Introdução: O transplante renal é amplamente reconhecido como a melhor forma de tratamento para os pacientes que necessitam de terapia de substituição renal, e isso o torna vítima de seu próprio sucesso. Apesar de ser considerado um triunfo clínico-cirúrgico, é igualmente uma fonte de frustração, pela carência de doadores de órgãos e pelo crescimento das listas de espera. Há necessidade do desenvolvimento de estratégias que tornem maior o número de rins disponíveis para transplante. A idade do doador, o tempo de isquemia fria (TIF) e o HLA (antígeno leucocitário humano de histocompatibilidade) são fatores que estão relacionados à sobrevida do enxerto e, desta forma, envolvidos na diminuição da demanda e no aumento da oferta de órgãos. Objetivos: Avaliar o impacto das variáveis, idade do doador, compatibilidade HLA e tempo de isquemia fria, na sobrevida do enxerto de pacientes submetidos à alotransplantes renais com doador cadáver. Materiais e Métodos: Foram analisados retrospectivamente 454 pacientes submetidos a transplantes renais com doadores cadáveres realizados de abril de 1987 a dezembro de 2003, no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP). Resultados: Das variáveis analisadas, a idade do doador foi a de maior impacto estatístico na sobrevida dos transplantes renais estudados. A sobrevida dos enxertos oriundos de doadores com idade de 16 a 40 anos (143,30 meses em média), foi significativamente maior em comparação com a sobrevida nos grupos com doadores acima de 40 anos (66,46 meses) (p= 0,005) e nos doadores de 0 a 10 anos de idade (63,29 meses) (p= 0,01). A compatibilidade HLA e o TIF não interferiram de modo significativo na sobrevida dos transplantes estudados (p= 0,98 e p= 0,16 respectivamente). Conclusões: O tempo de isquemia fria (TIF) e a compatibilidade HLA não apresentaram impacto na sobrevida dos transplantes renais analisados. Os doadores cadáveres com idade de 16 a 40 anos podem ser considerados ideais, uma vez que demonstraram, de modo estatisticamente significativo, impacto favorável na sobrevida dos rins por eles doados. / Introduction: Renal transplantation is world wide recognized as the best therapy for patients that need kidney substitution treatment. It can be considered a clinical and surgical triumph and at the same time, its a form of frustration by the few organs donations available and by the growth of the waiting lists. New strategies are needed to be developed to increase the numbers of kidneys for transplantation. Donors aged, cold ischemia time (CIT) and human leukocyte antigen (HLA) compatibility are correlated with graft survival and consequently, with a diminished organs demand. Objectives: To study the impacts of donors age, cold ischemia time and HLA compatibility, on graft survival patients submitted to cadaver kidney allograft transplantation. Materials and Methods: Records from 454 patients, submitted to cadaver kidneys allograft transplantations between April/1987 and December/2003 by Division of Urology of the Clinical Hospital of Ribeirao Pretos School of Medicine at Sao Paulo University, were analyzed. Results: The age of kidneys donors was the most statistically significant data in the survival graft rate. Donors between 16 and 40 years old had a median survival rate about 143.30 months, that was significantly higher when compared with aged donors above 40 years (66.46 months) (p= 0.005) and below 10 years old (63,29 months) (p= 0.01). In our study, HLA compatibility and cold ischemia time didnt have statistically significant impact on renal allograft survival rate (p= 0.98 and p= 0.16, respectively). Conclusions: HLA compatibility and cold ischemia time didnt have significantly impact on renal allograft survival rate. Donors between 16 and 40 years old can be considered the ideal donors age, since they demonstrated statistically a favorable impact on grafts survival rate.

In der vorliegenden Arbeit wird beschrieben, wie intrapulmonal stufenweise per Instillation gegebenes, hochgereinigtes Perfluorocarbon (FC 3280) die Hämodynamik, die Lungenfunktion und die Überlebenszeit bei ARDS im Tierexperiment beeinflusst. An zwölf anästhesierten wurde eine prospektive, randomisierte und kontrollierte Studie durchgeführt. Bei den Tieren wurde durch wiederholte Lavagen mit warmem Kochsalz ein Surfactantmangel erzeugt. Anschließend wurden sechs Tiere mit partieller Flüssigkeitsbeatmung (PLV) durch zweimalige Applikation von 7,5 ml/kgKG FC 3280 behandelt (Behandlungsgruppe). In der Kontrollgruppe erhielten 6 Tiere keine weitere Therapie. Die Hämodynamik und der Gasaustausch wurden alle 30 Minuten nach Gabe des PFC kontrolliert. In der Behandlungsgruppe lag der PaO2 nach 7,5 ml/kgKG PFC bei 67 +- 33 mmHg und nach insgesamt 15 ml/kgKG bei 106 +- 74 mmHg. Drei der Tiere sprachen dabei gut auf die Therapie an. Bei ihnen konnten beachtliche Verbesserungen in der Sauerstoffversorgung gezeigt werden. So verbesserte sich der PaO2 von 62 mmHg auf 450 mmHg bei einem der Tiere, welches gut auf PLV ansprach. In der Kontrollgruppe blieb der Gasaustausch jedoch unverändert. Die hämodynamischen Parameter verhielten sich während der ersten 6 Stunden stabil in der Behandlungsgruppe während sich bei den Kontrolltieren die Verhältnisse zunehmend verschlechterten. In der Behandlungsgruppe lag das Mittel der Überlebenszeit bei 8,2 +- 4,5 Std. und bei 1,8 +- 1,4 Std. in der Kontrollgruppe (p < 0,05). Zusammenfassend lässt sich sagen, dass die partielle Flüssigkeitsbeatmung mit Perfluorocarbon nicht bei allen Tieren im experimentellem Lungenversagen durch Lavage die arteriellen Oxygenierung bessert. Jedoch auch die Tiere die keinen Anstieg des PaO2 zeigten, lebten länger als die Kontrolltiere. Somit zeigt die verbesserte Überlebenszeit durch PLV einen positiven Effekt in der Behandlung des akuten Lungenversagens. / This thesis discusses the effects of intrapulmonal application of a highly purified perfluorocarbon (FC3280) concerning haemodynamics, gas exchange and survival rates in an experimental animal model of ARDS. A randomised, controlled and prospective study was performed on twelve anesthetised pigs. Repetitive saline lunglavage resulted in surfactant depletion. Subsequently six pigs received partial liquid ventilation with two aliquots of 7,5 ml/kg FC3280 (treatment group), whereas 6 pigs received no further treatment (control group). Haemodynamic values and gas exchange were recorded in a 30 minutes interval. Within the treatment group the PaO2 after 7, 5 ml/kg PFC was 67 +- 33 mmHg and after 15 ml/kg 106 +- 74 mmHg. Three animals responded well to the treatment. The responding animals showed improvements of arterial oxygen contents. One pig showed a increase in PaO2 from 62 mmHg to 450 mmHg. Within the control group gas exchange remained unchanged. Haemodynaimc values in the treatment group remained stable over six hours but deteriorated in the control group. Survival rates were 8,2 +- 4,5 hours in the treatment group and 1,8 +- 1,4 hours in the control group. In conclusion our study showed that partial liquid ventilation improved oxygenation not in all animals treated with perfluorocarbons. While these animals showed no improved in oxygenation they survived longer than the controls. The significant improvement in survival time shows a positive effect in the treatment of ARDS.

Introdução: A crescente demanda por restaurações estéticas possibilitou novas escolhas de tratamento para restaurar dentes posteriores com extensa destruição coronária. Os tratamentos destes dentes podem envolver restaurações diretas com resina composta ou indiretas do tipo onlays, fabricadas com cerâmica pura ou resina composta. Porém, dados clínicos sobre a longevidade de restaurações com recobrimento de cúspides comparando as técnicas direta e indireta e os materiais resina composta e cerâmica são raros. Objetivo: Realizar uma avaliação clínica retrospectiva de restaurações diretas (resina composta) e indiretas (resina composta e cerâmica) com envolvimento de cúspides utilizando o método FDI. Metodologia: Foram avaliadas 229 restaurações em 121 pacientes (37 homens e 84 mulheres) que receberam pelo menos uma restauração direta de resina composta com recobrimento de pelo menos uma cúspide ou uma onlay de cerômero ou cerâmica entre os anos de 2003 e 2016. A avaliação visual foi feita por um examinador previamente calibrado pelo coeficiente Kappa, utilizando-se os critérios do método FDI. Os dados foram analizados através do método Kaplan-Meier, da análise de regressão de Cox multivariada e do teste Kruskal-Wallis (p <0.05). Resultados: Entre as restaurações avaliadas foram detectadas 69 falhas. As restaurações obtiveram uma taxa de sucesso de 69,9%, com taxa anual de falha (AFR) de 8,0%. Restaurações diretas de resina composta apresentaram 34,1% de falha, com AFR de 9,6%. Onlays em cerômero apresentaram 27,3% de falha, com AFR de 7,1%. Onlays de cerâmica apresentaram 28,8% de falha com AFR de 7,6%. Restaurações em homens falharam mais do que em mulheres. A causa mais comum de falha foi fratura e retenção, ocorrendo em 48 casos (69,56% das falhas). Conclusão: Restaurações diretas de resina composta e indiretas de cerômero ou cerâmica demonstraram longevidade semelhante, independente do número de cúspides envolvidas. Restaurações indiretas tiveram menor índice de falha anual do que restaurações diretas, apresentando melhor desempenho na avaliação qualitativa. Pacientes mulheres apresentaram menor prevalência e menor risco de falha de restaurações do que pacientes do sexo masculino. / Introduction: The increasing demand for aesthetic restorations had enabled new treatment choices to restore posterior teeth with extensive coronary destruction. The treatments of these teeth involve direct composite restoration or indirect onlays, made with ceramic or composite. However, clinical data on the longevity of cuspal restorations comparing direct or indirect techniques and the materials are rare. Objective: To perform a retrospective clinical evaluation of direct restorations (composite resin) and indirect restorations (composite resin and ceramics) with cuspal involvement using the FDI criteria. Methodology: 229 restorations were evaluated in 121 patients (37 men and 84 women) who received at least one direct composite restoration with envolvement of at least one cusp or ceramic and composite onlays among the years 2003 and 2016. The visual evaluation was done by an examiner previous calibrated by the Kappa coefficient, using the FDI criteria. Data were analyzed by the Kaplan-Meier method, multivariated Cox regression analysis and Kruskal-Wallis test (p<0.05). Results: Among the evaluated restorations, 69 failures were detected. Restorations achieved a survival rate of 69.9%, with annual failure rate (AFR) of 8.0%. Direct composite restorations presented a 34.1% failure, with AFR of 9.6%. Composite onlays presented 27.3% of failure, with AFR of 7.1%. Ceramic onlays showed a 28.8% failure rate with AFR of 7.6%. Restorations in men have failed more than in women. The most common reason for failure was fracture of the material and retention, occuring in 48 cases (69.56% of failures). Conclusion: Direct and indirect restorations showed similar longevity, regardless of the number of cusps involved. Indirect restorations had lower annual failure rate than direct restorations, presenting better performance in the qualitative analisys. Female patients presented lower prevalence and lower risk of failure of restorations than male.

Made available in DSpace on 2014-06-11T19:22:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-03-27Bitstream added on 2014-06-13T20:48:48Z : No. of bitstreams: 1 massago_h_me_jabo.pdf: 505723 bytes, checksum: 1b1f4ab5136c45685bc1851b627e27fc (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Este trabalho teve como objetivo verificar o desempenho inicial de quatro linhagens comerciais de Oreochromis niloticus denominadas Bouaké, GIFT, Supreme e Chitralada, com ênfase no ganho em peso e sobrevivência. Utilizou-se os alevinos revertidos com o peso médio de um grama. O experimento foi conduzido em sistema fechado durante 112 dias, com biometrias realizadas a cada 28 dias. Inicialmente eram mantidos 38 peixes por 120 L em cada caixa e, após 84 dias, 13 peixes por 180 L. A qualidade da água foi avaliada através dos seguintes parâmetros: temperatura, oxigênio dissolvido (OD) e Potencial Hidrogeniônico (pH). Forneceu-se inicialmente a ração em pó com 45% de proteína bruta e, depois, a ração extrusada contendo 40% do mesmo nutriente. Os pesos médios finais das linhagens Bouaké, GIFT, Supreme e Chitralada foram 98,83 g, 121,46 g, 133,20 g e 112,89 g, respectivamente. As linhagens Supreme e GIFT apresentaram melhor desempenho, sendo que o desempenho da linhagem GIFT foi semelhante ao da Chitralada. O desempenho da linhagem Bouaké não diferiu da Chitralada (p<0,05). A taxa de sobrevivência (acima de 80%, com exceção da Bouaké) pode ser considerada normal. / This work aimed to verify the initial performance of four commercial Oreochromis niloticus strains named Bouaké, GIFT, Supreme and Chitralada, with special attention on the weight gain and survival rates. Tilapia fingerlings, post reversion with mean weight of one gram were used. The experiment was carried out in a closed system of Tilapia laboratory of CAUNESP, during 112 days, and biometries for performance evaluation have been done every 28 days. Water quality was evaluated through the following parameters: temperature, dissolved oxygen and pH value. Feeding was initially with powdered ration with 45 % crude protein, and after three weeks, with extruded ration with 40% crude protein. The final mean weight of the Bouaké, GIFT, Supreme and Chitralada strains were 98.83g, 121.46 g, 133.20 g and 112.89 g, respectively. Supreme and GIFT strains presented better performance, and the GIFT and Chitralada strains were similar too (p<0.05). Survival rate was considered normal (above 80%), with the exception of Bouaké strain.

The combination of two factors, temperature and salinity might affect zoeal survival and morphological pattern of Thalamita crenata. In order to know the effect, newly hatched zoeae were reared under 45 combinations of temperature and salinity (i.e. combinations of five temperatures variables: 20, 25, 30, 33, 35¢J and nine salinity variables: 18,20,22,25,30,35,38,40,42 psu ). The zoeae were fed with newly hatched Artemia nauplii. The results showed that temperature and salinity as well as the interaction of the two parameters significantly affected the survival rate of zoeae. The effect of temperature at 20¢J and 35¢J resulted in no zoeal survival from zoea to megalopa stage. Under the temperature range of 25~33¢J, There is significant difference between the survival rates of zoeae (p < 0.05). High survival rate (above 64%) occurred at temperature range of 25~30¢J and salinity range of 30~35 psu. Survival rate decreased at salinity range of 20,22,25,38 psu. Under 30¢J and 18 psu condition, zoeae could develop into megalopa stage. Temperature, salinity and their interaction also significantly affected zoeal development. At 25¢J, the shortest zoeal developmental time to reach megalopa was 18 days under salinity 30 and 35 psu conditions and the developmental time extended to 20 and 21 days under salinity 38 and 20 psu conditions. At 30¢J, the shortest zoeal developmental time to reach megalopa was 11 days under salinity 30 psu conditions and the developmental time extended to 23 days under salinity 18 psu conditions. Under 33¢J and 25 psu condition, the zoeal developmental time to reach megalopa ranged from 16 to 22 days. The larval development of Thalamita crenata has five zoeal stages. Four tested zoeae had morphological differences in antennules, maxillule and maxilla in fifth stage which are shown as follow. There are 5 additional setae on the top of antennule exopod . The endite of maxillule coxal has 14 plumose setae; The basal endite has 8 plumose setae. The maxilla basal endite has 8 plumose setae. The scaphognathite has 27 plumose setae. In addition to basic five zoeal stages, an additional zoeal stages was observed from the tested crab. There were evidences suggested that the appearance of the additional zoeae was associated with limited temperature condition for life and lower salinity. Based on exuviae and larval specimens, the major morphological characteristics of the additional zoeal larvae were as follow: oblong carapace, lateral spine disappeared; prolonged cheliped and pereiopods compared to Z5 stage; with setae on pleopods.

Adams et al. was the first to demonstrate an association between improved outcomes and provider experience in a 1973 study examining complication rates from coronary arteriograms.[1] In this study, a questionnaire was mailed to the directors of coronary arteriography laboratories throughout the US. They found that mortality was eight times higher in institutions performing fewer than 200 examinations per two-year period compared to institutions performing more than 800 examinations per two-year period. It was not until 1979, however, that efforts to systematically study outcomes in surgery were made by Luft and colleagues.[2] They demonstrated lower mortality rates at high-volume centers compared with low-volume centers for several high risk procedures, such as coronary artery bypass graft surgery (CABG) and vascular surgery. This landmark study set the stage for outcomes research in surgery. Over the past decade, additional studies have continued to show higher surgeon or hospital volumes to be associated with improved patient outcomes. [3-13] To what degree surgeon versus hospital volume each contribute to outcomes is controversial and depends on the procedure examined. Nevertheless, formal recommendations encouraging certain high-risk procedures be performed at high-volume hospitals began as early as 2000 by the Leapfrog group and other policy initiatives.[14, 15] Formal recommendations for surgeon volume, on the other hand, have been lacking. There has been mounting evidence, particularly in the last decade, that surgeon volume is associated with improved patient outcomes, independent of hospital volume. To what measure these data have influenced referral patterns from low- to high-volume surgeons is unknown.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.