At least half of the world’s primate species are currently threatened with extinction. Slow life histories combined with rapid habitat loss and hunting in recent years has heightened the extinction risk for many species, including the two largest extant lemurs, the diademed sifaka (Propithecus diadema) and the indri (Indri indri). Both species belong to the taxonomic family Indriidae, have similar adult weights, and occur in sympatry in certain areas of the montane rainforests of eastern Madagascar. Both species are adapted for folivory however I. indri spend considerably more time feeding on leaves than do P. diadema resulting in several energy-saving adaptations in I.indri. In this dissertation, I explore infant development and maternal strategies of these critically endangered primates with the goal of increasing our knowledge of reproduction and ontogeny in both species. Although previous studies have elucidated key differences in adult behaviour, there is a dearth of information on infants and lactating females in either of these two species. Between June and December of 2011 and 2012, I collected continuous time focal animal data, in Maromizaha forest, to examine behavioural patterns of 12 infants and their mothers from 0 – 33 weeks. In addition, I developed a framework to define and quantify the weaning process and facilitate comparisons across different species and studies. P. diadema infants developed feeding competency and independent locomotion faster than did I. indri infants however both species were consistently feeding independently more than they were suckling by week 20. The process of feeding ontogeny in I. indri was likely accelerated by coprophagy, as all infants of this species consumed their mother’s feces regularly from 10 – 15 weeks old. Lactating females of both species spent more time feeding in mid-lactation when maternal investment was the highest. The prolonged inter-birth interval in I. indri is suggested as another adaptation that reduces energetic expenditures. In addition, the protracted period of close contact with their mother may offer infant I. indri more time for social learning of the mother’s diet and the group song and for developing competency in vertical clinging and leaping without a tail for balance and support. / Graduate

Bakgrund Ventilatorbehandling kan orsaka lidande i form av bland annat Ventilator Associerad Pneumoni (VAP) och delirium. Att avsluta behandlingen för tidigt kan också orsaka lidande och därför är tydliga kriterier för att verifiera urträning och extubation, borttagande av ventilatorn och endotrakealtuben är viktiga aspekter i vården och omvårdnaden av patienten. Syfte Syftet med studien var att identifiera kriterier för att verifiera lyckade eller misslyckade urträningar och extubationer hos intensivvårdspatienter och att undersöka vilka bedömningsprotokoll för detta som används. Metod Metoden har varit en (deskriptiv) litteraturöversikt med systematisk ansats. Sökning har gjorts i databasen PubMed. Vid sökningen hittades 627 artiklar och av dessa inkluderas 17 artiklar i studien. Resultat Resultatet visar att det finns flera kriterier för att verifiera lyckade eller misslyckade urträningar och extubationer, men de mest uttalade kriterierna var, hemodynamisk status, inställda/uppmätta ventilatorvärden, blodgasvärden, det mentala/neurologiska tillståndet hos patienten och spontant andningstest (SBT). Slutsats Kriterier och dess protokoll är viktiga redskap för vårdpersonalen för att avgöra när det är dags att börja urträning och förbereda för extubation av den ventilatorbehandlade patienten. / Background Mechanical ventilation can cause suffering in the form of, among other things Ventilator Associated Pneumonia (VAP) and delirium. Stopping treatment too early may also cause suffering and therefore clear criteria to assess extubation withdrawal and weaning of the ventilator are important aspects in the care and nursing of the patient. Purpose The purpose of the study was to identify criteria for verifying successful or unsuccessful weaning and extubations in ICU patients and to investigate assessment protocol. Method The method has been a descriptive literature review with a systematic approach. Conclusion The result shows that there are several criteria to verify successful or unsuccessful weanings and extubations, but the most explicit criteria were - hemodynamic status, set / measured values for the mechanical ventilations, blood gas status, mental / neurological state of the patient and spontaneous breathing test (SBT). Criteria and subsequent protocols are important tools for caregivers to determine when it is time to start weaning and prepare for extubation.

Microbial succession, composition and ecological distribution within the gastro-intestinal tract are critical areas of study since commensal bacteria have been shown to affect animal health and development. A series of experiments were conducted to determine whether altered microbial succession in neonatal animals would modulate the development and health of pigs later in life. An initial experiment in conventional pigs was conducted to establish the early postnatal microbial succession profile and to identify early colonizing bacterial species. Culture-independent analysis of digesta and mucosal microbiota showed distinct variation between the proximal and distal gastro-intestinal tract (GIT) indicating that fecal or distal gut profiles cannot be used to predict succession in the upper GIT. Temporally, Clostridium spp. were found to be most prevalent in the GIT microbiota of the neonatal pig up to 0.5 d of age, accompanied by a high abundance of Escherichia and Shigella spp. These genera were transiently displaced by Streptococcus spp. followed by a preponderance of Lactobacillus spp. between 3 and 20 d of age. Subsequently, a “snatch-farrow” model was employed to modulate early postnatal microbial succession and investigate the effects on postweaning microbial composition. Pigs were collected into sterile towels directly from the vaginal canal and transferred to a sterile isolator environment for the first 4 days. Pigs were either inoculated with sow feces or not at 1 d of age resulting in significant differences in fecal microbial profile at 4 days of age, prior to removal from isolators. Analysis using terminal restriction fragment length polymorphisms (TRFLP) of intestinal microbiota at 28 d of age did not show significant clustering or variation in diversity indices for either group during the 4-d postnatal isolator phase. However, enumeration of selected taxa using quantitative PCR did indicate significant treatment differences in postweaning microbiota. Despite these results, this approach was rejected for further use as the protocol provided only moderate control of early postnatal colonization and variation and unpredictability of the timing of natural farrowing contributed to significant litter effects. Finally, a gnotobiotic monoassociation model was used investigate the effects of modulating early postnatal microbial succession on postweaning physiology, microbial composition and mucosal gene expression. Twenty-four cesarean-section derived piglets were monoassociated for the first 4 days of life with either L. mucosae (L), S. infantarius (S), C. perfringens (C) or E. coli (E). Pigs from treatments E and L animals showed the highest growth rate during the conventional rearing period (7-28 d of age). Monoassociation with different bacterial species during the first 4 d of life resulted in significant changes in postweaning microbial composition in small intestine and colon as assessed by quantitative PCR, although TRFLP did not identify unique clustering by treatment or variation in diversity. L. mucosae was the only inoculant species with significant variation, with a reduction in the colonic mucosa at 28 days of age. Monoassociation with L. mucosae was also associated with increased nutrition related gene expression in small intestine. Pigs monoassociated with E. coli had low expression of microbial sensing (TLR2 and 4), NFkappaB complex genes and mucins at 28 d of age. This study clearly showed that controlled early microbial succession in neonatal pigs altered post-weaning commensal microbiota composition, postweaning physiology and host gene expression in small and large intestine. The findings suggest the importance of peri-natal management and feeding strategies in promoting postweaning health and performance.

No description available.

No description available.

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Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2003. / Härtill 5 uppsatser.

Made available in DSpace on 2015-05-14T12:47:19Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 3269699 bytes, checksum: af9285a2857f32a228efc8a34c2c80c4 (MD5) Previous issue date: 2014-08-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Of critically ill patients in intensive care units (ICUs), about 40% develop acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV), which should be conducted as soon as possible for weaning, which may be defined as the process of transition from mechanical ventilation to spontaneous in patients who remain at MVI for more than 24 hours time. To consider that they had successfully weaned, the patient must maintain spontaneous ventilation for at least 48 hours after discontinuation of artificial ventilation. However, if the return to ventilatory support is needed in this period of 48 hours after extubation, called unsuccessful weaning. In clinical practice, patients are subjected to interruption of MVI, the passage through the spontaneous breathing trial (SBT) is recommended, achieving tolerate 30 minutes disconnected from ventilatory support without important clinical changes. The SBT is recommended as a diagnostic test to bring greater security to taking the patient off the machine decision. Although recommended, it is important to note that in studies, this test has not been shown to be accurate, not identified approximately 15% of weaning failure. The aim of this study is to propose a model to predict the success of weaning from mechanical ventilation to assist decision making for weaning in patients admitted to the Intensive Care Unit. This is an observational, longitudinal, prospective, quantitative and descriptive. 24 hours after the institution of MVI at the time prior to the SBT and the team after the withdrawal of MVI until the occurrence of the outcome of weaning success or failure: an instrument for data collection, divided into four periods was used. The statistical method of logistic regression was used to support decision making from clinical variables collected in the study. The clinical variables that were statistically significant (p-value <0.05) were: Tobin index between 51 and 105 (OR = 79.3); Sodium levels between 135 and 14 (OR = 20.3) and balances the Hydraulic balanced (OR = 9.6). The findings of this study present a valid logistic model, revealing the clinical variables that correlate with the success of weaning from invasive mechanical ventilation, thereby guiding decision making in this context. / Dos pacientes graves internados em unidades de terapia intensiva (UTI s), cerca de 40%, desenvolvem insuficiência respiratória aguda (IRpA), necessitando de ventilação mecânica invasiva (VMI), a qual deve ser conduzida tão logo seja possível para o desmame, definido como o processo de transição da ventilação artificial para a espontânea nos pacientes que permanecem em VMI por tempo superior a 24 horas. Para considerar que houve sucesso no desmame, o paciente deve manter a ventilação espontânea durante pelo menos 48 horas após a interrupção da ventilação artificial. No entanto, se o retorno ao suporte ventilatório for necessário neste período de 48hs pós-extubação, denomina-se insucesso do desmame. Na prática clínica, para que os pacientes sejam submetidos à interrupção da VMI, recomenda-se a passagem pelo teste de respiração espontânea (TRE), conseguindo tolerar 30 minutos desconectados do suporte ventilatório, sem apresentar alterações clínicas importantes. O TRE é recomendado como um teste diagnóstico para trazer maior segurança à tomada de decisão da desconexão do paciente à máquina. Embora recomendado, é importante ressaltar que, nos estudos, esse teste não tem se mostrado acurado, não identificando aproximadamente 15% das falhas de desmame. O objetivo deste estudo foi propor um modelo para predizer o sucesso do desmame da ventilação mecânica invasiva, para auxiliar a tomada de decisão para o desmame em pacientes internados na unidade de terapia intensiva. Trata-se de um estudo observacional, longitudinal, prospectivo, quantitativo e descritivo. Foi utilizado um instrumento de coleta de dados, dividido em quatro momentos: apos 24 horas da instituição da VMI, no momento antes da realização do TRE pela equipe e após a retirada da VMI ate a ocorrência do desfecho sucesso ou insucesso do desmame. O método estatístico de regressão logística foi usado para subsidiar a tomada de decisão a partir das variáveis clínicas coletadas no estudo. As variáveis que apresentaram significância estatística (p-valor < 0,05) foram: índice de Tobin entre 50 e 105 irpm/L (OR= 79,3); nível de sódio entre 135 e 145 mEq/L (OR=20,3) e balanço hídrico equilibrado (OR = 9,6). Os achados deste estudo possibilitaram a construção de um modelo logístico válido, revelando as variáveis clínicas que se correlacionaram com o sucesso do desmame da ventilação mecânica invasiva, orientando, assim, a tomada de decisão neste contexto.

Introdução: Descontinuação prematura ou tardia da ventilação mecânica invasiva (VM) associa-se a maior morbimortalidade. Redução da pressão intratorácica durante o teste de respiração espontânea (TRE) pode precipitar disfunção cardíaca através da elevação abrupta do retorno venoso e da pós-carga do ventrículo esquerdo. Da mesma maneira, alterações na demanda respiratória e cardíaca que ocorrem ao longo do TRE também podem manifestar-se à ultrassonografia pulmonar. O padrão B é um artefato sonográfico que se correlacionada com edema intersticial. Um ensaio clínico randomizando concluiu que a ultrassonografia pulmonar foi capaz de prever insuficiência ventilatória pós extubação através de variações na aeração pulmonar observadas durante o procedimento de desmame; contudo, a ferramenta não pôde rastrear pacientes antes da submissão ao TRE. O impacto do balanço hídrico (BH) e de sinais radiológicos de congestão pulmonar antes do TRE sobre os desfechos no desmame também precisam ser determinados. Métodos: Cinquenta e sete indivíduos elegíveis para o desmame ventilatório foram recrutados. Traqueostomizados foram excluídos. Realizou-se avaliação ultrassonográfica de seis zonas pulmonares imediatamente antes e ao final do TRE. Predominância B foi definida como qualquer perfil com padrão B presente bilateralmente em região torácica anterior. Os pacientes foram seguidos por até 48 horas depois da extubação. Após esse estudo piloto, foi conduzido um estudo observacional, prospectivo, multicêntrico em duas unidades de terapia intensiva (UTIs) clínico-cirúrgicas ao longo de dois anos. Os mesmos critérios de inclusão e de exclusão foram aplicados; contudo, a ultrassonografia foi realizada apenas antes do TRE. O desfecho primário foi falha no TRE, definido como incapacidade de tolerar o teste T durante 30 a 120 minutos e, nesse caso, o paciente não era extubado. Dados demográficos e fisiológicos, BH das 48 horas antecedendo o TRE (entrada de fluidos menos débitos durante 48 horas) e desfechos foram coletados. Em uma análise post hoc de 170 procedimentos de desmame, um radiologista aplicou um escore radiológico na interpretação de radiografias digitais de tórax realizadas previamente ao TRE – o exame mais recente disponível foi avaliado em termos de congestão pulmonar. Resultados: No estudo piloto, 38 indivíduos foram extubados com sucesso, 11 falharam no TRE e 8 necessitaram de reintubação em até 48 horas após a extubação. No início do teste T, padrão B ou consolidação já estava presente em porções inferiores e posteriores dos pulmões em mais da metade dos casos, e tais regiões mantiveram-se não aeradas até o final do teste. Perda de aeração pulmonar durante o TRE foi observada apenas no grupo que falhou no mesmo (p= 0,07). Esses pacientes também demonstraram maior predominância B ao final do teste (p= 0,019). Antes do procedimento de desmame, todavia, não foi possível discernir indivíduos que falhariam no TRE, tampouco aqueles que necessitariam de reintubação dentro de 48 horas. Posteriormente, de 2011 a 2013, 250 procedimentos de desmame foram avaliados. Falha no TRE ocorreu em 51 (20,4%). Cento e oitenta e nove pacientes (75,6%) foram extubados na primeira tentativa. Indivíduos que falharam no TRE eram mais jovens (mediana de 66 versus 75 anos, p= 0,03) e apresentaram maior duração de VM e maior prevalência de doença pulmonar obstrutiva crônica (DPOC) (19,6 versus 9,5%, p= 0,04). Predominância B mostrou-se um preditor muito fraco para falha no TRE, exibindo sensibilidade de 47%, especificidade de 64%, valor preditivo positivo de 25% e valor preditivo negativo de 82%. Não houve diferença estatisticamente significativa no BH das 48 horas antecedendo o TRE entre os grupos (falha no TRE: 1201,65 ± 2801,68 ml versus sucesso no TRE: 1324,39 ± 2915,95 ml). Entretanto, em pacientes portadores de DPOC, ocorreu associação estatisticamente significativa entre BH positivo nas 48 horas antes do TRE e falha no TRE (odds ratio= 1,77 [1,24 – 2.53], p= 0,04). O escore radiológico, obtido em 170 testes T, foi similar entre os pacientes com falha e sucesso no TRE (mediana de 3 [2 – 4] versus 3 [2 – 4]), p= 0, 15). Conclusão: Maior perda de aeração pulmonar observada à ultrassonografia durante o TRE pode sugerir disfunção cardiovascular e aumento na água extravascular, ambos induzidos pelo processo de desmame. BH, sinais radiológicos de congestão pulmonar ou padrão B documentado através de um protocolo ultrassonográfico simplificado não devem contraindicar o TRE em pacientes estáveis hemodinamicamente e adequadamente oxigenados, haja vista o fato de tais variáveis não terem predito maior probabilidade de falha de desmame em pacientes críticos clínico-cirúrgicos. Ainda assim, evitar BH positivo em pacientes com DPOC parece otimizar os desfechos do desmame. / Introduction: Both delayed and premature liberation from mechanical ventilation (MV) are associated with increased morbi-mortality. Inspiratory fall in intra-thoracic pressure during spontaneous breathing trial (SBT) may precipitate cardiac dysfunction through abrupt increase in venous return and in left ventricular afterload. Changes in respiratory and cardiac load occurring throughout SBT might manifest with dynamic changes in lung ultrasound (LUS). B-pattern is an artifact that correlates with interstitial edema. A randomized controlled trial concluded that bedside LUS could predict post extubation distress due to changes in lung aeration throughout weaning procedure; however, it could not screen patients before submission to SBT. The impact of fluid balance (FB) as well as of radiological signs of pulmonary congestion prior to SBT on weaning outcomes must also be determined. Methods: Fifty-seven subjects eligible for ventilation liberation were enrolled. Patients with tracheostomy were excluded. LUS assessment of six thoracic zones was performed immediately before and at the end of SBT. B-predominance was defined as any profile with anterior bilateral B-pattern. Patients were followed up to 48 hours after extubation. After this pilot report, we conducted a 2-year prospective, multicenter, observational study in two adult medical surgical intensive care units (ICUs). Same inclusion and exclusion criteria were applied; however, LUS was performed only immediately before SBT. The primary outcome was SBT failure, defined as inability to tolerate a T-piece trial during 30 to 120 minutes, in which case patients were not extubated. Demographic, physiologic, FB in the preceding 48 hours of SBT (fluid input minus output over the 48-hour period), and outcomes data were collected. As a post hoc analysis in 170 weaning procedures performed in one of the ICUs, an attending radiologist applied a radiological score on interpretation of digital chest x-rays performed before SBT - the most recent available exam was analyzed regarding degree of lung fluid content. Results: In the pilot study, 38 subjects were successfully extubated, 11 failed the SBT and 8 needed reintubation within 48 hours of extubation. At the beginning of T-piece trial, B-pattern or consolidation were already found at lower and posterior lung regions in more than half of the individuals and remained nonaerated at the end of the trial. Loss of lung aeration during SBT was observed only in SBT-failure group (p= 0.07). These subjects also exhibited higher B-predominance at the end of trial (p= 0.019). Prior to weaning procedure, however, we were not capable to discriminate individuals who would fail SBT, nor who would need reintubation within 48 hours. Afterwards, from 2011 to 2013, 250 weaning procedures were evaluated. SBT failure occurred in 51 (20.4%). One hundred eighty-nine patients (75.6%) were extubated at first attempt. Individuals who failed SBT were younger (median 66 versus 75 years, p= 0.03), had higher duration of MV (median 7 versus 4 days, p< 0.0001) and higher prevalence of chronic obstructive pulmonary disease (COPD) (19.6 versus 9.5%, p= 0.04). B-predominance was a very weak predictor for SBT failure, showing 47% sensitivity, 64% specificity, 25% positive predictive value, and 82% negative predictive value. There were no statistically significant differences in 48 hour-FB prior to SBT between groups (SBT failure: 1201.65 ± 2801.68 mL versus SBT success: 1324.39 ± 2915.95 mL). However, in COPD subgroup, we found significant association between positive FB in the 48 hours prior to SBT and SBT failure (odds ratio = 1.77 [1.24 – 2.53], p= 0.04). Radiological score, obtained in 170 T-piece trials, was similar between SBT failure and success subjects (median 3 [2 - 4] vs 3 [2 - 4], p= 0.15). Conclusion: Higher loss of lung aeration observed by LUS during SBT might suggest cardiovascular dysfunction and increases in extravascular lung water, both induced by weaning. Neither FB, nor radiological findings of pulmonary congestion, nor B-pattern detected by a simplified LUS protocol should preclude hemodynamically stable, sufficiently oxygenated patients from performing an SBT, since such variables did not predict greater probability of weaning failure in medical-surgical critically ill population. Notwithstanding, avoiding positive FB in COPD patients might improve weaning outcomes.