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Kelly, Michael James. "Stereoselective synthesis of novel natural products from carbohydrates." Thesis, University of Exeter, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.385726.
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Nascimento, João Francisco Gouveia. "Doença renal crónica e a sua relação com doença cardio-vascular." Master's thesis, Universidade da Beira Interior, 2012. http://hdl.handle.net/10400.6/1114.
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Introdução: A doença renal crónica tem uma prevalência em constante crescimento, estimando-se cerca de 265 milhões de pessoas em todo o mundo com risco aumentado para desenvolver esta doença. Os doentes renais crónicos no estadio mais avançado da doença apresentam um risco 10 a 30 vezes superior do que a população em geral de morrer por doença cardio-vascular. Objectivos: Aprofundar o conhecimento actual sobre a insuficiência renal crónica e a sua relação com a doença cardio-vascular. Métodos: Pesquisa bibliográfica na base de dados electrónica “PubMed”, com as seguintes palavras-chave: "chronickidneydisease", "glomerular filtration rate", "GFR", "eGFR", como pesquisa para doença renal crónica, e "cardiovascular disease" e "stroke", como pesquisa para doença cardio-vascular.Também se utilizou informação presente em diversos websites nacionais e internacionais. Conclusões: A doença renal crónica aumenta o risco de desenvolver doença-cardiovascular, em especial a hipertrofia ventricular esquerda, a doença coronária e o acidente vascular cerebral. Também se encontra relacionada com o desenvolvimento de lesões cerebrais, tais como lesões da substância branca, enfartes cerebrais silenciosos e atrofia cerebral. O consumo de pequenas quantidades de álcool, desde 7 gramas de etanol por semana, torna-se altamente prejudicial a estes doentes, pois aumentam o risco para desenvolver acidentes vasculares cerebrais. Além disto, concluiu-se que apesar do método indicado actualmente para avaliar a função renal ser através da equação CKD-EPI, utilizando a concentração sérica de creatinina, sexo, idade e raça, a maioria dos médicos continuam a utilizar a concentração sérica da creatinina isoladamente, o método menos preciso e que pode levar a que 50% dos idosos com doença renal crónica estadio 3 não sejam diagnosticados.Introduction: Chronic kidney disease has its prevalence in constant growth, estimating 265 million people around the world with increased risk for developing this disease. People with chronic kidney disease in its later stage have 10 to 30 times increased risk to die from cardiovascular diseases than the general population. Objectives: Deepen the current knowledge about chronic kidney disease and its relation with cardiovascular disease. Methods: Bibliographic search in the electronic database “PubMed”, with the following keywords: “chronic kidney disease”, “glomerular filtration rate”, "GFR", "eGFR", as search terms for chronic kidney disease, and "cardiovascular disease" e "stroke" as terms for cardiovascular disease. Several Portuguese and international websites were used too. Conclusions: Chronic kidney disease increases the risk for developing cardiovascular disease, in particular left ventricular hypertrophy, coronarian disease and stroke. It is also related with the presence of brain lesions, such as white matter lesions, silent brain infarcts and brain atrophy. Even little alcohol consumption, i.e. 7 grams of ethanol per week, is highly prejudicial to patients with chronic kidney disease, because it increases their risk to have a stroke. Furthermore, although the current recommended way to evaluate renal function is by applying CKD-EPI equation, which uses patient serum creatinine concentration, age, sex and race, most medical personnel still uses serum creatinine concentration at its own, which can result in about 50% percent of old people with stage 3 chronic kidney disease not being diagnosed.
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Gunter, Bryan R., Kristen A. Butler, Rick L. Wallace, Steven M. Smith, and Sam Harirforoosh. "NSAIDs-Induced Cardio- and Cerebro-Vascular Adverse Events: a Meta-analysis." Digital Commons @ East Tennessee State University, 2017. https://doi.org/10.1111/jcpt.12484.
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What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk.
Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib.
Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379-2·378), placebo (OR: 1·655: 95% CI: 1·029-2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146-4·053), and COXIBs (OR: 1·800, 95% CI: 1·217-2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396-0·857) and (OR: 0·609, 95% CI: 0·375-0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027-2·155) and (OR: 1·933, 95% CI: 1·052-3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410-0·887), (OR: 0·517, 95% CI: 0·287-0·929), and (OR: 0·509, 95% CI: 0·280-0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313-1·981), (OR: 1·572, 95% CI: 1·123-2·201) and (OR: 1·838, 95% CI: 1·323-2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658-0·986) and (OR: 0·557, 95% CI: 0.404-0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data.
What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.
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AOKI, KUNIO, MOTOKO FUJIMOTO, REIKO SAKURAI, RYUICHIRO SASAKI, and NOBUYUKI KATSUDA. "Sociomedical Factors Affecting Participation in Screening Program on Cerebro- and Cardio- Vascular Disease." Nagoya University School of Medicine, 1990. http://hdl.handle.net/2237/17513.
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Inthawong, Rungkarn. "Assessing the impact of reducing risk factors for cardio-vascular disease in Thailand." Thesis, Sheffield Hallam University, 2015. http://shura.shu.ac.uk/20833/.
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Cardiovascular disease (CVD) is a global health problem and there has been an epidemiological transition of CVD from high income countries to low-middle income countries. In the case of Thailand, the prevalence of heart disease and stroke is increasing. In order to reduce the risk of CVD, the Ministry of Public Health in Thailand has implemented a number of primary CVD prevention strategies within the last decade. These strategies are being specifically implemented to address the future potential economic burden of increasing CVD. However, the economic impact of reducing multiple risk factors, at a population level in Thailand, in terms of health care costs is unclear. In order to plan for investment in public health interventions within finite resources, it is imperative that decision makers have sufficient information to identify the target populations and risk reduction strategies, and to assess the impact of these strategies on the population. This study aims to estimate the future prevalence of CVD in Thailand over the next 5-10 years and the potential economic and health benefits of strategies to reduce the population risk factors during this period. The mathematic CVD cost-offset model has been developed in this study in 7 stages. 1) Descriptive analysis of the CVD risk profile data from the 4th National Health Examination Survey (NHESIV) 2008-2009 data set in order to explore the association of CVD risk factors in Thailand. 2) Calculate the probability of future CVD event which applies the CVD risk prediction equation. 3) Estimate of the number of future CVD events. 4) Validation of the estimated number of annual CVD event with the actual CVD hospitalisation event in Thailand. 5) Calculate the cost of hospital admission due to CVD from the Universal Coverage Health Care Scheme (UC) data in 2009. 6) Estimate the burden of CVD in terms of the DALYs. 7) Estimate the impact of reducingCVD risk factors in different scenarios. The study outcomes being the number of hospitalisation cost savings, number of premature death savings, DALY savings and health care cost savings. The outcomes will also account for the uncertainty analysis. As indicated above, no studies currently exist that focus specifically on the mathematic model for estimating the future situation of CVD in Thailand. Therefore, this study represents an original contribution to that knowledge. The findings of this study will contribute to health policy by providing specific new knowledge and information regarding Thai CVD risk factors and the impact of the risk reduction which will assist health policy makers in the planning and future investment in prevention programs for CVD in Thailand. Moreover, it is expected that the finding from this research will establish a CVD prediction model for Thailand, and one which may be applicable and compatible to the Asia and Pacific regions.
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Gusmão, Maria Helena Lima. "Desnutrição, inflamação e outros fatores de risco para doença cardio vascular em pacientes sob diálise peritoneal." Programa de Pós-Graduação em Alimentos, Nutrição e Saúde (PGNUT), 2007. http://www.repositorio.ufba.br/ri/handle/ri/9680.
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Avaliar a associação entre desnutrição, inflamação e outros fatores de risco para doença cardiovascular em pacientes sob diálise peritoneal contínua. Métodos Estudo transversal, envolvendo 61 pacientes em Diálise Peritoneal Contínua em duas Unidades de Diálise em Salvador-Ba. O estado nutricional foi avaliado por meio da Avaliação Subjetiva Global. Realizou-se a dosagem de Proteína C Reativa Ultra Sensível para determinar inflamação. Foram estudados fatores de risco tradicionais para Doença cardiovascular, como sexo, idade, etilismo, tabagismo, sedentarismo, hipertensão, diabetes, dislipidemia e hábitos alimentares e fatores não tradicionais, como alterações no metabolismo de cálcio e fósforo e anemia. Nesta população 36% dos pacientes encontravam-se desnutridos e 49,2% com processo inflamatório. Desnutrição e inflamação foram evidenciadas em 21,3% dos pacientes. O grupo de pacientes desnutridos apresentou níveis maiores de Proteína C Reativa Ultra Sensível do que aqueles de pacientes com bom estado nutricional (p=0,04). Não foram evidenciadas associações entre desnutrição na presença de inflamação e outros fatores de risco para Doença Cardiovascular. A desnutrição ainda é freqüente nos pacientes sob Diálise Peritoneal Contínua, assim como a inflamação. Ambos agravos estão associados nesta população, contudo não há associação entre desnutrição na presença de inflamação e os outros fatores de risco para doença cardiovascular.
Salvador
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Mbangani, Roselyn. "Exploring the knowledge, attitudes, perceptions and practices of teachers around obesity and nutrition related non-communicable diseases." University of the Western Cape, 2018. http://hdl.handle.net/11394/6905.
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Magister Scientiae (Nutrition Management) - MSc(NM)Introduction: Non-communicable diseases (NCDs) are among the leading causes of premature death in South Africa. As is the case with many countries in transition, in South Africa the burden of pre-NCDs such as overweight and obesity is increasing. The aim of this mixed method study was to gain an understanding on the knowledge, attitudes, practices and perceptions and related factors of primary and secondary school teachers in Limpopo Province of South Africa regarding nutrition related non-communicable diseases (NR-NCDs). Methodology: A mixed method approach, parallel convergent study design was used to collect both qualitative and quantitative data from a group of randomly selected public school teachers in Rakwadu Circuit, Limpopo, with due consideration of the ethical issues involved. For the quantitative inquiry, a previously validated structured questionnaire was adapted to collect data from 114 teachers, while 2 Focus Group Discussions (FGDs) were conducted by the researcher to collect the qualitative data. Information collected included teachers‟ dietary practices, physical activity levels and their knowledge, attitudes and perceptions towards nutrition related non-communicable diseases. Each of these variables had a number of questions which were scored and a mean score for each participant was obtained. Anthropometric measurements collected included Body Mass Index (BMI) and waist circumference (WC).
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Simon, Peter. "Ein präventivmedizinisches Konzept zur Untersuchung der kardiovaskulären Gesundheit." Master's thesis, Dresden International University, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-230445.
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Kardiovaskuläre Erkrankungen spielen eine immer dominanter werdende Rolle als Ursachen von Morbidität und Mortalität. Endotheliale Dysfunktion, Arteriosklerose und ischämische Herzerkrankungen sind unangefochten die häufigsten Todesursachen in hochentwickelten Ländern. Die Krankheitslast kardiovaskulärer Erkrankungen wird durch die globale Zunahme von Risikofaktoren wie Übergewicht, metabolischem Syndrom und Diabetes mellitus Typ 2 in Zukunft wohl weiter steigen. Keines der in der heutigen Form existierenden Gesundheitssysteme ist den gesundheitlichen Folgen dieser bedenklichen epidemiologischen Entwicklung gewachsen, ohne dafür beträchtliche Einschnitte in Qualität oder Quantität hinnehmen zu müssen. Präventivmedizinische Strategien haben im Vergleich zur Akutmedizin bisher eine wesentlich geringere Aufmerksamkeit erfahren. Aufgrund der weiterhin steigenden Krankheitslast werden gerade präventivmedizinische Strategien immer wichtiger. Die Ermittlung der individuellen kardiovaskulären Gesundheit beinhalten neben einer Untersuchung wichtiger physiologsicher Kernsysteme, einen besonderen Fokus auf die Stärkung der gesundheitlichen Eigenverantwortung durch Vermittlung entsprechender medizinischer Zusammenhänge. Dies kann durch geeignete und prognostisch wertvolle Untersuchungsmethoden und laienverständliche Interpretationen der komplexen kardiovaskulären Zusammenhänge realisiert werden. Mithilfe eines besseren Verständnisses für die eigene kardiovaskuläre Gesundheit und gezielter konkreter Hilfestellungen von ärztlicher Seite, können grundlegende Strukturen für einen achtsameren Umgang mit der eigenen Gesundheit geschaffen werden. Alltägliche körperliche Aktivität, Körperzusammensetzung, Gefäßsteifigkeit und die maximale Leistungsfähigkeit bilden aktuellen Studien zufolge vier relativ einfach zu erhebend Hauptdeterminanten kardiovaskulärer Gesundheit mit großer prädiktiver Vorhersagekraft für kardiovaskulärer Ereignisse. Die Einordnung der Untersuchungsbefunde unter Berücksichtigung altersentsprechender Referenzdaten bietet zusätzlich die Möglichkeit, chronologisches und biologisches Alter zu differenzieren. Darüber hinaus könnte das hier vorgestellte Untersuchungskonzept ebenso dafür eingesetzt werden, die Effektivität von zuvor eingeleiteten therapeutischen Strategien zu überprüfen und eine Übermedikation zu vermeiden. Ein stärkerer Fokus auf nachhaltige kardiovaskuläre präventivmedizinische Strategien birgt das Potential Morbidität und Mortalität zu Reduzieren und die Lebensqualität und Selbstbestimmung der Klienten zu steigernNowadays endothelial dysfunction, arteriosclerosis and ischaemic heart disease depict major issues in most developed countries. Chronic diseases cause an increasing number of deaths worldwide. Responsible for approximately 30% of all deaths, this number is shocking despite the knowledge that these lives could be saved in a realistic point of view. However, disturbing global tendencies and the increase in epidemic overweight, obesity, glucose intolerance and diabetes mellitus type 2 seem to amplify cardiovascular diseases and deaths. No existing medical care system could ever sufficiently match these emergent burdens of global chronic diseases if these tendencies will continue to grow. Due to fatal epidemiological changes general practitioners will not only have to treat more diseases of elderly people, but also be the first contact person for enquiries about their health concerning the cardiovascular systems of younger and older generations. Strengthening prevention concerning cardiovascular diseases is probably the most efficient and only way to escape the vicious circle of pathophysiological processes. To implement cardiovascular prevention it is essential to focus on cardiovascular health rather than on cardiovascular disease. In order to master this challenge sufficiently a deliberate concept of preventive examinations for cardiovascular health is required to quantify cardiovascular wellness and sharpen the awareness of one’s health. Therefore, it is to establish precise, predictive and cost-efficient examination methods to quantify cardiovascular health and subclinical changes at early stages of a disease. Broader acceptance of the preventive potential and the use of modern technological advances could therefore be a powerful instrument to solve the growing global problem of chronic diseases. In this context the routine evaluation of daily physical activity, body composition, arterial stiffness and the maximum physical performance could be a starting point for a preventive diagnostic approach. They can serve as future parameters reflecting health, detecting subclinical diseases and encouraging people’s responsibility for their own health. Detailed information about the major cardiovascular parameters opens specific and efficient course of action to create multiple strategies for gaining or rehabilitating cardiovascular wellbeing
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Achmat, Ghaleelullah. "Coronary artery disease risk factors among fire-fighters in the Western Cape Province." University of the Western Cape, 2017. http://hdl.handle.net/11394/6294.
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Magister Sport, Recreation and Exercise Science - MSRESThe work demands involved in fire-fighting place significant stress on the cardiovascular system. Cardiovascular disease is the leading cause of on-duty death among fire fighters and is a major cause of morbidity. This study investigated the prevalence of coronary artery disease risk factors among career fire fighters in the Western Cape.
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DeAraugo, Jodi. "The effect of website, face-to-face, and combined programs on physiological, psychological, and lifestyle risk variables for cardio-vascular disease." Thesis, Federation University Australia, 2005. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/165026.
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"Although a multitude of preventative programs have been utilised worldwide to modify cardiovascular risk factors, none have included internet based interventions. Study 1 aimed to compare internet based (n = 21), face-to-face (n = 27), and combined (n = 21) treatment groups with a naturally occurring control group (n = 24) on physiological, psychological, and lifestyle risk variables for cardiovascular disease across 6-months, and to determine if there were relationships between changes in the psychological and physiological variables over time. Results indicated that the internet based group had significantly greater social reciprocity than the face-to-face group. Significant time effects were noted for heart rate, stress, depression, anxiety, reciprocity, anger expression-out, anger expression-in, anger control-out, and anger control-in. Results also demonstrated that increases in reciprocity and anxiety, and decreases in anger expression-out, were related to increases in heart rate. "In contrast, less anger suppression was a significant predictor of greater systolic blood pressure. However, there were no significant results for group, time, or predictive value for the other psychological, physiological, and lifestyle risk variables. A follow-up study examined the effects of unstructured (n = 13) and highly structured (n =14) internet based programs on physiological, psychological, and lifestyle risk variables for coronary heart disease over 6-months. It also investigated if there were relationships between changes in the psychological and physiological variables over time. Participants stages of change were assessed in relation to psychological and lifestyle risk variables. Results showed that the unstructured group scored significantly higher on anger-expression-out than the highly structured group and that the unstructured groups alcohol usage significantly reduced over time. "The remaining psychological, physiological and lifestyle risk variables did not produce significant group, time, or predictive changes. The stage of change results indicated no significant group or time effects. Results indicated that greater angry reaction scores were predictive of higher heart rate and increased stress scores were predictive of higher diastolic blood pressure. The critical psychological variables predictive of poorer cardiovascular functioning should be targeted in future interventions."Doctorate of Psychology
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DeAraugo, Jodi. "The effect of website, face-to-face, and combined programs on physiological, psychological, and lifestyle risk variables for cardio-vascular disease." Thesis, University of Ballarat, 2005. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/43348.
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Although a multitude of preventative programs have been utilised worldwide to modify cardiovascular risk factors, none have included internet based interventions. Study 1 aimed to compare internet based (n = 21), face-to-face (n = 27), and combined (n = 21) treatment groups with a naturally occurring control group (n = 24) on physiological, psychological, and lifestyle risk variables for cardiovascular disease across 6-months, and to determine if there were relationships between changes in the psychological and physiological variables over time. Results indicated that the internet based group had significantly greater social reciprocity than the face-to-face group. Significant time effects were noted for heart rate, stress, depression, anxiety, reciprocity, anger expression-out, anger expression-in, anger control-out, and anger control-in. Results also demonstrated that increases in reciprocity and anxiety, and decreases in anger expression-out, were related to increases in heart rate. "In contrast, less anger suppression was a significant predictor of greater systolic blood pressure. However, there were no significant results for group, time, or predictive value for the other psychological, physiological, and lifestyle risk variables. A follow-up study examined the effects of unstructured (n = 13) and highly structured (n =14) internet based programs on physiological, psychological, and lifestyle risk variables for coronary heart disease over 6-months. It also investigated if there were relationships between changes in the psychological and physiological variables over time. Participants stages of change were assessed in relation to psychological and lifestyle risk variables. Results showed that the unstructured group scored significantly higher on anger-expression-out than the highly structured group and that the unstructured groups alcohol usage significantly reduced over time. The remaining psychological, physiological and lifestyle risk variables did not produce significant group, time, or predictive changes. The stage of change results indicated no significant group or time effects. Results indicated that greater angry reaction scores were predictive of higher heart rate and increased stress scores were predictive of higher diastolic blood pressure. The critical psychological variables predictive of poorer cardiovascular functioning should be targeted in future interventions.Doctor of Psychology (Clinical)
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PONZI, Fabíola Karine Arruda Xavier. "Avaliação da Gordura Corporal Como Fator de Risco Cardio Vascular em Funcionários de uma Universidade Pública da Cidade do Recife/PE." Universidade Federal de Pernambuco, 2012. https://repositorio.ufpe.br/handle/123456789/10306.
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Guehi, Calixte Haba Hebane. "Facteurs de risque cardiovasculaire chez les patients avant et après initiation des antirétroviraux en Afrique Sub-Saharienne, expérience de l’Essai Temprano ANRS 12 136." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0324/document.
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Les initiatives internationales pour l’accès au traitement antirétroviral (ARV) ont permis une réduction de la morbi-mortalité liée au VIH. Parallèlement, il existe croissance des risques cardio vasculaire (FRCV) dans les pays en développement, témoin d’une transition épidémiologique. Notre objectif était d’évaluer l’importance des FRCV avant et après mise sous antirétroviraux chez des personnes infectées par le VIH en Afrique. L’essai Temprano avait pour objectif d’évaluer les bénéfices et risque du traitement antirétroviral précoce et d’une chimio prophylaxie par 6 mois d’isoniazide (IPT) après 30 mois de suivi. Cette étude a conclu à l’efficacité des 2 interventions sur la réduction de la morbidité sévère, conduisant l’OMS, dès 2015, à recommander les ARV dès que les CD4 sont inférieurs à 500 CD4/mm3. Dans ce travail, nous avons évalué la prévalence des FRCV, et en particulier l’importance de l’obésité et du surpoids, à l’inclusion puis après 24 mois d’ARV. Nous avons ensuite calculé le score de risque cardio vasculaire selon l’équation de Framingham, avec et sans lipides à l’inclusion et à la fin du suivi. Il existait(i) une bonne corrélation des 2 équations (ii) une augmentation plus marquée du risque cardiovasculaire chez les femmes et (iii) une absence de différence de l’augmentation du risque selon les stratégies thérapeutiques. Enfin, dans le suivi long terme de Temprano nous montrons une efficacité de l’IPT sur la réduction de la mortalité, ce qui apporte un espoir dans un contexte où, malgré la transition épidémiologique en cours, les causes de mortalité sont toujours dominées par la Tuberculose en Afrique sub-saharienneThe international initiatives for promoting access to antiretroviral therapy (ART) have reduced HIV- related morbidity and mortality. Meanwhile, there are growing cardiovascular risk factors (CVRF) in developing countries, which are witnessing an epidemiological transition. Our objective was to assess the significance of CVRF before and after initiating antiretroviral therapy in HIV-infected people in Africa. Temprano trial aimed to assess the benefits and risks of early antiretroviral therapy and 6-month isoniazid preventive therapy (IPT) after 30-month follow-up. This study concluded that both interventions are effective to reduce severe morbidity, what led WHO, in 2015, to recommend starting ART immediately if CD4 count drop below 500 cells / mm3. In this study, we assessed the prevalence of CVRF and the significance of obesity and overweight at baseline and after 24 months of ART in particular. We then assess the cardiovascular risk score according to the Framingham equation, with and without lipids, at baseline and at the end of follow-up. There were: (i) a positive correlation between the 2 equations (ii) a sharper increase in cardiovascular risks among women and (iii) no difference in the risk increase according to treatment strategies. Finally, in the long-term follow-up of Temprano trial, we are showing the efficacy of IPT on the reduction of mortality, which brings hope in a context where, despite the on-going epidemiological transition, the causes of deaths are still dominated by Tuberculosis in sub- Saharan Africa
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Lokaj, Jiří. "Hodnocení vztahu mezi kardiovaskulárními signály pomocí nelineárních metod." Master's thesis, Vysoké učení technické v Brně. Fakulta elektrotechniky a komunikačních technologií, 2019. http://www.nusl.cz/ntk/nusl-378149.
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The short-term regulation of blood pressure is influenced by many influences, some being represented by cardiovascular signals and their changes. Because of the complexity of this system, the linear methods for its analysis are not sufficient. Non-linear methods for time series analysis have been devised quite a lot. In the course of this work, the analysis of the relations of several signals was evaluated as the most suitable conditional entropy and the resulting indexes of affinity and directionality. This method was applied to a set of heart-rate signals and systolic and diastolic pressure signals measured on eight adults and nine children. Relationships were analyzed but unfortunately after the statistical test was held the expected information links between the individual signals were not established. The indices were very small - in the hundredths of bits. Finally, optimization of the algorithm of the whole method has been performed and the newly modified function already shows significantly better results, for example strong information binding from the time-series of systolic pressure to a series of diastolic pressures.
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Huttin, Olivier. "Dépistage du vieillissement cardio-vasculaire : impact des nouveaux marqueurs d’imagerie." Thesis, Université de Lorraine, 2017. http://www.theses.fr/2017LORR0017/document.
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Le vieillissement cardiaque est fortement associé à l’apparition d’une fibrose pouvant entrainer une dysfonction progressive du remplissage et de l’éjection ventriculaire. Le dépistage du remodelage et du vieillissement cardiovasculaire sont primordiaux afin de proposer des stratégies de prévention et de prises en charge spécifiques visant à retarder l’apparition ou ralentir la progression d’une insuffisance cardiaque à fraction d’éjection préservée. Les outils cliniques, biologiques ou d’imagerie sont insuffisamment performants à l’heure actuelle pour dépister ces modifications précoces ou prédire l’apparition de remodelage ultérieur de façon efficace. La réalisation d’une méta-analyse avec revue de la littérature, nous a permis de montrer la valeur de la déformation myocardique comme marqueur du remodelage cardiovasculaire dans le post-infarctus, mais nous a aussi éclairé sur la complexité du phénomène et le manque de preuves sur sa potentielle valeur additionnelle en pratique clinique. Après avoir validé les différents outils de quantification du remodelage dans nos cohortes, nous avons montré l’importance d’une expertise précise de la morphologie et de la fonction cardiaque lors d’un évènement aigu pour prédire un remodelage ultérieur. Nous avons précisé le rôle de la déformation myocardique dans la quantification de la taille de l’infarctus, sa sévérité et son éventuelle extension au ventricule droit. Enfin, nous avons mis en relation les paramètres de contractilité et de fonction vasculaire en montrant la valeur du couplage ventriculo artériel mesuré en IRM. Ces travaux ouvrent la voie pour une stratégie d’évaluation d’imagerie précoce en post-infarctus pouvant orienter les thérapeutiques de revascularisation et/ou de réhabilitationCardiovascular aging is strongly associated with myocardial fibrosis and progressive LV systolic/diastolic dysfunction including vascular stiffening. Cardiac remodeling with left ventricular parietal stress and hypertrophy take place over several years and can ultimately lead to the occurrence of heart failure. Clinical, biological or imaging tools are currently insufficient to detect early changes or to predict the onset of subsequent remodeling in an effective manner. However, if subclinical structural and functional cardiac abnormalities are not detected by conventional echocardiographic techniques, they may be evaluated by others imaging tools with the measurement of myocardial deformation parameters. We performed a systematic review suggesting that deformation imaging is associated with left ventricular volume and function changes regardless the mechanisms and deformation direction. But added strain predictive value over other clinical, biological and imaging variables remains to prove. After validation of various remodeling indices, we proved the add value of a comprehensive assessment of ventricule geometry and function to evaluate remodeling after an acute event. We confirmed the central role of myocardial deformation for infarct size quantification and detect right ventricle extension. Finally, we used vascular function measured by MRI to demonstrate the relation between ventriculo-arterial coupling and remodeling. Further studies are needed to assess the gain in information provided by strain and these new biomarkers
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Ianotto, Jean-Christophe. "Néoplasies myéloprolifératives et thromboses : épidémiologie et identification des facteurs de risque." Thesis, Brest, 2018. http://www.theses.fr/2018BRES0017.
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Les néoplasies myéloprolifératives (NMP) sont des hémopathies myéloïdes clonales, chroniques et prolifératives. Les plus fréquentes sont la polyglobulie de Vaquez et la thrombocytémie essentielle. Elles s’accompagnent de risques importants de thrombose (artérielles et veineuses) et de transformation en pathologies plus agressives (myélofibrose secondaire et leucémie aigüe). Les thromboses peuvent être la situation diagnostique de ces maladies, ou survenir au cours de la prise en charge. Le sujet de cette thèse est d’étudier la relation clinique entre NMP et thrombose. Dans un contexte de survenue de thrombose veineuse idiopathique, sans antécédent NMP, nous nous sommes intéressés à la recherche de mutation clonale chez les patients comme moyen diagnostique d’une NMP. Nous avons ainsi exploité la cohorte EDITH du CIC en prenant les patients ayant expérimentés un puis une récurrence thrombotique. A l’inverse, nous avons constitué une base de données (OBENE) des patients pris en charge pour une NMP au CHRU de Brest.Nous avons ensuite exploité cette base, en analysant la fréquence et l’impact des arythmies cardiaques auriculaires, la balance bénéfice-risque à l’utilisation des NACO, l’impact des statines sur la réduction du risque de thrombose ainsi que la fréquence et l’impact de la nonadhérence aux traitements dans les PV et TE.NMP et thromboses sont liées, il est donc nécessaire d’approfondir les connaissances de leur physiopathologie spécifique pour améliorer la prévention et le traitement des épisodes. Cette thèse amène quelques réponses àcertaines questions mais elle est surtout le point de départ de réflexion commune entre les praticiens et biologistes intéressés par ces domainesThe myeloproliferative neoplasms (MPN) are clonal myeloid, chronic and proliferative disorders. The most frequent are polycythemia vera and essential thrombocythemia. The more frequent complications are thromboses (arterial and venous) and phenotypic evolutions (secondary myelofibrosis and acute leukemia). Thromboses can be a situation of diagnosis or observed during the followup of a MPN. This thesis is focused on the clinical link between MPN and thromboses.In a context of idiopathic venous thromboses (first event or recurrence), without medical history of MPN, we have tested patients for the most frequent MPN clonal mutations. So, we have used the informations and patients of the dedicated EDITH cohort.On the other hand, we have constituted a MPN database (OBENE) of the patients diagnosed for MPN in our Hospitalcentre. By this way, we have analysed the frequency and impact of atrial arrhythmias, the benefit-risk balance of the use of DOAC, the impact of statins to reduce the thrombotic risk and the frequency and impact of the treatment nonadherence in this population.MPN and thromboses are linked, so it is necessary to increase our knowledge of their physiopathology to improve prevention and treatment of the events. This thesis brings some answers to some questions but, she is almost the starting point of common reflexion between clinicians and biologists interested in these domains
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Florens, Nans. "Modifications post-traductionnelles des lipoprotéines de haute densité (HDL) et risque cardio-vasculaire dans l’insuffisance rénale chronique." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSE1034.
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Les complications cardiovasculaires restent prépondérantes dans l’insuffisance rénale chronique bien que les causes demeurent assez méconnues. Il existe une addition chez les patients insuffisants rénaux chroniques de facteurs de risque cardiovasculaires classiques et d’autres plus spécifiques à l’insuffisance rénale. Parmi ces derniers, la formation de modifications post-traductionnelles (adduits issus de réactions oxydatives et non-oxydatives) sur les lipoprotéines HDL pourrait jouer un rôle. Dans ce travail nous avons mis en évidence d’une part, un excès de carbonylation par le 4-HNE sur les HDL dans l’IRC sur un modèle animal de lapin et chez le patient hémodialysé ou dialysé péritonéal. Cette carbonylation par le 4-HNE est responsable d’une altération des propriétés anti-agrégantes des HDL et ce par une voie médiée par le récepteur scavenger CD36. Nous avons aussi montré que le protéome des HDL était modifié chez le patient HD et qu’il existait un large éventail d’adduits covalents sur les HDL de patients hémodialysés non-diabétiques. La formation de carboxy-méthyl-lysine issue de la glycation était la principale modification post-traductionnelle observée chez les patients HD. Cela questionne sur l’origine de cet excès de glycation qui pourrait être dû à un environnement chimique favorable chez les patients mais un apport exogène par les solutés utilisés en hémodialyse est aussi possibleCardiovascular complications remain the main problem in chronic kidney disease (CKD) but all the reasons of this risk are not fully understood. there is an addition of traditional risk factors and uremia-related ones. Among the latter, the generation of post-translational modifications of HDL could play a role. In this work, we highlighted an excess of carbonylation by 4-HNE onto the protein part of HDL in CKD in a rabbit model of CKD and in hemodialysis and peritoneal dialysis patients. This carbonylation by 4-HNE is responsible for ablunted anti-aggregant properties of HDL mediated by a CD36-dependant pathway. We also showed that the proteome of HDL from non diabetic hemodialysis patients is deeply modified and that there were several post-translational modifications onto the protein cargo of these HDL. The generation of carboxylate-methyl-lysine from non-enzymatic glycation processes was the main modification in our patients. The origin of such glycation could be from a favorable chemical environment but a potential load from hemodialysis fluids should be addressed
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Patrier, Laure. "Stratification du risque cardio-vasculaire en insuffisance rénale chronique : place des biomarqueurs émergents." Thesis, Montpellier 2, 2014. http://www.theses.fr/2014MON20227.
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L'insuffisance rénale chronique (IRC) demeure un problème de santé publique du fait de l'augmentation de sa prévalence. Malgré l'amélioration de la prise en charge, le taux de mortalité reste plus élevé comparé à la population générale. Parmi les causes de décès, les maladies cardiovasculaires, d'origine multifactorielle (élargissement et hypertrophie des artères, athérosclérose, calcifications vasculaires et valvulaires) sont au premier plan. A côté des facteurs de risque classiques, des facteurs non traditionnels, liés aux perturbations métaboliques de l'IRC, ont été mis en évidence, comme l'inflammation, la malnutrition, le stress oxydant, les anomalies du métabolisme minéralo-osseux. La meilleure connaissance de la physiopathologie de la vasculopathie de l'IRC permet d'émerger de nouveaux biomarqueurs pour stratifier le risque cardiovasculaire chez l'IRC.OBJECTIFS-METHODOLOGIE GENERALE : Nous avons réalisé une approche biochimique pour explorer trois composantes du risque cardiovasculaire chez l'IRC : stress oxydant, perturbations qualitatives des HDL (high-density lipoprotein) et métabolisme minéralo-osseux.RESULTATS : Dans une première publication la production d'anion superoxyde a été évaluée, via une méthode de chemoluminescence, en fonction du stade de l'IRC. Alors que la surproduction de formes réactives de l'oxygène est bien connue au stade 5d et peut être liée à la procédure dialytique, il existe peu de données aux stades précoces. Notre étude a porté sur 136 patients IRC non dialysés des stades 1à 5. Les résultats montrent que la production de FRO est assurée aux stades 4 et 5. Un bas débit de filtration glomérulaire (MDRD<30ml/min/1.73m2), l'inflammation (fibrinogène >3.7g/l) et des taux anormaux d' HDL (<1.42mM et >1.75mM) apparaissent comme les principaux déterminants du stress oxydant chez l'IRC non dialysé.Alors que dans la population générale, un taux bas de HDL est reconnu comme un facteur de risque important, nous avons montré (publication 1) que des taux anormaux de HDL, bas comme hauts, étaient indépendamment associés au stress oxydant chez les sujets IRC. Dans une deuxième publication, nous avons précisé la composition des HDL en se basant sur d'éventuelles modifications qualitatives des protéines associées à la structure des lipoprotéines. Une étude protéomique a été réalisée chez 7 patients hémodialysés versus 7 sujets sains. Nous avons retrouvé 40 protéines exprimées différemment sur les 122 identifiées, dont l'apoCII, l'apoCIII qui sont significativement augmentées et la transferrine abaissée. Ces protéines interviennent dans de nombreuses fonctions comme la réponse inflammatoire, l'activation du complément, la régulation de l'oxydation des lipoprotéines, l'homéostasie des cations.Dans une troisième publication, l'épuration du FGF23, phosphatonine impliquée dans les anomalies du métabolisme minéralo-osseux, été étudiée chez l'hémodialysé chronique en fonction de la techniques de dialyse (hémodialyse (HD) high flux versus hémodiafiltration on line (OL-HDF)). Notre étude a porté sur 53 patients dans le groupe HD et 32 patients dans le groupe OL-HDF. Dans les deux groupes le taux de FGF23 en post-dialyse est significativement plus bas qu'en pré-dialyse. Cependant, le taux de réduction, la clairance et le KT/V du FGF23 sont significativement plus bas dans le groupe OL-HDF.CONCLUSION-PERSPECTIVES : Chez l'IRC, avec l'appariation de facteurs de risque non traditionnels, de nouveaux biomarqueurs ont émergés dans la stratification du risque cardio-vasculaire. Ces biomarqueurs peuvent devenir des bioacteurs et représenter de nouvelles cibles d'action et de prévention de l'atteinte cardio-vasculaire chez l'IRC. La complexité des mécanismes physiopathologiques impliqués, nous incite à proposer des approches multimarqueurs. Actuellement des études biocliniques se poursuivent en mettant en place des cohortes régionales de patients aux stades 1 à 5 et de patients incidents en dialyseBACKGROUND: Chronic kidney disease (CKD) is a public health problem because of its increasing prevalence. Despite care improvements, the mortality rate remains higher compared to general population. Among causes of death, cardiovascular diseases with multifactorial origins (enlargement and hypertrophy of arteries, atherosclerosis, vascular and valvular calcifications) are in the foreground. Besides the traditional risk factors, non-traditional factors associated with metabolic disorders in CKD were bring out, such as inflammation, malnutrition, oxidative stress, mineral and bone disorder. A better knowledge of vasculopathy physiopathology in CKD allows the emergence of new biomarkers to stratify cardiovascular risk in CKD.AIMS-METHODOLOGY: We performed a biochemical approach to explore three components of cardiovascular risk in CKD: oxidative stress, qualitative alterations of HDL (high-density lipoprotein) and mineral and bone disorder.RESULTS: In a first publication, the superoxide anion production, according to the stage of CKD, was assessed using a chemiluminescence method. While the overproduction of reactive oxygen species is well known at the 5d stage of CKD and may be related to the dialysis procedure, there are few data in the early stages. Our study included 136 non-dialysis patients at stages 1 to 5 of CKD. Results showed an enhanced superoxide production at the pre-dialysis phase, stages 4 and 5 of CKD. Reduced glomerular filtration rate (MDRD <30 ml / min / 1.73m2), inflammation (fibrinogène≥3.7g / l) and abnormal levels of HDL (<1.42mM and ≥1.75mM) appears as main determinants of oxidative stress in non-dialysis CKD patients.While in general population, a low HDL rate is recognized as an important risk factor, we showed (publication 1) that abnormal levels of HDL, low as high, were independently associated with oxidative stress in CKD subjects. In a second publication, we have defined the HDL composition based on qualitative changes in the structure of proteins associated with lipoproteins. A proteomic study was performed in 7 patients on hemodialysis versus 7 healthy subjects. We found 40 proteins differently expressed on the 122 identified, including apoCII, apoCIII which are significantly increased and transferrin lowered. These proteins are involved in many functions such as inflammatory response, complement activation, regulation of lipoprotein oxidation and homeostasis cations. In a third publication, the removal of FGF23, phosphatonin involved in mineral and bone metabolism, was studied in chronic hemodialysis according to the dialysis techniques (high flux hemodialysis (HD) versus on line hemodiafiltration (OL- HDF)). Our study included 53 patients in the HD group and 32 patients in the OL-HDF group. In both groups the rate of FGF23 in post-dialysis was significantly lower than in pre-dialysis. However, rate of reduction, clearance and KT / V of FGF23 were significantly lower in the OL-HDF group.CONCLUSION-PROSPECTS: In the IRC, with the appearance of non traditional risk-factors, new biomarkers have emerged in the stratification of cardiovascular risk. These biomarkers can become bioactors and represent novel targets of action and prevention in the cardiovascular disease in CKD. The complexity of the involved physiopatholological mechanisms, leads us to propose multimarkers approaches. Currently bioclinical studies continue with the constitution of regional cohorts of patients at stages 1 to 5 of CKD and incident dialysis
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Evin, Morgane. "Caractérisation de la fonction hémodynamique suite au remplacement valvulaire mitral. Etude in-vitro." Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM4123.
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Ce travail de doctorat se décompose en quatre parties distinctes. La première partie concerne la caractérisation hémodynamique sur simulateur cardiovasculaire de prothèses valvulaires mitrales de différents constructeurs en vue de leur évaluation clinique et du diagnostique de leur dysfonction. La seconde partie se focalise sur les prothèses valvulaires mécaniques bi-clapet au travers desquels le phénomène de recouvrement de pression dû au passage de l'écoulement à travers les trois orifices formés par les clapets peut engendrer une surestimation du gradient transvalvulaire. Ce phénomène peut entrainer une ambiguïté lors de l'évaluation de la prothèse en cas de gradient transvalvulaire important. Cette partie s'attache à quantifier ce phénomène et à évaluer l'influence d'une dysfonction (disproportion patient-prothèse ou obstruction d'un clapet) sur celui-ci. La troisième partie concerne la procédure valve-in-valve dans laquelle une prothèse percutanée est implantée dans une bioprothèse défaillante. Elle fournit une caractérisation in vitro, première au niveau mondial, d'assemblages de la prothèse SAPIEN Edwards dans des bioprothèses issues de différents constructeurs. Enfin et suite à la mise en évidence dans les parties précédentes de profils de vitesse en amont de la prothèse ne pouvant être assimilés à des profils plats, l'étude des patrons de flux auriculaires a été réalisée grâce à des acquisitions in-vitroThis PhD work is divided into four different parts. the first part concerns the hemodynamic characterization by in-vitro cardiovascular testing of mitral valvular prosthesis from different manufacturers in order to provide reference values for clinical diagnosis. The second part focus on bi leaflet mechanical heart valve in each pressure recovery resulting of flow through the three orifices could lead to an overestimation of transvalvular pressure gradient. This could create ambigious assessment in case of high value of transvalvular pressure gradient. This part aims to quantify this pressure recovery and identify the influence of dysfunction (leaflet obstruction or patient prosthesis mismatch) on this value. Third part consists in valve-in-valve procedure in which a transcatheter valve is impllanted in a failled bioprosthesis. It provides in vitro testing, first globally, of assemblies composed of SAPIEN Edwards prostheses in different manufacturers' bioprosthesis.As highlighted in the previous parts inflows of the mitral prostheses can not be considered as plane and results of left atrium flow patterns. The last part studies the left atrium flow following mitral valve replacement
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Батаев, Д. А., В. П. Лиходедова, Ю. И. Журавлев, and П. К. Алферов. "Качество жизни и эмоциональный фон у пациентов с сердечно-сосудистыми заболеваниями на фоне метаболического синдрома." Thesis, Сумский государственный университет, 2016. http://essuir.sumdu.edu.ua/handle/123456789/47735.
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Результаты клинических исследований свидетельствуют о значительном снижении,
интегральных показателей качества жизни (КЖ), в том числе – за счет нарушений в психо-эмоциональной сфере (ПЭС) у больных сердечно-сосудистыми заболеваниями (ССЗ) на фоне метаболического синдрома (МС) (Коц Я. И., 1993; Беспалова, И. Д., 2012). Цель исследования: Изучить КЖ и психо-эмоциональный фон у больных ССЗ на фоне МС.
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Sallee, Marion. "Mécanismes cellulaires, moléculaires et épigénétiques impliqués dans les complications de l'insuffisance rénale chronique." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM5001.
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L'insuffisance rénale chronique (IRC) se caractérise par la diminution progressive et irréversible des fonctions renales. Elle s'accompagne d'une accumulation d'un ensemble de toxines responsable du syndrome urémique. Le syndrome urémique touche tous les organes, et de façon préoccupante le système cardiovasculaire. Il est associé à une dysfonction endothéliale, à la production d'un stress oxydant et d'une inflammation. L'objectif de cette thèse était d'identifier les mécanismes moléculaires responsables des complications du syndrome urémique. La première partie a tenté d'identifier des épissages alternatifs associés à l'IRC. Deux épissages alternatifs ont été identifiés. Cependant, le petit nombre d'épissages alternatifs trouvé au vue du nombre de gènes étudiés, nous permet de conclure que si l'IRC peut être responsable de l'apparition d'épissages alternatifs, ce phénomène n'est pas déterminant dans la régulation de l'expression des gènes responsable des complications de l'IRC. Dans la deuxième partie, nous avons montré par une étude clinique que le taux d'une toxine urémique, l'acide indole acétique (IAA), était associé à la mortalité et à la survenue d'événements cardio-vasculaires. In vitro, l'IAA induit un stress oxydant et un signal inflammatoire par l'induction de la cyclooxygénase 2 (COX-2). Une voie inflammatoire non génomique impliquant aryl hydrocarbon receptor (AhR), p38 MAPK et NF-κB est responsable de l'induction de la COX-2 endothéliale par l'IAA. Nos travaux ont identifié de nouvelles cibles thérapeutiques dont la modulation pourrait avoir un impact sur la mortalité cardiovasculaire des patients présentant une maladie rénale chroniqueChronic kidney disease (CKD) is characterized by an irreversible decrease in kidney functions. Accumulation of uremic toxins is implicated in the uremic syndrome. Uremic syndrome affects all organs and particularly the cardiovascular system. The aim of this thesis was to identify and understand the molecular mechanisms implicated in the uremic syndrome.The first part attempted to ascertain the existence of alternative splice events associated with CKD. Two alternative splicing were identified. The small number of alternative splice events highlighted allows us to conclude that this phenomenon does not seem to be a key event in the modulation of gene expression during CKD.In the second part of this work, we demonstrated that the plasmatic concentration of an uremic toxin, Indole-3-acetic acid (IAA), is associated with all-cause mortality and major cardiovascular events. In vitro, we demonstrated that IAA induced endothelial cyclooxygenase-2 expression and endothelial oxidative stress production. IAA activated an endothelial Aryl hydrocarbon receptor/P38MAPK/NF-κB pathway. The activation of this inflammatory AHR dependant pathway could play a critical role in the increase of cardiovascular morbidity and mortality observed during CKD.Our work provides new therapeutic targets. The modulation of their activation could reduce cardiovascular mortality in patients with chronic kidney disease
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Harbaoui, Brahim. "Rigidité Vasculaire en cardiologie interventionnelle." Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1265/document.
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Le vieillissement vasculaire est un phénomène inéluctable. Il s'accompagne de modifications structurelles et fonctionnelles du système cardio-vasculaire constituant la rigidité vasculaire. Ce processus dégénératif affecte essentiellement la matrice extra cellulaire des artères élastiques. La perte de l'élasticité du système vasculaire va impacter la fonction ventriculaire gauche et la perfusion cardiaque, rénale et cérébrale par des mécanismes différents. La rigidité vasculaire est un puissant marqueur de risque cardio-vasculaire. Cette notion est peu répandue dans le domaine de la cardiologie interventionnelle alors qu'elle pourrait avoir des implications pronostiques et thérapeutiques importantes. Nous nous sommes intéressés à deux domaines de la cardiologie interventionnelle, pour lesquels la rigidité vasculaire pourrait ouvrir de nouvelles voies de recherche, la maladie coronaire et le traitement interventionnel du rétrécissement aortique. Concernant la maladie coronaire il existe un besoin de mieux comprendre la physiopathologie de la microcirculation et de l'ischémie myocardique. La survenue des accidents coronaires aigus reste également incomplètement comprise. Nous avons abordé la problématique par une approche épidémiologique en étudiant l'impact pronostique de la rigidité vasculaire sur la mortalité liée aux coronaropathies dans une cohorte de 1034 patients hypertendus avec 30 années de suivi. La rigidité vasculaire a été appréciée par la pression pulsée et un score d'athérosclérose de l'aorte abdominale. Un lien très fort a été mis en évidence entre la rigidité vasculaire et la survenue d'infarctus du myocarde. Nous avons ensuite développé un moyen d'étudier la rigidité vasculaire localement au niveau des artères coronaires. Nous avons mis au point une technique de mesure de la vitesse de l'onde de pouls coronaire. Cette technique repose sur l'utilisation d'un guide de pression ntra-coronaire et un algorithme breveté du traitement de signal. Nous sommes parvenus à mesurer une vitesse de l'onde de pouls sur 71 artères coronaires chez 49 patients. Nous avons observé une vitesse de l'onde de pouls plus lente témoignant d'artères plus compliantes chez les patients présentant un infarctus du myocarde en comparaison aux patients présentant un angor stable. Nous avons également constaté une augmentation de la vitesse de l'onde de pouls après implantation d'un stent endocoronaire témoignant d'une rigidification attendue de l'artère coronaire. Ces travaux pourraient ouvrir une nouvelle voie de recherche dans la compréhension de l'ischémie myocardique et de la survenue de l'accident coronaire aigu à savoir l'interaction rigidité vasculaire globale et rigidité locale coronaire. Concernant le traitement interventionnel du rétrécissement aortique, de nouveaux facteurs prédictifs du bénéfice de l'intervention sont nécessaires chez des patients souvent âgés et fragiles. Nous nous sommes intéressés à l'étude du volume de calcifications de l'aorte, reflet de la rigidité vasculaire. Ce paramètre a été mesuré par scanner chez des patients traités par remplacement valvulaire aortique par voie percutanée appelé TAVI pour transcatheter aortic valve implantation. Nous avons d'abord montré que le volume de calcifications de l'aorte ascendante était un puissant marqueur de risque indépendant de mortalité cardiaque et d'insuffisance cardiaque sur une série de 127 patients consécutifs traités par TAVI, avec un suivi médian de 907 jours. Ce travail a ensuite été complété en étudiant le volume de calcifications de l'aorte totale sur une série de 164 patients. Le volume de calcifications de l'aorte complète était prédicteur de mortalité totale et cardiaque. De plus, chaque segment d'aorte pris séparément (aorte ascendante, descendante et abdominale) prédisait la mortalité cardiaque. Enfin, seul le volume de calcifications du segment ascendant était prédicteur d'insuffisance cardiaque [etc…]Vascular aging is an inevitable phenomenon. It is accompanied by structural and functional modifications of the cardiovascular system mainly referred to as vascular stiffening. This degenerative process essentially affects the extracellular matrix of the elastic arteries. The loss of elasticity of the vascular tree affects left ventricular function as well as cardiac, renal and cerebral perfusions involving different mechanisms. Vascular stiffness is a powerful risk marker of cardiovascular disease. However, most interventional cardiologists are not familiar with this concept while it may have both important prognostic and therapeutic implications. We tackled two areas of interventional cardiology, where vascular stiffness may open new fields of research; coronary artery disease and interventional treatment of aortic stenosis namely, transcatheter aortic valve implantation (TAVI). With regards to coronary artery disease there is a need to better understand the pathophysiology of microcirculation and myocardial ischemia. Moreover, the occurrence of acute coronary events is also incompletely understood. Our first approach was epidemiological. We studied the prognostic impact of vascular stiffness on coronary artery disease mortality in a cohort of 1034 hypertensive patients after 30 years of follow-up. Vascular stiffness was assessed both by pulse pressure and by a score related to atherosclerosis of the abdominal aorta. A strong link was found between vascular stiffness and the occurrence of myocardial infarction and coronary artery disease related deaths. We then developed a way to study the local vascular stiffness at coronary artery level by measuring coronary pulse wave velocity. This technique relies on the use of an intracoronary pressure wire and a patented signal processing algorithm. We measured a coronary pulse wave velocity on 71 coronary arteries in 49 patients. Interestingly, patients with acute coronary syndromes had a lower coronary pulse wave velocity (which means more compliant arteries) when compared to patients with stable coronary artery disease. After an endocoronary stent implantation we noticed an increase of coronary pulse wave velocity in line with an expected stiffening. This work opens a new avenue of research regarding coronary perfusion physiology and plaque complications by studying the interaction of regional vascular stiffness and local coronary stiffness. Regarding TAVI, a procedure that often concerns elderly and frail patients, new factors predicting the benefit of the intervention are needed. We studied aortic calcifications as a surrogate of vascular stiffness. This parameter was measured by CT scan before TAVI. We first showed in 127 consecutive patients with a median follow-up of 907 days that ascending aorta calcifications were a powerful risk marker of cardiac mortality and heart failure after TAVI. This study was then completed by studying the volume of the whole aorta in 164 patients. The volume of calcifications of the whole aorta was a predictor of both all-cause and cardiac mortality. In addition, each segment of aorta taken separately (ascending, descending and abdominal aorta) predicted cardiac mortality. Finally, only ascending aorta calcifications predicted heart failure. These results support the hypothesis that ascending aorta calcifications are a marker of vascular stiffness and contribute to the left ventricular afterload. Moreover the volume of the whole aorta could mirror the global atherosclerosis burden of the patient. This easily measurable parameter could thus represent a new risk stratification tool in patients treated with TAVI. This work on vascular stiffness opens a new field of research in several areas of interventional cardiology. Regarding coronary artery disease, coronary pulse wave velocity could represent a way to better understand coronary perfusion, microcirculation, ischemia and the occurrence of coronary plaque rupture [etc...]
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Goueslard, Karine. "Intérêt des bases de données médico-administratives dans l'évaluation du dépistage, de la surveillance et des complications du diabète." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCI022.
Full textAbstract:
Le diabète constitue une des cibles mondiales prioritaires. Le besoin de définir des priorités, d’élaborer des objectifs clairs et de mener des actions coordonnées rend tout aussi prioritaire l’accès aux données probantes. Les bases de données médico-administratives sont de plus en plus utilisées à ses fins. Nous avons choisi d’illustrer et d’évaluer l’intérêt de la base française de données de consommation de soins dans l’évaluation du dépistage, de la surveillance et des risques de complications aigues ou chroniques du diabète dans certaines populations à risque. Nous avons conclu à l’insuffisance du dépistage précoce du diabète de type 2 chez des femmes ayant un antécédent de diabète gestationnel. Si une légère augmentation s’est produite après les recommandations en 2010, une femme sur deux ne réalise aucun dépistage dans la première année suivant la grossesse. Après un infarctus du myocarde, le dépistage préconisé du diabète de type 2 est très insuffisant en population générale. La prescription du test de dépistage au moment de la réadaptation cardiaque crée une forte implication, avec un taux de dépistage de 97% des patients, pour un diagnostic de diabète ou prédiabète chez 40% d’entre eux. Après un accident vasculaire cérébral, la surveillance du diabète reste faible. Le contrôle du risque de récidive semble s’intégrer pleinement à la prise en charge de la maladie cérébrovasculaire dans les cas les moins lourds. Le risque précoce de complications cardiovasculaires après un diabète gestationnel et de réhospitalisation pour complications aigues chez les personnes jeunes, atteintes de diabète de type 1 et de schizophrénie a pu être démontré. La politique de prévention du diabète s’appuyant sur un plaidoyer offrirait l’opportunité de créer des coalitions fortes entre des partenaires aux intérêts divers. L’usage des bases de données médico-administratives et des études observationnelles a prouvé sa capacité à augmenter nos connaissances sur le diabète. Il implique l’évaluation préalable de la qualité des données et des algorithmes de sélection, la mise en œuvre de méthodes d’analyse statistique appropriéesDiabetes is a priority health target worldwide. Access to conclusive data is equally a priority in order to establish clear objectives and to implement coordinated action. Medico-administrative databases are being used more and more frequently for this purpose. We set out to illustrate and assess the interest of using a French healthcare consumption database to evaluate screening, surveillance and the risk of acute or chronic complications of diabetes in certain at-risk populations. We concluded that early screening for type-2 diabetes in women with a history of gestational diabetes was inadequate. Although a slight improvement occurred following the recommendations published in 2010, one woman in two has no screening test in the first year following the pregnancy.Recommended screening for type-2 diabetes following myocardial infarction in the general population is seriously insufficient. At the time of cardiac rehabilitation, 97% of patients were screening for type-2 diabetes screening and 40% of these are diagnosed with diabetes or prediabetes. After stroke, surveillance of diabetes remains poor. In the least severe cases of stroke, it seems that the control of risk factors for recurrence is an integral part of the management of the cerebrovascular disease. We showed that women with gestational diabetes have a risk of early cardiovascular complications and that young persons with type-1 diabetes and schizophrenia have a risk of rehospitalisation for acute complications. Prevention policies for diabetes could be improved if they were based on opportunities to create strong partnerships involving actors from different sectors. The use of medico-administrative databases and observational studies has extended our knowledge of diabetes. However, before being used, data quality and the pertinence of selection algorithms must be evaluated, and it must be shown that the methods used for the statistical analysis are appropriate
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Kuldavletova, Olga. "L'intégration multisensorielle fonctionnelle et la plasticité des réflexes vestibulaires Vestibulo-sympathetic Reflex in Patients With Bilateral Vestibular Loss Influence of Graviceptor Stimulation Initiated by Off-Vertical Axis Rotation on Ventilation Effect of self-motion perception on autonomic control Vestibulo-Ocular Responses, Visual Field Dependence, and Motion Sickness in Aerobatic Pilots." Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC405.
Full textAbstract:
L’objectif de ce travail de thèse était d’évaluer le rôle du système vestibulaire dans l’homéostasie en relation avec l’orientation.Nous avons évalué les réponses vestibulaires (1) dans une population normale pour évaluer le niveau d’implication des différents systèmes sensoriels dans la régulation cardiovasculaire et respiratoire et (2) dans des populations présentant des informations vestibulaires perturbées : soit des patients avec un déficit vestibulaire bilatéral soit des pilotes de voltiges aérienne.Les résultats indiquent que les informations vestibulaires et celles des gravicepteurs du tronc s’associent pour réguler la réponse respiratoire lors de la rotation à axe incliné selon la gravité (RAIG). La contribution respective des récepteurs vestibulaires et des gravicepteurs dans cette réponse varie en fonction des individus. Une autre étude a testé l’hypothèse selon laquelle la modulation de la réponse cardio-vasculaire par le système vestibulaire peut être influencée par les informations visuelles pendant la RAIG. Les résultats préliminaires de cette étude ont montré que la stimulation RAIG a un effet sur les valeurs moyennes des paramètres cardio-vasculaires. L'effet modulateur de la RAIG sur la pression artérielle a également été démontré. Cette modulation de réponse, et plus particulièrement la phase, variait entre les individus, ce qui peut indiquer la nature neuronale de la modulation observée. Un effet de la stimulation visuelle sur la modulation semble être également présent, mais une analyse plus approfondie est nécessaire pour confirmer ce résultat. Dans une autre étude, il s’est avéré que des patients présentant une déficience vestibulaire bilatérale avaient la même réponse cardio-vasculaire aux changements de position de la tête pendant le protocole « head down neck flexion » que les sujets témoins. Ces résultats indiquent que cette reconstruction du réflexe vestibulo-sympathique semble provenir de sources sensorielles autres que labyrinthiques. Enfin, nous avons étudié les pilotes de voltige aérienne comme modèle de sujets subissant des stimulations vestibulaires intenses et inhabituelles. Nous n'avons pas observé l’habituation vestibulaire attendue lors d’explorations fonctionnelles vestibulaires (RAIG et échelon de vitesse) en comparaison avec des sujets témoins, en revanche les pilotes étaient moins sensibles au mal des transports. Nous suggérons que les pilotes ne développent pas d'habituation vestibulaire comme attendu car ils ont besoin des réponses vestibulaires préservées et non altérées pour maintenir une performance optimum lors des activités de voltige aérienne.Nous concluons que pour générer des réponses en lien avec l’orientation, le système nerveux central intègre les signaux vestibulaires et non-vestibulaires et est sujet à un certain niveau de plasticité en conditions sensorielles altérées. Ce traitement multisensoriel est régulé individuellement, avec un poids variable des informations vestibulaires, en fonction de l'état sensoriel et des exigences liées à l’activitéThe aim of this thesis was to specify the role of the vestibular system in the orientation-related homeostasis. We evaluated vestibular responses to changes in orientation in space (1) in normal population to reveal in what proportion different sensory systems are implicated in the generation of the cardio-vascular and respiratory responses, and (2) in populations with altered vestibular afference: bilateral vestibular loss patients and aerobatic pilots.The results indicated that the vestibular system cooperates with trunk graviceptors to evoke respiratory response to changes in orientation during Off-Vertical Axis Rotation protocol (OVAR). The contribution of each sensory source was found to vary between individuals. Another study tested the hypothesis that the vestibular modulation of cardio-vascular parameters can be influenced by visual input during OVAR. Preliminary results from this study have demonstrated that the OVAR stimulation has an effect on the mean cardio-vascular parameters. The modulatory effect of OVAR on the arterial pressure has also been shown. The phases of modulation were varying between individuals which can indicate the neural nature of the observed modulation. The effect of visual stimulation on modulation has been detected, however further analysis is required. In another study, subjects presenting bilateral vestibular loss were shown to have the same cardio-vascular response to changes in the position of the head during Head-Down-Neck-Flexion protocol (HDNF) as normals. This reconstruction of the vestibulo-sympathetic reflex in human seems to originate from the sensory sources other than labyrinthine. Finally, we studied aerobatic pilots as humans experiencing intense and unusual vestibular stimulations. We have not revealed the expected vestibular habituation in the study using the OVAR and EVAR (Earth-Vertical Axis Rotation) stimulations, but were significantly less susceptible to motion sickness. We suggest that the pilots do not develop habituation, as they require unsuppressed responses for a better performance.We conclude that to generate the orientation-related responses, the Central Nervous System integrates the vestibular and non-vestibular signals and is subject to plastic changes in altered sensory conditions, if the response needs to be changed or restored. This multisensory processing is individually tuned, with the variable portion of vestibular impact in this processing, depending on activities, sensory state and the requirements to the response
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Gaston, Anne Fleur. "Les déterminants cardio-respiratoires de la performance en moyenne altitude chez des athlètes présentant une hypoxémie induite par l'exercice." Thesis, Perpignan, 2015. http://www.theses.fr/2015PERP0038/document.
Full textAbstract:
En plaine, la moitié des athlètes entrainés en endurance sont susceptibles de développer une hypoxémie induite par l’exercice (HIE). Actuellement, la pratique des sports d’endurance de montagne est en plein essor. Dans ces disciplines, les athlètes très entrainés en endurance et donc susceptibles de développer une HIE, évoluent régulièrement en altitude modérée. Ce travail s’est intéressé à l’évolution de la HIE en altitude modérée, ainsi qu’à ses conséquences et sa relation avec la modification des composantes cardio-respiratoires à l’exercice. Nos résultats indiquent que : 1) la désaturation artérielle n’est pas potentialisée en altitude aiguë chez les athlètes HIE par rapport à des athlètes non-HIE alors que les athlètes HIE ont une chute de consommation maximale d’oxygène et de fréquence cardiaque maximale plus importante, 2) les athlètes HIE développent un stress hémodynamique important associé à des réponses vasculaires pulmonaires spécifiques à l’exercice en plaine, 3) tous les athlètes présentent une limitation de la diffusion pulmonaire à l’exercice maximal en altitude aiguë et nos résultats ne permettent pas d’affirmer une limitation cardiaque plus importante chez les athlètes HIE, 4) en hypoxie chronique, la désaturation artérielle est influencée par les modalités de pratique sportive. Notre travail a permis d’établir des recommandations pour les athlètes entrainés en endurance, de plus en plus nombreux, désirant performer en altitude modéréeAt sea level, half of endurance trained athletes can develop an exercise induced hypoxemia (EIH). Currently, the practice of mountain endurance sports is booming. In these disciplines, highly endurance trained athletes, and thus likely to develop EIH, practise regularly at moderate altitude. This work has focused on the evolution of EIH at moderate altitude, as well as its consequences and its relationship with the change in cardiorespiratory components during exercise. Our results show that: 1) arterial desaturation is not potentiated at acute altitude in EIH athletes compared to non-EIH athletes while EIH athletes have a greater fall in maximal oxygen uptake and in maximal heart rate, 2) EIH athletes develop a significant hemodynamic stress associated with specific pulmonary vascular responses at sea level, 3) all athletes have a lung diffusion limitation at maximal exercise in moderate altitude and our results do not show a greater cardiac limitation in EIH athletes, 4) in chronic hypoxia, arterial desaturation is influenced by exercise modality. Our work resulted in a number of recommendations to help endurance trained athletes who want to perform at moderate altitude
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Boysson, Hubert de. "Caractérisation clinique, iconographique et pronostique des atteintes des gros vaisseaux dans l'artérite à cellules géantes The different clinical patterns of giant cell arteritis Vascular Presentation and Outcomes of Patients With Giant Cell Arteritis and Isolated Symptomatic Limb Involvement Large-vessel involvement and aortic dilation in giant-cell arteritis: a multicenter study of 549 patients Different patterns and specific outcomes of large-vessel involvements in giant cell arteritis Integration of clinical patterns and imaging in the classification criteria of giant-cell arteritis: Propositions from a monocentric prospective real-life cohort Apport de l’imagerie (hors Doppler) pour le diagnostic et le suivi de l’artérite à cellules géantes." Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC425.
Full textAbstract:
Les travaux concernant les atteintes des gros vaisseaux dans l’artérite à cellules géantes sont rares et ne concernent rarement plus que quelques dizaines de patients. Dans des travaux précédents, nous montrions que l’atteinte des gros vaisseaux était associée à un risque accru de dilatation aortique. Grâce à un recrutement inédit et des collaborations fructueuses, nous avons pu constituer une cohorte conséquente de patients et avons pu déterminer la fréquence et la présentation clinico-radiologique des patients avec une atteinte des gros vaisseaux. Nous avons pu confirmer que cette atteinte était associée à un pronostic cardio-vasculaire plus sombre et avons pu individualiser différentes formes d’atteinte des gros vaisseaux, chacune ayant un pronostic cardio-vasculaire différent. L’adjonction d’un traitement immunosuppresseur aux glucocorticoïdes semble avoir un effet protecteur sur le développement des complications cardio-vasculaires. Nos travaux nous ont également amené à discuter la place des différentes imageries disponibles pour dépister l’atteinte des gros vaisseaux, et à proposer des nouveaux critères de classification actualisés prenant en compte l’atteinte des gros vaisseauxStudies analyzing giant cell arteritis (GCA)-related large-vessel involvement are rare and only describe less than 100 patients. In previous studies, we showed that large-vessel involvement was associated with an increased risk of aortic dilation. Thanks to an unedited enrollment of GCA patients and collaborations with other teams, we created a large-sampled cohort. We analyzed the frequency and the clinical and radiological presentations of patients with large-vessel involvement. We confirmed poorer cardiovascular outcomes in patients with GCA-related large-vessel involvement. We also individualized different patterns of large-vessel involvement, with different cardiovascular prognoses. Combination of an immunosuppressant with glucocorticoids decreased the risk of cardiovascular complications in GCA patients with large-vessel involvement. We discussed in our studies the place of each imaging tool available to detect large-vessel involvement. Finally, we proposed updated classification criteria including large-vessel involvement in order to integrate the different disease patterns
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francesca, dassie. "CARDIO-CEREBRO-VASCULAR RISK ASSESSMENT AND COMPLICATIONS IN ACROMEGALY." Doctoral thesis, 2020. http://hdl.handle.net/11577/3345271.
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Chi-HungJhu and 朱啟宏. "Application of Adaptive Neural Fuzzy Inference System in Cardio Vascular Disease Diagnosis." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/89368929639441179626.
Full textAbstract:
碩士國立成功大學
工程科學系
104
Heart disease is one of the top ten causes of death in global, and coronary artery disease (CAD) is the main form of heart disease. Cardiac catheterization gives accurate results, but it is expensive and may be harmful to patients. Non-invasive methods can reduce damage risk but have lower accuracy and other problems like time-consuming and expensive. Therefore, a diagnosis method that is accurate, cost-effective, and time-saving is desirable. In this thesis, a model that uses an adaptive neural fuzzy inference system (ANFIS) is presented, which is able to build a diagnosis system with self-correction by training data. An expert system for heart diseases that follows doctor judgement from limited linguistic information given by patients is applied. There are two phases in the system. In the first phase, input features are obtained, checking if input features have defect. If so, the system has to correct the defect. In second phase, an ANFIS algorithm is used for classification. The ANFIS model is trained by using the back propagation method which combines with the least squares method. Four levels of CAD results which are classified by the severity of the disease, are used by the diagnosis system to help doctors choose the most appropriate treatment for patients. The training performance and classification accuracies are used to evaluate the performance of the ANFIS model. The performance of ANFIS model is compared with the fuzzy diagnosis system. The results shows that the accuracy of the ANFIS model (80.6%) is better than the accuracy of the fuzzy model (72.7%).
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Cathcart, Kellie. "Cardiovascular disease and depression: the potential of an integrated psychological treatment approach." Thesis, 2015. http://hdl.handle.net/1959.13/1300103.
Full textAbstract:
Masters Research - Master of Clinical Psychology (MClinPsych)Objective: Integrated psychological treatments addressing depression and other comorbidities together have the potential for developing better management skills for both conditions. Such programs have been successfully used in a number of populations to date including depression and alcohol and other drug use. There is emerging evidence for an additional benefit of integrated psychological treatments for lifestyle behaviours not specifically targeted by the treatment program. This study aimed to complete a 5-year follow up of initial participants across two clinical trials of integrated versus non-integrated treatments for depression and alcohol use problems to determine the long terms benefits of both the targeted and non-targeted behaviours. In doing this, and adding a CVD risk assessment, we aimed to compare the CVD risk factors for those who had completed the original treatment program (targeting depression and alcohol/cannabis use) and those who did not complete. Method: Participants completed a 30-45 minute telephone assessment. Of the 558 original participants in the treatment trials, 66 completed 60-month follow-up assessments. This sample was divided into “treatment completers” (those who attended their full complement of treatment session in the original study) and “non-completers”. Results: Treatment completers halved their cigarette consumption over time, whereas non-completers increased their tobacco use over time. This is despite tobacco not being specifically targeted by the original treatment programs. There were no significant differences between treatment completers and non-completers for CVD risk factors at 60-month follow-up, with the exception of tobacco use. At 60-months, the treatment non-completers smoked twice as many cigarettes as the treatment completers. Smoking is a leading risk factor for CVD, and is the leading preventable cause of morbidity. Conclusions: The SHADE and DAISI treatment programs were successful in reducing smoking behaviour, which suggests that the program has merit in reducing key CVD risk factors. Future studies should look at modifying the program to focus on increasing fruit and vegetable intake as well as physical activity to provide a more comprehensive CVD package.
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Wang, ZI-Chen, and 王子誠. "The risk of cardio-cerebral vascular events in type 2 diabetes patients with the usage of saxagliptin." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/40391727183387177674.
Full textAbstract:
碩士高雄醫學大學
藥學系碩士在職專班
104
Background: Saxagliptin is an oral hypoglycemic agent that can control blood sugar by inhibiting the metabolism of incretin. Several research studies recently showed that saxagliptin may increase the risk of cardiovascular events recetently. The aims of our study were to evaluate the risk of cardio-cerebral vascular events in patients who received saxagliptin and explore the precipitating risk factors of cardio-cerebral vascular events. Methods: There were two parts in our study. First, a systemic review and meta-analysis of randomized controlled studies of comparing saxagliptin to placebo with cardio-cerebral vascular events was conducted. Databases were searched for relevant published articles. Second, a retrospective cohort study was performed based on medical records of a medical center in southern Taiwan. Data such as patient’s basic information, medication records, lab data and diagnostic records were extracted and used to explore the risk factors of cardio-cerebral vascular events. Results: Six randomized controlled studies were included in the meta-analysis. Compared to control, treatment with saxagliptin significantly increased the risk of heart failure (RR=1.25, 95%CI：1.05-1.48；p value=0.01). Saxagliptin did not increase the risk of myocardial infarction and angina. The result of subgroup stratified by cardiovascular history showed that treatment with saxagliptin increased risk of heart failure (RR=1.26, 95%CI：1.06-1.49；p value=0.009) in the subgroup with CV history. Retrospective cohort study explored the significant risk factors of developing cardio-cerebral vascular events in patients who used saxagliptin were heart failure history (OR=3.395, 95%CI：1.118-10.305；p value=0.031) and atherosclerosis disease history OR=2.936, 95%CI： 1.017-8.481; p value=0.047). Conclusions: Our study showed that the usage of saxagliptin may increase the risk of heart failure in type 2 diabetes patients with history of cardiovascular disease. We found that the heart failure history and atherosclerosis disease history were important risk factors for developing cardio-cerebral vascular events.
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Lin, Kuo-Hua, and 林國華. "Effects of Acute and Chronic Ethanol Administration on Cardio- vascular Dynamics in Rats：Time- and Frequency- Domain Analysis." Thesis, 1996. http://ndltd.ncl.edu.tw/handle/35728714446919996583.
Full textAbstract:
碩士國防醫學院
生理學研究所
84
Long-term alcohol consumption elevates blood pressure. Epidemiological studies have consistently found alcohol consumption to be a significant risk factor for hypertension and stroke; and hypertension is prevalent among chronic drinkers. However, the mechanism of alcohol- induced hypertension still remains uncertain. Spectral analysis breaks down steady flucturating signals from time domain into frequency domain, by computing the power of the signal components at predetermined frequency values. It is generally assumed that the power in the low frequency (LF) and high frequency (HF) bands obtained by power spectral analysis of cardiovascular variables reflects sympathetic and vagal tone, respectively. In the present study we performed the power spectral analysis of systemic arterial pressure (SAP) and heart rate (HR) in an effort to identify autonomic correlates in alcohol- induced hypertension. It is concluded that chronic administration of ethanol elevates SAP and HR. Chronic administration of ethanol increases both sympathetic and parasympathetic activities without changing smpatho-vagal balance. Acute administration of ethanol tends to reduce SAP as well as HR, however, this effect is only significant in chronic EtOH rats. Acute administration of ethanol significantly reduces sympathetic and parasympathetic activities in chronic EtOH rats. The sympatho-vagal balance is also changed by acute administration of ethanol.
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Ezegbe, C. "Exposure to passive smoking in childhood as a risk factor for poorer health and wellbeing across the life course." Thesis, 2021. https://eprints.utas.edu.au/38370/2/Ezegbe_whole_thesis_ex_pub_mat.pdf.
Full textAbstract:
Background: Exposure to passive smoking in childhood, which mainly comes from parents, continues to be a concerning major public health issue many years after comprehensive global action on tobacco control was initiated. This thesis aimed to examine (1) the prevalence, determinants and the trend of maternal smoking during pregnancy; (2) hospital use among children associated with exposure to maternal smoking during pregnancy; (3) validity and reliability of a life course questionnaire on exposure to passive smoking during childhood and (4) the effect of exposure to passive smoke across childhood on cardiovascular function in adulthood. Previous studies in these areas had limitations related to measurement of exposure or outcomes, were cross-sectional, or did not have objectively measured outcomes. This thesis sought to overcome these limitations, adding new information in these areas that could be important for public health policy and practice.
Methods:
Participants were drawn from three datasets, Tasmanian Conception to Community study (C2C), Childhood Determinants of Adult Health Study (CDAH) and Tasmanian Infant Health Study (THIS).
C2C is a de-identified linked dataset comprising perinatal, emergency department, and admitted patient databases collected between the period July 2008 to June 2014. Data on maternal smoking during pregnancy and other study factors were self-reported by mothers and collected by midwives as part of nationally mandated perinatal datasets. Emergency department presentations and admission into hospital through ED were from public emergency department data.
The CDAH study comprised of the 1985 Australian Schools Health and Fitness Survey (ASHFS) cohort aged 7- 15 years that were subsequently followed up in CDAH-1 (2004-06), CDAH-2 (2009-11) and CDAH-3 (2014 - 19). A range of validated measures of cardiovascular structure and function were assessed by trained data collectors at face-to-face clinics around Australia. Data on passive smoking during childhood was collected with questionnaires in childhood and adulthood.
The TIHS included birth cohort between January 1988 to March 1990 that was followed up in 2015-16 for a pilot study of adult cardiovascular health. Measures of cardiovascular structure and function were taken in face-to-face clinics. Exposure to passive smoking during pregnancy and childhood was self-reported by mothers prospectively around the time of birth and shortly after.
Results:
The first study examined the trends and determinants of maternal smoking during pregnancy, changes in maternal smoking during pregnancy between and within pregnancies and their determinants in Tasmania, Australia. Maternal smoking during pregnancy declined from 25.9% (2008) to 16.4% (2014). A cessation proportion of 35.1% was observed between index (first birth recorded in the dataset) and last pregnancy. Maternal alcohol consumption during pregnancy, living in a highly socioeconomically disadvantaged area or being an Aboriginal or Torres Strait Islander was associated with an increase in the prevalence of maternal smoking during pregnancy and continued smoking between pregnancies.
The second study evaluated the effect of exposure to passive smoking during pregnancy on ED presentations and admission into hospital through ED in exposed children up to 1-year and 5- years of age. Exposed children had 26% and 45% higher overall presentation to ED and admission into hospital through ED, respectively, compared to unexposed children at 5 years of age. Higher presentation and admission for respiratory, eye, ear, nose, and throat illnesses, systemic and parasitic infections and psychosocial/other presentations were observed above the level of the negative control outcome of poisoning or injuries in exposed children at 5 years. Similar results were obtained at 1 year. These effects had a dose-response relationship with increased rates of presentation and admission associated with higher exposure to cigarettes per day.
The third study examined the reliability and validity of a retrospective questionnaire administered to middle-aged adults in CDAH phase 3 on prolonged exposure to tobacco smoke across childhood. The three measures of passive smoking derived from questions on other people smoking in the home (example. parents and siblings) included total household smoker (range: 0 to 5 smokers); cumulative years of exposure (range: 0 to 106 years) and severity of exposure index (range: 0 to 318). The three retrospective measures had good internal consistency and moderate agreement with childhood and adulthood factors in ASHFS and CDAH. The three measures were also significantly positively correlated with participant smoking and negatively with their lung function test. These results suggest that these measures are reliable and valid to measure prolonged passive smoke exposure from childhood to adulthood.
The fourth study illustrated the effect of exposure to passive smoking across childhood using the previously validated measures on cardiovascular function in adulthood. Greater exposure to passive smoking across childhood from the total number of smokers in the household was associated with an increase in central blood pressure. Worse left ventricular function as measured by global longitudinal strain was associated with greater cumulative years of exposure to passive smoke.
The fifth pilot study evaluated the effect of exposure to passive smoking during pregnancy and childhood on cardiovascular function in adulthood. There were significant increases in peripheral diastolic blood pressure and decreases in left ventricular function in children exposed to passive smoke at various time-points of exposure from pregnancy to adulthood.
Conclusion:
The findings in this thesis suggest that exposure to passive smoking during pregnancy and childhood negatively impacts the health of offspring in childhood and into adulthood. Though exposure to maternal smoking during pregnancy is declining, more work needs to be done to reduce exposure and improve the cardiovascular health of children exposed to this risk factor early in life.
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Masona, Sharon. "Physical activity participation among adults with hypertension in Mbabane, Swaziland." 2013. http://hdl.handle.net/11394/3621.
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>Magister Scientiae - MScScientific studies have shown that chronic diseases of lifestyle (CDL) such as hypertension and diabetes mellitus are major causes of mortality and morbidity, accounting for about 60% of the disease burden globally. Available statistics for Swaziland indicate that hypertension and heart diseases are on the increase and are responsible for 33,540 and 3,146 cases per year respectively. Regular physical activity (PA) is widely recognised as a means for the primary and secondary prevention of CDL due to their multi-factorial beneficial effects on an individual‟s health. Therefore, the aim of this study was to determine PA participation among adults with hypertension in Mbabane, Swaziland and the extent to which they are encouraged to be physically active. A cross-sectional design, utilising quantitative methods was employed in the study and three validated standardised interview administered questionnaires were used to collect data from both hypertensive individuals and health professionals. A sample size of 422 hypertensive individuals and 72 health professionals was included in the study. Statistical Package for Social Sciences (SPSS) version 20 was used to analyse the data. Descriptive statistics were employed to summarise data and was expressed as means, standard deviation, frequencies and percentages. The Students‟t-test was used to compare mean age and PA. Chi-square tests were used to test for associations between categorical variables with significant levels set at 5% (p < 0.05). Blood pressure was classified into controlled (≤ 140/≤ 90 mmHg) and uncontrolled (≥ 140/≥ 90 mmHg). PA was dichotomised into active (> 600 MET-minute/week) and sedentary (< 599 METminute/ week). BMI was classified as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9) and obese (>30). The findings of the current study revealed that a considerable number of individuals with hypertension (53%) were physically inactive with poorly controlled blood pressure (57%). A statistical significance was found between mean age and PA (sedentary and active) (P= 0.000 ˂ 0.05). iii The study also revealed that the perceived benefits of PA as reported by individuals with hypertension outweighed the perceived barriers. In addition, the majority of health professionals were found to be poor counsellors of PA (58%). Most health professionals informed their patients on becoming physically active but did not include important components of PA counselling such as the types of PA, intensity and duration. The common reasons for not including PA as part of the daily routine include: not my area of specialty and lack of time. These factors could significantly contribute to sedentary behaviour among hypertensive individuals in developing countries such as Swaziland. For this reason, an urgent need for PA promotion programmes which will motivate hypertensive individuals to participate in sufficient levels of PA as recommended by public health research has been established. The programmes should include educating health professionals on current trends in the promotion of PA. A combination of these approaches will help to reduce morbidity and mortality from cardio-vascular disease (CVD), in particular hypertension.
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Tshimanga, Ilunga Jeanmark. "Particle image velocimetry measurements of blood flow in aneurysms using 3D printed flow phantoms." Diss., 2019. http://hdl.handle.net/10500/27390.
Full textAbstract:
Cardiovascular diseases (CVD) remain one of the leading causes of deaths worldwide. The formation and
presence of aneurysm is a very important question in the study of this CVDs. An aneurysm is a balloon-like
bulge on a blood vessel which forms over time. An aneurysm is usually considered to be a result of weakening
of the blood vessel walls, this definition has stood over many years without being conclusively proven.
Eventually, the aneurysm could clot or burst due to degradation of the aneurysm wall and accumulation of
blood. The latter would lead to internal bleeding and result in a stroke. Local hemodynamics have been found
to be very important in the study of the evolution of an aneurysm. In this study, a steady flow experimental
investigation was conducted using planar Particle Image Velocimetery (PIV) on a rigid flow phantom of an
idealised geometry consisting of a curve parent artery and a spherical aneurysm located on the outer convex
side of the curvature. The flow phantom was fabricated directly using a commercially available desktop
Stereolithography (STL) 3D printer instead of the more conventional investment casting method using a core.
Although 3D printing technologies have been around for many years, the fabrication of flow phantoms by
direct printing is still largely under-explored. This thesis details the results of investigation into the optimal
printing and post-printing procedures required to produce a flow phantom of suitable clarity and transparency.
Other important areas of concern such as the geometric accuracy, surface topography and refractive index of
the final model are also investigated. A planar PIV is conducted to study the impact of flow rates on the local
flow field in and around the aneurysm and their impact on the wall shear stress. It was found that direct 3D
printing is appropriate for the fabrication of flow phantoms suitable for PIV or other flow visualisation
techniques. It reduces the complexities and time needed compared to the conventional investment casting
methods. It was observed that the optical properties of the printed material such as the high refractive index
(RI) and the transmittivity of light could cause a problem in large models. From the PIV measurements it was
found that flow rates affect the flow field in both the parent artery and the aneurysm. First, high velocities
were observed on the outer curvature of the parent artery. Secondly the centre of rotation in the aneurysm is
not at the geometric centre but is displaced slightly in the direction of the flow. Finally, the flow rate affects
the angle in which flow enters the aneurysm from the parent vessel. This change in the flow angle affects the
flow within the aneurysm. A higher flow rate in the parent artery increases the incident angle which brings the
centre of rotation closer to the geometric centre of the aneurysm, this changes the location and magnitude of
high velocities and hence the local wall shear stress (WSS) on the wall of the aneurysm. This may have
implications in the evolution of aneurysms.Mechanical and Industrial Engineering
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Blignaut, Linda Joyce. "Die verband tussen fisiese fiksheid en psigiese welsyn van die werknemer." 1998. http://hdl.handle.net/10500/17356.
Full textAbstract:
Al hoe meer organisasies in Suid-Afrika gaan tans deur 'n herstruktureringsfase wat meebring dat die totale werksmilieu verander. Die werknemer verkeer onder druk om aan die nuwe eise in die wereld van werk te voldoen. Druk om te presteer en werksuitset te !ewer mag disfunksionele stres en antler psigiese probleme meebring. Organisasies speel 'n belangrike rol in die dinamiese groeiproses van die individuele werknemer en raak toenemend bewus van die werknemer se fisiese en psigiese gesondheid. Talle organisasies het reeds korporatiewe gimnasiums opgerig en sommige bied subsidiering van lidmaatskap aan gesondheidsklubs aan hul werknemers. Sekere mediese skemas begin self gesondheidsplanne ontwerp met behulp van gesondheidsklubs om die gesondheid van die werknemer te bevorder.M.A. (Bedryfsielkunde)