5 na fase pré-captopril e 47,0±24,4 após o captopril. A modificação da TFG determinada pelo captopril,foi avaliada pela relação da filtração glomerular pré/pós-captopril. A média da relação TFG pré/pós-captopril foi 1,36 ±0,54 no grupo total de pacientes e quando foi feita a comparação entre a TFG pré e pós-captopril, houve uma redução significativa (p= 0,016). O GH mostrou relação média da TFG pré/pós-captopril de 1,13, valor significativamente menor que o GP que teve a relação média de 1,57 (p= 0,007). Quando foi avaliada a variação da TFG após o captopril nos dois grupos não foi observada diferença estatisticamente significativa no GH (p=0,68), mas observou-se diferença significativa no GP (p<0,001). No total, 15 pacientes apresentaram melhora dos seus níveis pressóricos, sendo oito do grupo de intervenção e sete do grupo clinico, não havendo diferença estatisticamente significativa em relação à melhora clínica entre os dois grupos (p=0,36). Quando comparamos os pacientes com e sem melhora clínica não se observou diferença significativa na TFG basal (p=0,09) ou na relação TFG pré/pós-captopril (p=0,74). A função renal diferencial obtida pelo DMSA-99mTc pré e pós captopril não mostrou diferença estatisticamente significativa nos rins com e sem estenose, (p=0.09). CONCLUSÃO: O captopril acarreta uma redução significativa da TFG e esta redução é mais acentuada em pacientes com EAR, mas não houve correlação entre as mediadas da TFG e a evolução clínica dos pacientes / INTRODUCTION: Renovascular hypertension (RVH) resulting from renal artery stenosis (RAS) is a potential curable pathology, but the revascularization benefits are not reached among all patients because selecting patients on the basis of clinical and angiographic criteria may not be sufficient to achieve clinical success. There has been increasing interest in developing screening tests capable of accurately detecting the presence of RAS and also of evaluating its functional consequences PURPOSE: the purpose of this study was to evaluate if captopril induced changes in 51Cr-EDTA clearance could be used to differentiate between hypertensive patients with and without renal artery stenosis and to investigate if there was a correlation between these changes and patients clinical response to therapy. METHODS: 41 patients with poor-controlled severe hypertension were studied. Patients were divided into two groups: GP=patients with renal artery stenosis (n=21), and GH=patients without renal artery stenosis (n=20). They were submitted to a Glomerular Filtration Rate (GFR) measurement with EDTA-51Cr pre and post captopril administration. The GP patients were submitted simultaneously to 99mTc-DMSA scintigraphies to estimate individual renal function. GP patients were further subdivided according to the treatment strategy: optimization of clinical treatment (GP-Cl) and interventional procedures (GP-I). The GFRs before and after captopril administration were compared between the groups. It was also investigated if baseline to post-captopril GFR ratio had a correlation to clinical response of patients. RESULTS: The GFR average (ml/min./1,73m2) on the total patients, was 56,7±26,5 on pre-captopril phase and 47,0±24,4 post captopril. The GFR alteration determinated by captopril was evaluated by Baseline/post-captopril GFR ratio. Baseline/post-captopril GFR mean ratio was 1,36 in total patients and the GFR had a significant decrease after captopril administration (p value 0.016). Baseline/post-captopril GFR mean ratio in GH was 1.13, value significantly lower than the GP which had the average relation of 1,57 (p= 0,007). When GFR pre and post-captopril was compared among the two groups separately, there was no significantly difference on the GH (p=0,68), but a expressive difference was observed on GP (p<0,001). 15 patients had a clinical response to the treatment. Clinical response was observed in 8/10 patients from GP-I and 7/11 from GP-Cl and there was not observed a significantly difference between the two groups (p=0,36). Comparing the groups with or without clinical improvement there was not a significantly difference on the GRF baseline (p=0,09) or on or baseline/post-captopril ratio (p=0,74). When evaluating the differential renal function obtained by pre and post-captopril DMSA-99mTc, significantly difference was not observed (p=0.09) for the kidneys with or without stenosis. CONCLUSION: captopril induced a decrease in GFR of hypertensive patients and it is more pronounced in patients with renal artery stenosis, but no correlation was observed between captopril induced decrease in GFR and clinical response of patients submitted to interventional or clinical treatment

<p>Funkcija nosa povezana je sa različitim anatomskim, fiziolo&scaron;kim i emocionalnim faktorima. Postoji mnogo teorija koje su poku&scaron;ale da objasne efekat ženskih polnih hormona (estrogena i progesterona) na fiziologiju nosa, ali sam mehanizam njihovog dejstva jo&scaron; uvek ostaje izazov za mnoge istraživače. Prethodno je opisano da ženski polni hormoni mogu da izazovu nazalnu opstrukciju, povećavajući ekspresiju histaminskih H1 receptora i menjajući koncentraciju neurotransmitera, &scaron;to dovodi do edema nosne sluznice i modifikacije nazalnog otpora. Kada je reč o mirisnoj funkciji na malom broju ispitanika i u različito dizajniranim studijama je pokazano da je u fazi ovulacije mirisni prag značajno niži u odnosu na folikularnu i luteinsku fazu, međutim ne postoje podaci o identifikaciji i diskriminaciji mirisa u menstrualnom ciklusu. Nizak nivo estrogena prouzrokovan fiziolo&scaron;kom atrofijom jajnika u postmenopauzi može dovesti do hiposmije ili čak anosmije, &scaron;to predstavlja jo&scaron; jedan dokaz o osetljivosti nazalne sluznice na estrogen.&nbsp; Cilj ovog istraživanja je bio da se ispita uticaj ženskih polnih hormona na respiratornu i mirisnu funkciju nosa u menstrualnom ciklusu i postmenopauzi. Istraživanje je u celosti prospektivno, sprovedeno je na Zavodu za fiziologiju, Medicinskog fakulteta, Univerziteta u Novom Sadu. Uključeno je 204 osoba ženskog pola koje su bile podeljene u dve grupe. Prvu grupu su činile 103 devojke uzrasta 23,126 &plusmn; 4,597 godina u reproduktivnom periodu sa regularnim menstrualnim ciklusom i 101 žena prosečnog uzrasta 60,069 &plusmn; 5,570 u postmenopauzi. Respiratorna i mirisna funkcija nosa procenjene su uz pomoć odgovarajućih standaradizovanih objektivnih i subjektivnih metoda. Funkcija donjih disajnih puteva ispitana je uz pomoć spirometrije. Kod žena u reproduktivnom periodu testiranje se vr&scaron;ilo u fazi ovulacije i lutealnoj fazi menstrualnog ciklusa, a kod ispitanica u postmenopauzi jednom. Nakon određivanja prvog plodnog dana ispitanice su uz pomoć standardizovanih urin - tračica za određivanje pika luteinizirajućeg hormona u urinu utvrđivale momenat ovulacije, dok se drugo testiranje u lutealnoj fazi vr&scaron;ilo sedam dana nakon prvog. Respiratorna funkcija nosa je značajno lo&scaron;ija u fazi ovulacije u odnosu na progesteronsku fazu menstrualnog ciklusa,ali se značajno ne razlikuje između žena u reproduktivnom periodu i žena u postmenopauzi. Subjektivni osećaj nazalne opstrukcije značajno se ne razlikuje u različitim fazama menstrualnog ciklusa, kao ni između testiranih populacija zdravih žena. Sposobnost identifikacije mirisa je statistički značajno slabija, a subjektivni osećaj intenziteta mirisa izraženiji u fazi ovulacije u odnosu na luteinsku fazu menstrualnog ciklusa. Međutim, sposobnost identifikacije mirisa značajno je lo&scaron;ija kod žena u postmenopauzi u odnosu na obe faze menstrualnog ciklusa. Reaktivnost nosne sluznice značajno je veća u fazi ovulacije u odnosu na lutealnu fazu menstrualnog ciklusa, ali se ista ne razlikuje između žena u reproduktivnom period i žena u postmenopauzi. Respiratorna i mirisna funkcije nosa u testiranim populacijama zdravih žena nisu značajno povezane.</p> / <p>The nasal function is associated with various anatomical, physiological and emotional factors. There are many theories that have tried to explain the effect of female sex hormones (estrogen and progesterone) on the nasal physiology, but the mechanism still remains unknown for many researchers. It has been previously described that female sex hormones can cause nasal obstruction by increasing the expression of histamine H1 receptors and altering the concentration of neurotransmitters, which leads to edema of the nasal mucosa and modification of nasal resistance. When it comes to olfaction on a small number of subjects and in differently designed studies, it was shown that in the ovulatory phase the olfactory threshold is significantly lower compared to the follicular and luteal phase, however there are no data on the identification and discrimination of odors in the menstrual cycle. Low estrogen levels caused by physiological atrophy of the ovaries in postmenopause can lead to hyposmia or even anosmia, which is another proof of the sensitivity of the nasal mucosa to estrogen.&nbsp; The aim of this study was to examine the effect of female sex hormones on respiratory and olfactory function of the nose in the menstrual cycle and postmenopause. The research is prospective and it was conducted at the Department of Physiology, Faculty of Medicine, University of Novi Sad. It included 204 females who were divided into two groups. The first group consisted of 103 women aged 23.126 &plusmn; 4.597 years in the reproductive period with a regular menstrual cycle and 101 women with an average age of 60.069 &plusmn; 5.570 in the postmenopausal period. The respiratory and olfactory function of the nose were assessed using appropriate standardized objective and subjective methods. The lower airway function was examined using spirometry. Young women in reproductive period were tested twice, in the ovulatory and luteal phase of the menstrual cycle, and the postmenopausal women were tested only once. After menstrual bleeding the participans used standardized urine strips consecutively day by day to determine ovulation (the peak of the luteinizing hormone (LH) in plasma which pointed out the estrogen plasma peak). The test was positive if two horizontal pink streaks appeared on the strip 5 to 10 minutes after the contact with the urine. One pink streak indicates a correctly performed test, while the second streak appears only if there is an LH peak. Within 24 hours of confirmed LH peak, the subjects were tested for the first time. The second measurement was performed in the luteal phase of the menstrual cycle (the progesterone plasma peak) seven days after the first one.&nbsp; The nasal respiratory function is significantly worse in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ significantly between women in the reproductive period and postmenopausal women. The subjective sense of the nasal obstruction does not differ significantly in different phases of the menstrual cycle, as well as between tested populations of healthy women. The odor identification ability is statistically significant weaker and the subjective sense of odor intensity is more pronounced in the ovulatory phase compared to the luteal phase of the menstrual cycle. However, the ability to identify odors is significantly worse in postmenopausal women compared to both phases of the menstrual cycle. The reactivity of the nasal mucosa is significantly higher in the ovulatory phase compared to the luteal phase of the menstrual cycle, but it does not differ between women in the reproductive period and postmenopausal women. The respiratory and olfactory nasal functions in these tested populations are not significantly corelated.</p>

No description available.

Bakgrund: Inom den prehospitala akutsjukvården kan specialistsjuksköterskan möta en stor variation av luftvägsproblematik. Att ställas inför situationer med patienter med ofri luftväg prehospitalt ställer höga krav på specialistsjuksköterskans kunskap och erfarenhet. En ofri luftväg är ett livshotande tillstånd där snabb och korrekt handläggning krävs för att minimera risken för hypoxi, med risk för efterföljande men som fatal utgång. Att identifiera ett luftvägsproblem och sätta in adekvata metoder för att skapa fria luftvägar är något som specialistsjuksköterskan behöver känna sig säker att utföra, vilket innebär att ha en god förmåga att hantera de tekniker och hjälpmedel som finns att tillgå. Syfte: Syftet med studien är att undersöka anestesisjuksköterskors och ambulanssjuksköterskors kunskapsnivå och erfarenhet av att hantera patientens ofria luftväg prehospitalt. Metod: Studien har en kvantitativ ansats. Specialistsjuksköterskor (n=145) verksamma inom den prehospitala akutsjukvården i en region i södra Sverige deltog i studien. Datainsamlingen genomfördes i form av enkäter och datan analyserades i programmet SPSS. Resultat: Studiens fyra huvudsakliga fynd var att ungefär 20 % av respondenterna hade minst en gång under det senaste året varit med om att inte lyckas skapa fria luftvägar. Anestesisjuksköterskor hade en högre självskattad säkerhet inför ofria luftvägar än ambulanssjuksköterskor. Två tredjedelar av respondenterna ville genomföra en repetitionsutbildning i hantering av ofria luftvägar, och hela 83 % av ambulanssjuksköterskorna ansåg att de var i behov av en repetitionsutbildning i att hantera ofri luftväg. Slutsats: Det finns en signifikant skillnad mellan yrkesgrupperna där anestesisjuksköterskor skattar sig säkrare med att hantera utrustningen vid ofria luftvägar jämfört med ambulanssjuksköterskor. Specialistsjuksköterskorna upplever ett behov av ytterligare utbildning samt kompetenskontroll av luftvägshantering.

The differentiation, in an infant with cholestasis, between extrahepatic biliary atresia (EHBA) and the neonatal hepatitis syndrome (NHS) is important in that laparotomy is always indicated in EHBA but is undesirable in NHS. This differentiation is particularly difficult in those infants with complete cholestasis. Hepatobiliary scintigraphy is a commonly used investigation in infants with obstructive jaundice. The scintigraphic demonstration of excretion into the gut excludes extrahepatic obstruction, however, absence of excretion may be due to EHBA, severe cholestasis with patent extrahepatic bile ducts or poor uptake of the agent, and is therefore not diagnostic. This study has examined the quantitative measurement of the hepatic uptake of p-butyl IDA and Sn colloid, and an estimation of liver shape, in a group of patients with complete cholestasis in whom conventional scan interpretation, based on excretion into the-gut, would not be useful. The scans were recorded as dynamic studies and the resultant time-activity curves were subjected to curve fitting to calculate a rate constant for uptake of radiopharmaceutical. Liver shape was determined from the anterior static image of the colloid scan. The results show a significant difference between the EHBA and the NHS patients in the rate of uptake of p-butyl IDA, in the ratio of the rate of uptake of p-butyl IDA/the rate of uptake of colloid and in the measurements used to express liver shape. Using this method of scan interpretation, a diagnostic accuracy of 85% was achieved in this study of patients who clinically, and on scan, had no evidence of bile flow. Hepatic scintigraphy is therefore a useful investigation in the diagnostic work-up of infants presenting with obstructive jaundice even when bile flow is completely absent.

Author of this dissertation presentation discuss in the begining definition and historical consequences of origin and consecutive evolution of the method of percutaneous electrogastrography. Intimately is described physiology, anatomy, embryology and function of gastrointestinal tract with special interest on construction and function of the stomach. Next to this author analyses current knowledge about location and function of the gastric pace setter. The technique of used perctutaneous electrogastrography equipmentt is described. In the second part results of original studies monitoring restoration of peristalsis in perioperative period at patients after open and laparoscopic cholecystectomy and laparoscopic non-adjustable gastric banding are discussed. Furthermore results of EGG measurement of patients with mechanic, vascular and paralytic intestinal obstruction are presented in correlation with plasma levels of interleukin 1β, interleukin-6, procalcitonin and C-reactive protein. Key words: Percutanous electrogastrography, laparoscopic cholecystectomy, laparoscopic gastric bandage, inflammatory mediators, intestinal obstruction.

This thesis deals with legislative obstruction in the United States Senate. It presents the filibuster as one of the key procedural tools in the hands of a legislative minority during the consideration of legislative proposals, presidential nominations and international treaties. At first it presents the main theoretical approaches to the topic and the historical development of Senate procedures. A key theme of the work is the necessity to distinguish between formal and informal provisions that determine how Senate business is conducted, since the formal text of the Standing Rules of the Senate is rutinely bypassed by alternative strategies. The last part of the thesis confronts the existing theoretical approaches with the important procedural changes of the last several years and assesses whether these models are still valid in light of the new Senate procedures.

It is emerging that the brain’s vasculature consists of a highly spatially heterogeneous network; however, information on how various vascular characteristics differ between brain regions is still lacking. Furthermore, aging studies rarely acknowledge regional differences in the changes of vascular features. The density of the capillary bed is one vascular feature that is important for the adequate delivery of nutrients to brain tissue. Additionally, capillary density may influence regional cerebral blood flow, a parameter that has been repeatedly correlated to cognitive-behavioural performance. Age-related decline in capillary density has been widely reported in various animal models, yet important questions remain concerning whether there are regional vulnerabilities and what mechanisms could account for these regional differences, if they exist. Here we used confocal microscopy combined with a fluorescent dye-filling approach to label the vasculature, and subsequently quantified vessel length, tortuosity and diameter in 15 brain regions in young adult and aged mice. Our data indicate that vessel loss was most pronounced in white matter followed by cortical, then subcortical gray matter regions, while some regions (visual cortex, amygdala, insular cortex) showed little decline with aging. Changes in capillary density are determined by a balance of pruning and sprouting events. Previous research showed that capillaries are naturally prone to plugging and prolonged obstructions often lead to vessel pruning without subsequent compensatory vessel sprouting. We therefore hypothesized that regional susceptibilities to plugging could help predict vessel loss. By mapping the distribution of microsphere-induced capillary obstructions, we discovered that regions with a higher density of persistent obstructions were more likely to show vessel loss with aging and vice versa. Although the relationship between obstruction density and vessel loss was strong, it was clear obstruction rates were insufficient to explain vessel loss on their own. For that reason, we subsequently used in vivo two-photon microscopy to track microsphere-induced capillary obstructions and vascular network changes over 24 days in two areas of cortex that showed different magnitudes of vessel loss and obstruction densities: visual and retrosplenial cortex. Surprisingly, we did not find evidence for differences in vessel pruning rates between areas, as we would have expected. Instead, we observed brain region-specific differences in recanalization times and rates of angiogenesis. These findings indicate that age-related vessel loss is region specific and that regional susceptibilities to capillary plugging and angiogenesis must be considered to explain these differences. Altogether, this work supports the overarching hypothesis that regional differences in vascular structure and function contribute to a regionally heterogeneous phenotype in the aging brain. / Graduate

Contribution of daylight to employees in terms of health, productivity, and overall wellness in the office spaces are undeniable. Apart from the psychological and biological benefits of employees, embracing daylight in office spaces increases the energy-efficiency of the building which leads to the sustainable development of a city. However, a considerable number of employees in Sweden lack daylight in their workspaces according to a report by the Swedish Work Environment Authority [Arbetsmiljöverket (Swedish)] (Lowden, 2019). Professionals like Architects, Lighting Designers, and students of architecture and lighting design across Sweden were asked their opinions pertaining to lack of daylight in a considerable number of office spaces in Sweden based on their experience through online questionnaires/ interviews to get to know the overview of this subject. Out of all the possible reasons, window design and economy were the two macro factors according to them that influenced daylight in an office building in Sweden but often, obstruction angle in a building due to urban densification is overlooked when it comes to daylight in an office building. This thesis discusses the influence of obstruction angles with an illustrated office building in Stockholm. Diva for Rhino was the software used for the modelling and daylight simulation.

Background – Feeding horses round bale hay (RBH) has been associated with airway inflammation. The purpose of this study was to determine if horses fed RBH for a 6-week period demonstrated more evidence of airway inflammation than horses fed square bale hay (SBH) of comparable quality. Hypothesis - The respiratory health of horses fed RBH will not differ from horses fed SBH of comparable quality. Animals – Two feeding groups of 15 healthy horses (mixed ages, breeds) from the University riding program. Methods – This was a prospective study performed during fall of 2009. At the beginning and end of a 6- week feeding trial, horses were examined (physical, upper airway endoscopic) and samples (tracheal aspirate (TA), bronchoalveolar lavage (BAL)) collected for cytology and/or bacterial/fungal culture. Hay was analyzed for nutritional value and bacterial/fungal content. Results – Horses fed RBH demonstrated an increase in pharyngeal lymphoid hyperplasia (p=0.0143) and percentage neutrophils (p=0.0078) in the TA samples post-feeding as compared to pre-feeding values. Nutritional analysis of hay and measurements of bacterial/fungal load did not differ over time and/or between hay types. Conclusions and clinical importance – The identification of airway inflammation in the horses fed RBH indicates that factors associated with the manner in which the hay is fed and consumed contribute to the development of subclinical airway inflammation. RBH affords horses continuous daily exposure to hay and as horses bury their muzzles in the bale, exposure to particulate matter is likely increased. These factors may partially explain the response in horses fed RBH. Further studies are required to confirm these predictions. / Master of Science