Introdução. A hidrocefalia é uma doença de complexa fisiopatologia, que não só afeta a dinâmica do líquido cefalorraquidiano (LCR), mas também outras estruturas do sistema nervoso central, e consequentemente pode trazer sequelas graves em crianças. Sua fisiopatologia, principalmente no nível bioquímico-celular, ainda é pouco conhecida. Objetivos. Avaliar aspectos clínicos (ganho ponderal, comportamento motor e memória), radiológicos (razão ventricular e transferência de magnetização), histopatológicos (astrocitose reativa e proliferação celular na matriz germinativa) e bioquímicos (presença de interleucinas inflamatórias no líquor) na fase aguda da hidrocefalia experimental induzida por caulim e o efeito do tratamento com derivação adaptada (ventrículo-subcutânea). Materiais e métodos. Utilizaram-se ratos Wistar com 7 dias de vida, que foram divididos em três grupos: controle sem injeção de caulim (n = 5), hidrocefálico sem tratamento (n=17), e hidrocefálico tratado com derivação ventrículo-subcutâneo (DVSC), a partir do 7o dia pós-indução (n=24). Os animais dos grupos hidrocefálicos tratado e não tratado receberam uma injeção de caulim a 15% na cisterna magna, para a indução da hidrocefalia, no 7o dia do estudo. Resultados. O ganho de peso foi semelhante nos grupos hidrocefálicos mas menor que no grupo controle. Animais tratados e não tratados exibiram desempenho inferior aos controles no comportamento motor pelo teste Open Field, ao passo que o desempenho no teste de memória foi melhor no grupo tratado. A DVSC reduz drasticamente as dimensões ventriculares, porém não reverte a desmielinização causada pela hidrocefalia, como visto na avaliação por ressonância magnética. Da mesma forma, os processos de astrocitose reativa (que aumenta com a hidrocefalia) e proliferação na matriz germinativa (que se reduz) não se alteram após o tratamento com a DVSC. A hidrocefalia aumenta os níveis liquóricos das interleucinas 1? e 6 e TNF-?, que retornam ao normal após o tratamento. Conclusões. O tratamento com a DVSC foi eficaz (considerando-se a redução ventricular) e trouxe benefícios comportamentais e celulares, porém não foi suficiente para alterar o curso dos processos de injúria e reparação celular cerebral já estabelecidos. Depreende-se que há participação de mecanismos inflamatórios neste modelo de hidrocefalia experimental a partir do achado de aumento de interleucinas inflamatórias no líquor / Introduction. Hydrocephalus is a complex disease, which affects not only cerebrospinal fluid dynamics, but also other cerebral structures, and therefore may result in severe disability for children. Its pathophysiology is still widely unknown, especially on a cellular-biochemical level. Objectives. Assessment of clinical (weight gain, behavior), radiological (ventricular index and magnetization transfer ratio), histopathological (reactive astrocytosis and cell proliferation over the germinal matrix) and biochemical (dosage of inflammatory interleukins) aspects of acute kaolin-induced experimental hydrocephalus and the effects of the treatment with an adapted shunt (ventricular-subcutaneous). Methods. 7-day-old Wistar rats were divided into three groups: untreated hydrocephalic (n=17), hydrocephalic treated with shunt on the 7th day after induction (n=24) and controls (n=5). Hydrocephalic animals, both treated and untreated, were injected with a 15% kaolin solution on the cisterna magna, to produce hydrocephalus. Results. Weight gain was similar on both hydrocephalic groups but lower than in controls. Motor behavior was also worse than controls for both groups, but treated animals showed better memory performance than their untreated counterparts. Shunting drastically reduces ventricular size, even though it does not reverse demyelination caused by hydrocephalus, as seen in magnetic resonance scanning analyses. Likewise, reactive astrocytosis and cell proliferation at the germinal matrix do not change after treatment. Interleukins 1? and 6 and TNF-? levels are raised in hydrocephalic rats and return to normal after shunting. Conclusions. The ventricular-subcutaneous shunt for treatment of kaolininduced hydrocephalus in rats is effective (i.e, reduces ventricular size) and has clinical and histological benefits, but is not enough to change the evolution of previously established injury and cellular reparation processes on the hydrocephalic brain. The finding of raised inflammatory interleukins on the cerebrospinal fluid suggests a role for inflammation in the pathogenesis of this experimental model of hydrocephalus

Orientador: Edmur Franco Carelli, Helder Jose Lessa Zambelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T10:27:48Z (GMT). No. of bitstreams: 1 DalFabbro_Mateus_M.pdf: 627253 bytes, checksum: e7dc6279817a6c66308fc4d45f8d1a59 (MD5) Previous issue date: 2008 / Resumo: Introdução: A hidrocefalia congênita é uma condição freqüente, estando associada a um terço de todas as malformações congênitas do sistema nervoso. O conhecimento clínico e epidemiológico da hidrocefalia congênita e dos variados fatores etiológicos e prognósticos a ela relacionados são até o momento insuficientes para a compreensão global e otimização do tratamento desta complexa patologia. Objetivos: analisar o prognóstico comparativo de hidrocéfalos com e sem mielomeningocele. Métodos: trata-se de um estudo retrospectivo descritivo, através da revisão dos prontuários de 168 neonatos nascidos no Centro de Assistência Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM - UNICAMP), Campinas - SP - Brasil, divididos em duas amostras: grupo 1 (G1), composto de 98 neonatos com hidrocefalia congênita não associada a mielomeningocele; grupo 2 (G2), composto por 70 neonatos com hidrocefalia congênita associada a mielomeningocele. Foram estudadas as comparativamente as seguintes características: idade materna, número de gestações, realização de pré-natal, apresentação fetal, tipo de parto, idade gestacional ao diagnóstico, idade gestacional ao nascimento, índice de Apgar ao 1o e 5o minutos, incidência de baixo peso, graduação ecográfica da hidrocefalia, tratamento cirúrgico de hidrocefalia, complicações dos shunts, duração da primeira internação, mortalidade na primeira internação, mortalidade no seguimento, incidência de retardo neuropsicomotor (RDNPM). Resultados: seguimento médio: G1 42 meses, G2 60 meses; parto cesáreo: G1 69,4%, G2 91,2% (p<0,05); baixo peso: G1 32,7%, G2 10% (p<0,005); Apgar 1o minuto < 8: G1 58,2%, G2 30% (p<0,025); hidrocefalia acentuada: G1 59,2%, G2 28,6% (p<0,005); realização de derivação ventrículo-peritoneal (DVP) na 1a internação: G1 34,7%, G2 71,4% (p<0,005); mortalidade na 1a internação G1 24,4%, G2 10% (p<0,05); internação menor que 5 dias G1 46,9%, G2 12,8% (p<0,005); RDNPM no seguimento G1 70,8%, G2 42,8% (p<0,05). Conclusão: os resultados revelam um prognóstico ruim para a hidrocefalia congênita, caracterizado por alto índice de mortalidade e alta incidência de RDNPM. Os pacientes com hidrocefalia acentuada (grave) pela ecografia apresentam pior prognóstico. A maior incidência de baixo peso, de hidrocefalias acentuadas, de óbitos no período neonatal e de RDNPM no grupo 1 revelam um pior prognóstico dos neonatos com hidrocefalia não associada a mielomeningocele quando comparada aos neonatos com hidrocefalia associada a mielomeningocele. / Abstract: Introduction: Congenital hydrocephalus is a frequent condition, and it is associated with one third of all Central Nervous System (CNS) malformations. The clinical and epidemiological knowledge about congenital hydrocephalus and the related risk and outcome predicting factors are still insufficient for the thorough comprehension of such a complex condition and for the optimization of its treatment. Objectives: to study comparatively the prognosis of hydrocephalic newborns with and without meningomyelocele (MMC). Methods: this is a retrospective study, based on the review of newborn and/or their mother's medical files, comprising 168 patients born at the State University of Campinas, Campinas - SP - Brazil, divided in two groups: group 1 (G1), consisting of 98 hydrocephalic newborns without MMC; group 2 (G2), consisting of 70 hydrocephalic newborns with MMC. These characteristics were comparatively analyzed between the groups: maternal age, number of pregnancies, prenatal diagnosis, fetal presentation, delivery type, gestational age at diagnosis, gestational age at birth, Apgar score at the 1st and 5th minute, low-weight incidence, ecographic severity of hydrocephalus, surgical treatment of hydrocephalus, shunt malfunctions, length of first hospital stay after birth, mortality on 1st hospital stay, mortality on follow-up, incidence of neurodevelopmental delay. Results: mean follow-up: G1 42 months, G2 60 months; cesarean section: G1 69,4%, G2 91,2% (p<0,05); low weight: G1 32,7%, G2 10% (p<0,005); Apgar score at 1st minute < 8: G1 58,2%, G2 30% (p<0,025); severe hydrocephalus: G1 59,2%, G2 28,6% (p<0,005); ventriculoperitoneal (VP) shunt insertion at 1st hospital stay: G1 34,7%, G2 71,4% (p<0,005); mortality at 1st hospital stay: G1 24,4%, G2 10% (p<0,05); length of 1st hospital stay up to 5 days: G1 46,9%, G2 12,8% (p<0,005); neurodevelopmental delay on follow-up: G1 70,8%, G2 42,8% (p<0,05). Conclusion: the results depict a bad outcome related to congenital hydrocephalus, characterized by high mortality and high neurodevelopmental delay rates. Patients harboring severe hydrocephalus on ultrasound present worse outcome. The higher low weight incidence, as well as higher rates of severe hydrocephalus, neonatal deaths and neurodevelopmental impairments on group 1 reveal a worse outcome in newborns with congenital hydrocephalus not related to MMC compared to MMC related hydrocephalic newborns. / Mestrado / Neurologia / Mestre em Ciências Médicas

L'allègement des structures est un enjeu économique important dans les domaines d'activités industrielles telles que l'automobile, l'aéronautique ou le naval, qui intègrent peu à peu les matériaux composites dans la fabrication des structures. Cet allègement s'accompagne d'un raidissement de la matière qui implique des problèmes de vibrations et d'isolation acoustique. Plusieurs méthodes de traitement existent pour diminuer les vibrations ou le bruit rayonné d'une paroi, mais ces méthodes ont l'inconvénient d'augmenter significativement la masse de la paroi. Afin de répondre à cette problématique, il est proposé dans cette thèse de modifier le comportement dynamique des structures à partir d'un réseau périodique de patchs piézoélectriques shuntés avec un circuit électrique dont il est possible de modifier l'impédance. En contrôlant ainsi le comportement dynamique des patchs piézoélectriques, il est possible de contrôler le comportement vibratoire de la structure et donc de traiter les problèmes de transmissions solidiennes ou de transmissions aériennes.La méthode de shunt choisie est la méthode dite de shunt à capacité négative qui permet de modifier la rigidité d'une structure. Cette méthode dite semi-passive présente plusieurs avantages : la mise en œuvre est simple, il est possible d'intégrer les patchs directement à l'intérieur de la paroi, elle consomme une faible quantité d'énergie électrique et sa mise en application est peu onéreuse. / Making the structure lighter is an important economic stake in the field of industrial activities such as automotive, aeronautic or naval, which gradually integrate composite materials in the manufacturing of structures. This reduction of the mass goes along with a stiffening of the matter implying acoustics and vibrations issues. Several methods exist to reduce vibrations or acoustic radiations of structures, but these methods increase the mass. In order to answer the problematic, we propose to change the dynamic behavior of structures with a periodic lattice of piezoelectric patches shunted with an electrical circuit whose the impedance can be controlled. Therefore, the control of the coupled behavior of the piezoelectric patches allows the control of vibrational wave's diffusion inside the structure and so to treat the structure-borne vibrations and airborne acoustics emission. The shunt method chosen is negative capacitance shunt which allows to modify the rigidity of a structure. This semi-passive method has several advantages: the implementation is simple, it is possible to integrate the patches directly inside the wall, it consumes a low amonte of electrical energy and its implementation is inexpensive.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第21837号 / 農博第2350号 / 新制||農||1069(附属図書館) / 学位論文||H31||N5209(農学部図書室) / 京都大学大学院農学研究科地域環境科学専攻 / (主査)教授 田中 千尋, 教授 本田 与一, 准教授 刑部 正博 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

This diploma thesis deals with wattmeters. The introduction is devoted to approach the issue. Subsequently, the principle of sensing of circumferential quantities, sampling theory and basic theory is explained. The next chapter discusses Arduino development kits. The practical part deals with the design of the circuit diagram and the printed circuit board. Further described is designed software. The final part tests the parameters of the designed power meter.

Einleitung: Der portosystemische Shunt (PSS) stellt eine vaskuläre Anomalie dar, die eine direkte venöse Kommunikation des portalen mit dem systemischen Kreislauf ermöglicht. Für die Bestätigung oder den Ausschluss eines makroskopischen PSS ist bildgebende Diagnostik unerlässlich. In der vorliegenden Arbeit wurden computertomographische (CT)-Portographie und Splenoportographie als nicht- bzw. minimalinvasive Verfahren zur Diagnose von PSS beim Hund untersucht. Ziel der Studie war ein Vergleich von CT-Portographie mittels Bolus Tracking (BT) und jeju-naler Portographie im Hinblick auf die Genauigkeit der Shuntlokalisation (intra-, extrahepatisch) und des Shunttyps (Ursprungs- und Mündungsgefäß bei extrahepatischen PSS; rechts-, linksseitig oder zentral bei intrahepatischen PSS). Zudem sollte das BT zur Abschätzung des korrekten Scanzeitpunktes in der CT evaluiert werden (Gruppe 1). In Gruppe 2 sollte mit Hilfe der ultraschallgestützten Splenoportographie die Darstellbarkeit des Portalvenensystems zur Diagnose und Charakterisierung eines PSS sowie Komplikationen durch dieses Verfahren eva-luiert werden. Zudem wurde die Nutzung der ultraschallgestützten Splenoportographie zur Beurteilung eines Restshuntflusses nach chirurgischem Shuntverschluss untersucht. Tiere, Material und Methoden: In die retrospektive Studie wurden Hunde aus dem Patientengut der Klinik für Kleintiere von Februar 2000 bis Dezember 2017 eingeschlossen, bei denen der Verdacht auf einen PSS bestand. Bei Tieren der Gruppe 1 wurde zunächst eine CT-Kontrastmittelstudie durchgeführt, in der Shuntlokalisation und Shunttyp klassifiziert wurden. Diese wurden mit den Befunden der anschließenden jejunalen Porto¬graphie verglichen. Der korrekte Scanzeitpunkt in der CT wurde mit Hilfe des BT ermittelt. Zur Objektivierung des korrekten Scanstarts in der portalvenösen Phase und zur Abgrenzung des Portalvenensystems zum umliegenden Lebergewebe wurden die Schwächungsprofile in der V. portae vor und nach Kontrastmittelgabe sowie im Leberparenchym ermittelt. Eine Kontrastmitteldifferenz zwischen der Portalvene und der Leber von mehr als 50 HU wurde als ausreichend definiert. In der Gruppe 2 wurde mit Hilfe uniplanarer Durchleuchtungsgeräte eine ultraschallgestützte Splenoportographie durchgeführt. Auswertbarkeit des Splenoportogramms und mög-liche Komplikationen sowie Auftreten und Grad des intraabdominalen Kontrastmittelaustrittes wurden notiert. Quantitative Daten wurden auf Normalverteilung getestet (Shapiro-Wilk-Test). Vergleiche zwischen Variablen wurden mit dem Wilcoxon-Mann-Whitney-Test, dem Kruskal-Wallis-Test bzw. dem exakten Test nach Fisher durchgeführt. Ergebnisse: Bei 54 der 59 Patienten (91,5 %) der Gruppe 1 stimmte die Lokalisation und der Typ des PSS in CT-Portographie und jejunaler Portographie überein. Bei 5 Hunden erfolgte hingegen eine differierende Befundung hinsichtlich der Shuntlokalisation (n = 2) oder des Shunttyps (n = 3) in der CT-Portographie. Bei 13 Hunden (22,0 %) lag die Differenz zwischen dem Enhancement der Portalvene und des Leberparenchyms in der CT unter den geforderten 50 HU, bei 46 Hunden (77,9 %) lag sie darüber. Dennoch war bei allen Hunden eine sichere Identifikation der V. portae nach CT-Angiographie mittels Bolus Trackings möglich. Bei allen 42 Tieren der Gruppe 2 ermöglichte die ultraschallgestütze Splenoportographie eine adäquate Darstellung des Portalvenensystems. Bei 25 Hunden konnte ein PSS ausgeschlossen, bei 10 ein PSS diagnostiziert werden. Komplikationen oder Blutungen wurden nicht beobachtet. Bei 18 Hunden trat kein, bei 13 ein geringgradiger, bei 7 ein mittelgradiger und bei 4 ein hochgradiger Kontrastmittelaustritt auf. Es lag kein Zusammenhang zwischen dem Grad des intraperitonealen Kontrastmittelaustrittes und dem Gewicht und der Lagerung der Hunde oder der Induktion einer Apnoephase vor. Schlussfolgerungen: Die CT-Portographie lässt eine sichere Klassifizierung der Shuntform bei Hunden mit PSS zu. Die diagnostische Wertigkeit der nicht invasiven CT-Portographie mit Hilfe von BT ist vergleichbar mit der jejunalen Portographie. Durch das BT wurde eine gute Synchronisation des Kontrastmittelbolus mit dem Scanstart erreicht und eine adäquate Kontrastierung des Portalvenensystems ermöglicht. Die Splenoportographie unter sonographi-scher Kontrolle stellt ebenfalls ein sicheres minimalinvasives Diagnostikum zur Diagnose bzw. zum Ausschluss portalvenöser Anomalien dar.

The purpose of this study was to investigate further the characteristics of hearing loss in ventriculoperitoneal (VP) shunted hydrocephalus. Twelve (VP) shunt treated hydrocephalus children participated in this study. The etiology of the hydrocephalus was either intraventricular hemorrhage or spina bifida. A recent neurological examination reported the shunt to be patent in each child. Audiometric examination included pure tone air conduction thresholds, tympanometry, contralateral and ipsilateral acoustic reflex thresholds and distortion product otoacoustic emissions (DPOAEʹs). A unilateral, high frequency, sensorineural hearing loss was found in the ear ipsilateral to shunt placement in 10 (83%) of the 12 shunt treated hydrocephalic children. No hearing loss was observed the ear contralateral to shunt placement. Based on the pure tone findings coupled with the decrease in DPOAE amplitude in the shunt ear, the hearing loss appears to be cochlear in nature. It is hypothesized that the cochlear hydrodynamics are disrupted as the result of fluid pressure reduction within the perilymph being transmitted via a patent cochlear aqueduct as a reaction to the reduction of CSF via a patent shunt. In addition, a concomitant brainstem involvement is evidenced in the ART pattern possibly produced by the paten shunt draining CSF from the subdural space resulting in cranial base hypoplasia.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18457号 / 医博第3912号 / 新制||医||1004(附属図書館) / 31335 / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 羽賀 博典, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background: It has been reported that transjugular intrahepatic portosystemic shunting (TIPS) might be utilized as a salvage option for hepatorenal syndrome (HRS), while randomized controlled trials are pending and real-world contemporary data on inpatient mortality is lacking. Methods: We conducted an observational retrospective cohort study from the National Inpatient Sample from 2005 to 2014. We included all adult patients admitted with HRS and cirrhosis, using ICD 9-CM codes. We excluded cases with variceal bleeding, Budd–Chiari, end-stage renal disease, liver transplant and transfers to acute-care facilities. TIPS’ association with inpatient mortality was assessed using multivariable mixed-effects logistic regression, as well as exact-matching, thus mitigating for TIPS selection bias. The exact-matched analysis was repeated among TIPS-only versus dialysis-only patients. Results: A total of 79,354 patients were included. Nine hundred eighteen (1.2%) underwent TIPS. Between TIPS and non-TIPS groups, mean age (58 years) and gender (65% males) were similar. Overall mortality was 18% in TIPS and 48% in dialysis-only cases (n = 10,379; 13.1%). Ninety six (10.5%) TIPS patients underwent dialysis. In-hospital mortality in TIPS patients was twice less likely than in non-TIPS patients (adjusted odds ratio [aOR] = 0.43, 95% CI 0.30–0.62; p < 0.001), with similar results in matched analysis [exact-matched (em) OR = 0.39, 95% CI 0.17–0.89; p < 0.024; groups = 96; unweighted n = 463]. Head-to-head comparison showed that TIPS-only patients were 3.3 times less likely to succumb inpatient versus dialysis-only patients (contrast aOR = 0.31, 95% CI 0.20–0.46; p < 0.001), with similar findings post-matching (emOR = 0.22, 95% CI 0.15–0.33; p < 0.001; groups = 54, unweighted n = 1457). Conclusions: Contemporary, real-world data reveal that TIPS on its own, and when compared to dialysis, is associated with decreased inpatient mortality when utilized in non-bleeders-HRS patients. Further randomized studies are needed to establish the long-term benefit of TIPS in these patients.