Dissertations / Theses: 'Peripheral vascular diseases Diagnosis'

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Insall, R. L. "Pulse waveforms and transit time from photoelectric plethysmography in the diagnosis of peripheral vascular disease." Thesis, University of Newcastle Upon Tyne, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.309069.

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Outif, Ahmed M. "Measurement of limb vascular volume using nuclear medicine technique : A new physiological approach to the diagnosis of peripheral arterial occlusive disease." Thesis, University of Bristol, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.310638.

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Silva, Rita de Cassia Gengo e. "Validação das características definidoras do diagnóstico de enfermagem: perfusão tissular periférica ineficaz em pacientes com doença arterial obstrutiva periférica sintomática." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-26082010-134117/.

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INTRODUÇÃO: O diagnóstico de enfermagem Perfusão Tissular Periférica Ineficaz (PTPI) e suas características definidoras (CD) ainda não foram validados em pacientes com doença arterial obstrutiva periférica dos membros inferiores (DAOMI), por meio de testes que avaliam a capacidade funcional e a função vascular arterial. OBJETIVO: Validar algumas CD de PTPI em pacientes com DAOMI sintomática e verificar sua importância na determinação desse diagnóstico de enfermagem. CASUÍSTICA E MÉTODO: Foram selecionados 65 pacientes com DAOMI (62,2 + 8,1 anos; 56,9% do sexo masculino; índice tornozelo-braquial - ITB = 0,59 + 0,14), nos quais a PTPI foi diagnosticada mediante a presença de claudicação intermitente e ITB < 0,90, e 17 indivíduos--controle (63,4 + 8,7 anos; 41,2% do sexo masculino; ITB = 1,14 + 0,08). Todos os participantes foram submetidos a exame físico, à medida do ITB, à avaliação de sua capacidade funcional e das propriedades funcionais das artérias. O ITB foi calculado para cada membro inferior, dividindo-se a maior pressão arterial do tornozelo pela maior pressão obtida nos braços; para análise considerou-se o pior ITB. Os pacientes com PTPI secundária à DAOMI foram divididos de acordo com o grau de prejuízo da circulação periférica. A capacidade funcional foi determinada por meio do teste de caminhada de seis minutos (TC6), registrando-se as distâncias percorridas, total e livre de dor. As propriedades funcionais das artérias foram avaliadas em termos da rigidez da parede (VOP C-F e VOP C-R), utilizando-se o Complior®, e da reatividade vascular, com a técnica de ultrassom vascular de alta resolução em condições basais, após manobra de hiperemia reativa e após administração sublingual de nitrato. A hiperemia reativa promove vasodilatação dependente do endotélio e é mediada pelo fluxo (DMF); por sua vez, o nitrato é um doador de óxido nítrico e causa vasodilatação independente do endotélio. RESULTADOS: A prevalência da CD pulsos periféricos ausentes ou filiformes foi maior nos pacientes com PTPI do que nos indivíduos-controle (> 70,0% versus 5,3%, respectivamente, p < 0,0001). Ainda, observou-se que pacientes com PTPI percorreram menores distâncias no TC6 (265,1 + 77,4 versus 354,7 + 42,1 m, p < 0,001) e apresentaram maior VOP C-F (12,2 + 4,0 versus 9,6 + 2,2 m/s, p = 0,016), menor DMF (2,7 + 4,2% versus 6,1 + 5,4%, p = 0,014) e menor dilatação pós- -nitrato (14,3 + 8,4% versus 20,6 + 10,0%, p = 0,019). Na análise individual, verificou-se que a presença das CD associou-se à redução das distâncias percorridas no TC6, total e livre de dor, ao aumento da VOP C-F e a menores DMF e dilatação pós-nitrato. Na análise conjunta, pulsos pedioso e/ou tibial posterior ausentes ou filiformes foram preditivos de: (1) menor capacidade funcional, com redução de 61 metros na distância total percorrida e 124 metros na distância livre de dor; (2) maior rigidez da parede arterial, pois aumentou em 18% a média da VOP C-F; e (3) maior prejuízo da reatividade vascular, evidenciada pela redução de 2,6% na DMF. Além disso, a alteração na amplitude de algum pulso periférico ou sopro na artéria femoral esquerda aumentou 1.024 vezes a chance de ocorrência de PTPI. Observou-se que as distâncias, total e livre de dor, percorridas no TC6, a VOP C-F e a dilatação pós-nitrato associaram-se de forma significativa com o maior prejuízo da circulação periférica, verificado pelo ITB, sendo que o aumento de 1m na distância percorrida livre de dor reduziu em 0,8% (IC 95% = 0,985 - 0,998) a chance de prejuízo grave (ou moderado e grave) da circulação periférica. Já o aumento de 1m/s na VOP C-F elevou essa chance em 23,7% (IC 95% = 1,057 - 1,448). CONCLUSÃO: A CD pulsos periféricos ausentes ou filiformes foi a mais relevante para o diagnóstico de enfermagem PTPI, pois apresentou maior prevalência, associou-se à maior limitação funcional e mostrou forte associação com alterações funcionais das artérias.
INTRODUCTION: The nursing diagnosis Ineffective Peripheral Tissue Perfusion (PTPI) and its defining characteristics (CD) have not yet been validated in patients with peripheral arterial obstructive disease (DAOP) in the lower limbs, through tests that evaluate functional capacity and arterial vascular function. OBJECTIVE: To validate some CD of PTPI in patients with symptomatic DAOP and verify the relevance of these characteristics in determining this nursing diagnosis. METHOD: 65 patients with DAOP were selected (62.2 + 8.1 years; 56.9% male; ankle brachial index - ABI = 0.59 + 0.14), in which PTPI was diagnosed considering the presence of intermittent claudication and ABI <0.90, and 17 control subjects (63.4 + 8.7 years; 41.2% male; ABI = 1.14 + 0.08). All participants were submitted to physical assessment, ABI measurement, evaluation of functional capacity and arteries functional properties. ABI was calculated for each leg, dividing the higher pressure of the ankle by the higher pressure of the arms, whereas the worst ABI was considered. Patients with ABI related to DAOP were split according to the impairment of peripheral circulation. Functional capacity was determined through the six-minute walk test (TC6). Total and pain free distances were recorded. Arteries funcional properties were evaluated in terms of arterial stiffness (C-F PWV and C-R PWV) using the Complior®, and in terms of vascular reactivity using high-resolution ultrasound in basal condition and after reactive hyperemia and sublingual administration of nitrate. Reactive hyperemia promotes endotlhelium dependent vasodilation which is flow mediate (DMF); nitrate is a nitric oxide donor and causes endothelium independent vasodilation. RESULTS: The prevalence of the CD absent or weak peripheral pulses was higher among patients with PTPI compared with control subjects (> 70.0% versus 5.3%, respectively, p < 0.001). Patients with PTPI traveled shorter distances in the TC6 (265.1 + 77.4 versus 354.7 + 42.1 m, p < 0.001), presented higher C-F PWV (12.2 + 4.0 versus 9.6 + 2.2 m/s, p = 0.016), lower FMD (2.7 + 4.2% versus 6.1 + 5.4%, p = 0.014) and lower post nitrate dilation (14.3 + 8.4% versus 20.6 + 10.0%, p = 0.019) than the control group. The individual analysis of CD showed that their presence were associated with reduction in the total and pain free walking distances in TC6, increased C-F PWV, and diminished FMD and post nitrate dilation. The absent or weak dorsalis pedis and/or posterior tibial arterial pulses in the cluster analysis predicted: (1) poor functional capacity, reduction of 61 meters in the total walking distance and 124 meters in the pain free walking distance; (2) higher arterial stiffness, because the average of C-F PWV increased 18%; and (3) greater impairment of vascular reactivity, evidenced by a reduction of 2.6% in the FMD. In addition, alteration in the amplitude of some peripheral pulse or bruit in the left femoral artery increased 1024 times the risk of PTPI. Total and pain free walking distances in the TC6, C-F PWV and the post nitrate dilation were significantly associated with greater impairment of peripheral circulation evaluated through ABI. An increase of 1m of pain free travelled distance reduced the risk of severe (or moderate and severe) impairment of peripheral circulation in 0.8% (CI 95% = 0.985 - 0.998), whereas an increase of 1m/s in the C-F PWV increased the risk by 23.7% (CI 95% = 1.057 - 1.448). CONCLUSION: The CD absent or weak peripheral pulses was the most relevant characteristic determining the nursing diagnosis PTPI because it presented the highest prevalence, was associated with reduced functional capacity, and presented a strong association with arteries functional alteration.

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Sigvant, Birgitta. "Epidemiological aspects of peripheral arterial disease." Stockholm : Department of Molecular Medicine and Surgery, Karolinska Institutet, 2009. http://diss.kib.ki.se/2009/978-91-7409-670-5/.

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Eneroth, Magnus. "Amputation for vascular disease prognostic factors for healing, long-term outcome and costs /." Lund : Lund University, Dept. of Orthopedics, Lund University Hospital, 1997. http://catalog.hathitrust.org/api/volumes/oclc/39752358.html.

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Ögren, Mats. "Vascular morbidity and mortality in men with non-invasively detected peripheral arterial disease results from the prospective population study "Men born in 1914" /." Lund : Dept. of Community Health Sciences and the Dept. of Clinical Physiology, Malmö General Hospital, Lund University, 1994. http://catalog.hathitrust.org/api/volumes/oclc/39693808.html.

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Layman, Hans Richard William. "Tissue Engineering Strategies for the Treatment of Peripheral Vascular Diseases." Scholarly Repository, 2010. http://scholarlyrepository.miami.edu/oa_dissertations/461.

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Peripheral vascular diseases such as peripheral artery disease (PAD) and critical limb ischemia (CLI) are growing at an ever-increasing rate in the Western world due to an aging population and the incidence of type II diabetes. A growing economic burden continues because these diseases are common indicators of future heart attack or stroke. Common therapies are generally limited to pharmacologic agents or endovascular therapies which have had mixed results still ending in necrosis or limb loss. Therapeutic angiogenic strategies have become welcome options for patients suffering from PAD due to the restoration of blood flow in the extremities. Capillary sprouting and a return to normoxic tissue states are also demonstrated by the use of angiogenic cytokines in conjunction with bone marrow cell populations. To this point, it has been determined that spatial and temporal controlled release of growth factors from vehicles provides a greater therapeutic and angiogenic effect than growth factors delivered intramuscularly, intravenously, or intraarterialy due to rapid metabolization of the cytokine, and non-targeted release. Furthermore, bone marrow cells have been implicated to enhance angiogenesis in numerous ischemic diseases due to their ability to secrete angiogenic cytokines and their numerous cell fractions present which are implicated to promote mature vessel formation. Use of angiogenic peptides, in conjunction with bone marrow cells, has been hypothesized in EPC mobilization from the periphery and marrow tissues to facilitate neovessel formation. For this purpose, controlled release of angiogenic peptides basic fibroblast growth factor (FGF-2) and granulocyte-colony stimulating factor (G-CSF) was performed using tunable ionic gelatin hydrogels or fibrin scaffolds with ionic albumin microspheres. The proliferation of endothelial cell culture was determined to have an enhanced effect based on altering concentrations of growth factors and method of release: co-delivery versus sequential. Scaffolds with these angiogenic peptides were implanted in young balb/c mice that underwent unilateral hindlimb ischemia by ligation and excision of the femoral artery. Endpoints for hindlimb reperfusion and angiogenesis were determined by Laser Doppler Perfusion Imaging and immunohistochemical staining for capillaries (CD-31) and smooth muscle cells (alpha-SMA). In addition to controlled release of angiogenic peptides, further studies combined the use of a fibrin co-delivery scaffold with FGF-2 and G-CSF with bone marrow stem cell transplantation to enhance vessel formation following CLI. Endpoints also included lipophilic vascular painting to evaluate the extent of angiogenesis and arteriogenesis in an ischemic hindlimb. Tissue engineering strategies utilizing bone marrow cells and angiogenic peptides demonstrate improved hindlimb blood flow compared to BM cells or cytokines alone, as well as enhanced angiogenesis based on immunohistochemical staining and vessel densities.

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Christman, Sharon Klopfenstein. "Intervention to slow progression of peripheral arterial disease." Connect to this title online, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1054059524.

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Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains xiii, 123 p.; also includes graphics (some col.). Includes bibliographical references (p. 114-123). Available online via OhioLINK's ETD Center

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Lewis, M. H. "Peripheral arterial disease from aetiology to surgical management." Thesis, University of South Wales, 2013. https://pure.southwales.ac.uk/en/studentthesis/peripheral-arterial-disease-from-aetiology-to-surgical-management(7defd31a-6995-4fc7-9302-2fced42b5982).html.

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The work presented includes over thirty peer reviewed published manuscripts based on studies undertaken during my surgical career. As Principal Investigator, I led the study conception/design/data acquisition/analysis/interpretation and was involved with writing the final drafts of all manuscripts prior to their formal submission to high impact factor peer-reviewed specialist journals. The thesis is divided into subsections reflecting my development and different interests within surgery. The subsections start with my learning basic research principles, moving onto clinical problem solving in general surgical dilemmas, followed by a collection of papers in my subspecialty of vascular surgery. The work culminates with a group of papers focused on aneurysmal disease, specifically, abdominal aortic aneurysms (AAA), the clinical impact of which has had a bearing on the introduction of a National AAA Screening Program in Wales in 2013. I conclude these sections with a collection of papers that reflect my long term commitment to surgical training both at regional level (as Secretary and Deputy Chairman to the Higher Surgical Training Committee and Chairman of the Basic Surgical Training Committee) and national level including my involvement with the Four Royal Colleges of Surgeons for the Intercollegiate Examinations in General Surgery. This examination is undertaken at completion of junior surgical training and used to confirm a doctor's competence for safe independent practice as a consultant. In conclusion, over forty years of academic research during my career as a vascular surgeon has provided unique insight into the pathophysiology, treatment and ultimately prevention of artherosclerotic disease. These findings have improved health policies in Wales and significantly reduced patient morbidity and mortality.

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Richardson, Jim. "Living with peripheral vascular disease a one-person case study : a dissertation [thesis] presented in partial fulfilment of the requirements for the Master of Health Science at Auckland University of Technology, December 2002." Full thesis. Abstract, 2002.

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Collins, Patrick William Hugh. "Assessing the severity of lower limb ischaemia and the thrombo-inflammatory response to surgery and exercise in peripheral arterial disease." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources. Restricted contains 3rd party material and therefore cannot be made available electronically until Jan. 1, 2012, 2008. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=53369.

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Thesis (M.D.)--Aberdeen University, 2008.
With: Surgical revascularisation in patients with severe limb ischaemia induces a pro-thrombotic state / P. Collins ... et al. Platelets. 2006: 17(5), 311-317. With: A preliminary study on the effects of exercising to a maximum walking distance on platelet and endothelial function in patients with intermittent claudication / P. Collins ... et. Eur. J. Vasc. Endovasc. Surg. 2006: 31, 266-273. Includes bibliographical references.

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Wilson, Alasdair. "The effects of combination antiplatelet therapy on smooth muscle mitogenesis after angioplasty for claudication." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=165239.

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peripheral arterial disease (PAD), a limiting factor in the success of percutaneous transluminal angioplasty (PTA) is the development of restenosis secondary to vascular smooth muscle cell (SMC) proliferation. The aim of this study was to determine the effect of combination antiplatelet therapy on the ability of plasma, from patients undergoing PTA, to stimulate SMCs in vitro. We aimed to investigate the effect of combination treatment on levels of circulating adhesion molecules and factors which mediate SMC proliferation in experimental models. We also sought to demonstrate any association between changes in measured markers and the development of restenosis or vascular events. Methods Fifty patients were randomised to receive clopidogrel or placebo, for thirty days, in addition to their daily 75mg aspirin. To measure proliferative capacity, diluted plasma was incubated with 24h-growth-arrested rat vascular SMCs, and Extracellular-regulated-kinase (ERK)1/2 activation was analysed by Western blotting at baseline, 1-hour pre-PTA, and at 1-hour, 24-hours and 30-days post-PTA. Plasma platelet-derived growth factor (PDGF-BB), soluble (s)E-selectin, sICAM-1 (intracellular adhesion molecule-1) and von Willebrand factor (vWF) were measured by ELISA (Enzyme-linked immunosorbent assay), at the same time-points. Platelet activation was measured by flow cytometry of ADP-stimulated platelet fibrinogen binding at baseline and 1-hour post-PTA. Patients’ notes and all investigations were reviewed for 2 years post-PTA to record restenosis or vascular events. Results Samples were available for all 50 patients at baseline, 1-hour pre-PTA and 1-hour post-PTA timepoints. In this cohort ERK1/2 activation was significantly increased post-PTA in both the aspirin/clopidogrel and aspirin/placebo groups. Those who developed a symptomatic restenosis had a significantly higher level of SMC activation at the 1-hour post-PTA time-point. There was a statistically significant decrease in PDGF-BB, and increase in vWF, following loading with clopidogrel. sICAM-1 levels significantly decreased in the aspirin/placebo group following PTA. ADP-stimulated platelet fibrinogen binding was significantly inhibited by clopidogrel therapy post-PTA. Conclusions This is the first study to show in-vitro ERK1/2 activation (a marker of SMC proliferation) increases post-PTA. Patients developing a symptomatic restenosis had a significantly higher level of SMC activation at the 1-hour post-PTA time-point. Clopidogrel therapy had no significant effect on ERK1/2 activation, although it did reduce PDGF-BB in the larger cohort of patients. Further work is required to evaluate potential therapeutic treatments which may reduce peripheral PTA-induced smooth muscle cell activation.

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Hou, Xiang-Yu. "Exercise performance and mitochondrial function in peripheral arterial disease." Thesis, Queensland University of Technology, 2002. https://eprints.qut.edu.au/36778/1/36778_Digitised%20Thesis.pdf.

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Peripheral arterial disease (PAD) is an atherosclerotic disease in the peripheral arteries, which reduces blood supply to the lower extremities. Intermittent claudication is the symptom that develops early in PAD patients and is accompanied by the haemodynamic finding of a fall in systolic blood pressure at the ankles following exercise. In PAD patients, exercise performance is not well correlated with haemodynamic measurements and other mechanisms have been suggested to account for the impairment. There have been reports about the impaired mitochondrial metabolism (eg, decreased activities of mitochondrial enzymes) and abnormal mitochondrial structure in the skeletal muscle in PAD patients. It is not known, however, whether mitochondrial ATP production is impaired in the skeletal muscle in PAD. Whether the mitochondrial function is impaired in PAD patients, and whether the impaired mitochondrial function in the muscle contributes to the impaired exercise performance in PAD patients is unknown. The object of this work is to explore the mitochondrial function in the skeletal muscle of PAD patients and its relationship to exercise performance. Impaired exercise performance in PAD patients is evaluated using a treadmill walking performance test, which is closely correlated to patients' daily activity performance. Treadmill walking however, in addition to being influenced by local muscle factors, is influenced by central contributions, such as cardiac output and the central nervous system. As walking is limited by intermittent claudication in PAD patients localized in the legs, it would be valuable to develop a local calf muscle performance test to better understand the underlying pathophysiology in PAD. Such a protocol has not been used previously in experiments involving PAD patients. Hence, the research aim for Study 1 was to establish a calf muscle performance test protocol and to investigate its variability. Fourteen healthy control subjects and eight PAD patients undertook the maximal plantar flexion test once a week for five weeks using a Kin-Com Dynamometer. In the traditional assessment, the total impulse and peak impulse are the variables that were measured as representing the calf muscle performance. Both these variables are significantly lower in PAD patients than in controls. Alternatively, by applying simple mathematical models, the muscle function dimensions of endurance, strength and fatigability can be investigated in a single test. Compared with control subjects the PAD patients had lower muscle endurance, lower muscle strength, higher fatigue index, but no difference were found in magnitude or rate-of-fatigue. The variability of the test was different for different estimated parameters of the models, with the highest variability in muscle fatigability (rate of fatigue, CV=75% in controls) and the lowest variability in muscle strength (CV=16% in controls). The variability of the traditional assessment parameters, which included total impulse and peak impulse, was around 13% in controls and 18- 24% in PAD patients for the five tests. Based on these findings the calf muscle performance test can be applied in PAD patients to investigate different muscle function dimensions. While many of the dimensions were impaired in PAD patients compared with controls, the high variability of some of the parameters have to be considered during its application. Having established a local calf muscle performance test, the aim of Study 2 was to explore the relationship between the calf muscle performance and the traditional treadmill walking performance. Seventeen PAD patients and fourteen control subjects were tested using both the calf muscle performance test described earlier and walking performance test. The walking performance was tested using a graded treadmill protocol. The total walking time was significantly lower in PAD than that in control subjects. No variable of calf muscle performance correlated with walking performance in control subjects. However, in PAD patients, a number of calf muscle performance variables correlated with walking performance. The total impulse and the peak impulse in the best legs (higher ABI) tended to correlate with pain-time. In simple mathematical models, the muscle endurance in the worst legs (lower ABI) correlated positively with pain-walking time, and the muscle fatigue-index in the worst legs correlated negatively with total walking time. In conclusion, in PAD patients, some dimensions of calf muscle performance correlated with walking performance. This suggests that some factors of local calf muscle performance might contribute to the impaired walking performance in PAD patients. The research aim for Study 3 was to investigate a number of calf muscle physiological factors, and to ascertain their relationship with calf muscle and walking performance in PAD patients and control subjects. The physiological factors examined include ankle brachial pressure index (ABI), calf muscle weight, calf blood flow, and skeletal muscle mitochondrial ATP production rate (MAPR) in vitro. The calf muscle weight in PAD patients was significantly lower than that in control subjects. In PAD patients, the calf muscle weight was significantly lower in the worst legs than that in the best legs. The ABI was lower in PAD than in controls and significantly lower in PAD worst legs than in PAD best legs. The leg blood flow (measured by venous-occlusion plethysmography) was lower in PAD than that in controls, but there was no significant difference between PAD best legs and PAD worst legs. The MAPR was measured using different substrate combinations. The MAPR (PM, pyruvate + malate), MAPR (PCM, palmitoyl-carnitine + malate) and MAPR (PPKM, pyruvate + palmi_toyl-carnitine + alpha-ketoglutarate + malate) shows the capacity of mitochondria to produce ATP by oxidising glucose or fatty acids or both of these substrates respectively. The MAPR for the three substrate combinations in PAD patients was no different from controls. The relationship between these physiological measurements and exercise performance differed between PAD and controls. In control subjects, the calf muscle weight, ABI, leg blood flow and MAPR were not significantly correlated with walking performance, but correlated with some variables of local calf muscle performance. In PAD patients, the calf muscle weight, ABI and blood flow did not correlate with walking performance. However, the MAPR (PMkg) was positively correlated with total walking time, and MAPR (PPKMg) was positively correlated with pain-free walking time. In calf muscle performance, in the best legs, the body weight was positively correlated with total impulse and peak impulse; the calf muscle weight was positively correlated with contraction number and peak impulse; and the blood flow correlated with peak impulse. In the worst legs, the calf muscle weight and ABI were not significantly correlated with any variables; the leg blood flow was negatively correlated with contraction number; the mitochondrial protein content correlated with total impulse; the MAPR (PM) tended to correlate with peak impulse. These results suggest the importance of all these local muscle physiological factors in calf muscle performance. However, only MAPR was important in the walking performance in PAD patients. The aim of Study 4 was to further explore the relationship between MAPR and exercise performance in PAD patients after exercise training. The effect of 16 weeks of treadmill exercise training on exercise performance and MAPR was evaluated in five PAD patients. In the treadmill walking performance test, total walking time increases ranged from 100 to 150% in these five patients. The pain-free walking time increased in three patients but did not change in the other two. In the calf muscle performance test, the total impulse and contraction number increased in both legs of four patients and decreased in both legs of one patient, but the magnitude of improvement was less than 5% and the peak impulse did not change in a consistent trend. The changes in body weight, calf muscle weight, and ABI in these five patients were less than 5%. However, the increased blood flow measured by venousocclusion plethysmography in both legs ranged from 100 to 150%. The MAPR by oxidising glucose was significantly higher in trained patients than that in untrained patients, which suggested a possible change in mitochondrial function in response to exercise training. Such change in mitochondrial function may have a potential role in contributing to calf muscle performance and walking performance after exercise training. In summary, for the first time, a local calf muscle performance test has been established to allow better understanding of calf muscle pathophysiology in PAD patients. Using this test, it has been shown that calf muscle performance is significantly impaired in PAD patients compared with control subjects. The impairment is characterised by lower muscle endurance, lower muscle strength and higher fatigability. The impaired local calf muscle performance might contribute to the impaired overall walking performance in PAD patients. The MAPR, especially 5 through oxidising glucose, contributed to walking performance. In this pilot exercise training study, a 20 weeks exercise training program failed to improve the calf muscle performance and walking performance in PAD patients. The higher MAPR in oxidising glucose in trained PAD patients again suggested the importance of muscle glucose oxidation as a contributing factor in the exercise performance in PAD patients.

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Cunningham, Margaret. "Psychological factors associated with walking in patients with Peripheral Arterial Disease." Thesis, University of Stirling, 2010. http://hdl.handle.net/1893/3040.

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Objectives This thesis aimed to explore psychological factors associated with walking behaviour in patients with Peripheral Arterial Disease, within the framework of Leventhal et al’s (1998) Common-sense Model of Self-regulation of Health and Illness. The objective was to identify psychological factors which could be modified to increase walking behaviour in these patients. Method A series of three studies were conducted to achieve these aims. The first study was an exploratory qualitative study, to explore the illness and treatment beliefs and walking behaviour of patients with intermittent claudication. The second study was a cross-sectional postal questionnaire to a cohort of patients with intermittent claudication, which tested the influence of the psychological factors identified in the qualitative study, in a larger sample. The final study was a randomised controlled trial of a brief psychological intervention designed to modify the illness and walking beliefs of patients with intermittent claudication, in order to increase walking behaviour. Results Beliefs about intermittent claudication, and beliefs about walking were both found to be associated with walking behaviour in the qualitative study. The results from the cross-sectional postal questionnaire confirmed this relationship – taken as a set, illness and walking beliefs accurately predicted adherence to minimum walking levels for 93.4% of the sample. The brief psychological intervention successfully modified illness and treatment beliefs and increased walking behaviour in patients newly diagnosed with intermittent claudication. Conclusion This thesis highlights the importance of illness and walking beliefs to the walking behaviour of patients with intermittent claudication. The thesis has added to the body of knowledge about intermittent claudication, and the findings of this thesis have implications for the treatment of patients with intermittent claudication within the health service. Theoretical and clinical implications of this research are discussed.

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Sanderson, Brad E. "Supervised stationary cycling versus supervised treadmill-walking for periperal arterial disease /." [St. Lucia, Qld.], 2005. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18988.pdf.

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Mamadu, Hadii M., Timir Paul, Liang Wang, Sreenivas P. Veeranki, Hemang B. Panchal, Arsham Alamian, Pooja Subedi, and Mattew Budoff. "Association Between Multiple Modifiable Risk Factors of Cardiovascular Disease and Hypertension in Rural Appalachia. Arteriosclerosis, Thrombosis and Vascular Biology (ATVB)/Peripheral Vascular Disease (PVD) 2016 Scientific Sessions." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1394.

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Lee, Kui-Joo. "The detection of double product break point in individuals with peripheral arterial disease." Virtual Press, 2000. http://liblink.bsu.edu/uhtbin/catkey/1178340.

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Peripheral arterial disease (PAD) is a common manifestation of stenoses and occlusions of the arteries of the lower extremities. Clinically, PAD is an important effect on functional ability, and quality of life because symptomatic patients are typically able to walk less than one to three blocks before rest is required.The double product break point (DPBP), also defined as the oxygen consumption at which the first portion of nonlinear increase in rate pressure product (systolic blood pressure X heart rate) begins has been identified to determine the anaerobic threshold during exercise test. The purpose of this study was to determine whether the DPBP could be detected in patients with PAD during a symptom-limited GXT on the motor-driven treadmill. Six male subjects (68.2 ± 6.5 yrs) with history of diagnosis of PAD participated in this study. Double product (DP) was assessed every 15 seconds during the test via the Kyokko Bussan CM-4001 automated blood pressure unit. The DPBP and VT were determined visually by three blinded observers. The mean values of Peak V02 and maximal heart rate were 19.4 ± 5.8 (ml/kg/min) and 130 ± 13 (bpm), respectively. In 4 of the six exercise tests in the present study, the DPBP and the VT were determined. The mean V02 at the DPBP and the VT were 15.7 ± 2.6 ml/kg/min and 14.2 ± 0.6 ml/kg/min, corresponding to 73 ± 7.2 and 74.5 ± 5.4 % respectively. In 3 of the six exercise tests both of the DPBP and VT were determined. The Mean V02 at the DPBP and VT were 14.6 ± 1.8 and 14.3 ± 0.7, respectively. The difference of the mean VO2 at the VT and DPBP was -.0.33 ml/kg/min.In conclusion, the results of the present study suggest that the DPBP can be identified and used as a useful marker to determine the functional performance in PAD patients. Walking time or distance measurement depends on the patient's perception of the pain. Thus, this study provides an objective way to appraise the functional performance and therapeutic results obtained from the exercise training in PAD patients, and provides a reference for exercise prescription for this population.
School of Physical Education

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Al, Talalwah Waseem. "The vascular variability of the iliac system and clinical diagnosis in radiology and neurology." Thesis, University of Dundee, 2013. https://discovery.dundee.ac.uk/en/studentTheses/1aa955a0-1289-4670-b226-0eea5425ae0b.

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The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

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Arreguy-Sena, Cristina. "A trajetória de construção e validação dos diagnósticos de enfermagem: trauma vascular e risco para trauma vascular." Universidade de São Paulo, 2002. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-04102011-100032/.

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Ao percorremos a trajetória de construção dos diagnósticos de enfermagem \"Trauma vascular\" e \"risco para trauma vascular\", buscamos, no capítulo 1, apresentar a classificação dos tipos de veias superficiais periféricas de adolescentes, adultos e idosos, segundo as características de uma veia passível de ser puncionada para fins terapêuticos e de diagnóstico, com base na aplicação da técnica Delphi, envolvendo juízes de quatro categorias profissionais distintas (angiologistas, anestesistas, enfermeiros e bioquímicos). Obtivemos índice de concordância para totalmente adequado/pertinente de mais de 90% e menos de 10% para moderadamente adequado/pertinente nos 13 critérios, a saber: mobilidade; trajeto; inserção/derivação; calibre; visibilidade; palpação e localização, tendo, como referencia: a articulação; localização da veia, tendo como referência, sua anatomia; regularidade do diâmetro do trajeto venoso; consistência do trajeto venoso; solução de continuidade das paredes do vaso; facilidade de punção e outros critérios a serem incluídos. No segundo capítulo, apresentamos a construção dos elementos (titulo, características definidoras, fatores relacionados) do diagnóstico de enfermagem \"trauma vascular\" e dos elementos (título e fatores de risco) para o diagnóstico de enfermagem \"Risco para trauma vascular\", baseando-nos na revisão literária e em nossa experiência profissional, e a validação de seus respectivos componentes, segundo o modelo de Fhering (1986) e adaptação do mesmo aos fatores relacionados e aos fatores de risco. Participaram 60 peritos. Reafirmamos: das 18 características definidoras analisadas, 15 são maiores (ponto de corte >=0,8) e 1 menor (ponto de corte >=0,50 ou <0,80); dos 14 fatores relacionados analisados, todos tiveram aceitação, sendo que 11 deles obtiveram escores de media ponderada >=0,8 e, dos 51 fatores de riscos analisados, 8 foram aprovados com escores >=0,50 para as situações ligadas a medicação e a forma/periodicidade de infusão; 4 foram aprovados para situações ligadas ao dispositivo endovenoso e seu tempo de permanência num mesmo sítio de inserção; 5 foram aprovados para situações ligadas a fixação do dispositivo endovenoso; 10 foram aprovados para situações ligadas ao indivíduo, seus hábitos, padrão de comunicação, estilo de vida e capacidade sensório-motora e 20 aprovados para as situações ligadas as decisões profissionais, a política institucional e ao procedimento propriamente. Finalmente, no capítulo 3, apresentamos validação clínica de alguns componentes do diagnóstico \"trauma vascular\" e \"Risco para trauma vascular\", utilizando um estudo de coorte, quando foram avaliadas 323 pessoas e 427 sítios de inserção de dispositivos endovenosos. Obtivemos significância no teste de ajuste do modelo para um conjunto de nove variáveis passíveis de serem transpostas para populações similares, merecendo destaque o tempo de permanência do dispositivo num mesmo sítio de inserção e a qualidade da fixação dos dispositivos (se fixos ou frouxos). Outros fatores mostraram-se relevantes somente para a população do estudo.
As we investigate the process of the construction of nursing diagnoses (vascular trauma and/or Risk of vascular trauma), we intend to classify, in the first chapter, the types of peripheral surface veins of teenage, adult, and elderly patients, according to the characteristics of a vein that can be punctured for therapeutic and diagnostics purposes, based on the application of the Delphi technique, judged by people from our different professional categories (angiologists, anesthetists, nurses and biochemists). We obtained a C.I. of over 90% for totally adequate/pertinent and less than 10% for moderately adequate/pertinent for the 13 criteria applied: mobility, course, insertion/derivation, caliber, visibility, palpation and localization with reference to the joint, location of the vein with reference to its anatomical structure, regulation of the diameter of the venous course, consistency of the venous course, continuity of the vessel tissue, how easy it is to puncture the vein, and other criteria to be included. In chapter 2, we present the construction of the elements (name, defining features, related factors) of the nursing diagnosis \"vascular trauma\" and of the elements (name, risk factor) of the nursing diagnosis \"risk of vascular trauma\", based on our reading of the existing literature and on our work experience, and the validation of their respective components as in Fhering´s (1986) model, and the adaptation of these to the related factors and risk factors. 60 experts took part. To summarize: of the 18 defining features analyzed, 15 were found to be greater (cut-off point >=0,8) and one smaller (cut-off point >=0,5 and <=0,8); of the 14 related factors analyzed, all met with approval, 11 of them with weighted average scores greater than or equal to 0,8 and of the 51 risk factors analyzed, 8 were approved with scores over 0,5 for situations connected with medication and the manner or intervals of infusion; 4 were approved for situations connected with the intravenous device and the time it remained in the same place of insertion, 5 were approved for situations connected with the individual, his/her habits, standard of communication, lifestyle and sensory-motor ability, and 20 were approved for situations connected with professional decisions, institutional policies and the procedure itself. Finally, in chapter 3, we present the clinical validation of some components of the diagnoses \"vascular trauma\" and \"risk of vascular trauma\", using a group study; our observations were based on 323 people and 427 point of insertion of the intravenous device. The results of the model adjustment test were significant tor a set of nine variables which may be transposed to similar populations. The most prominent of these variables were the time the device remained in one place of insertion and the quality of fixing of the devices (whether they were fixed or loose). Other factors were shown to be relevant only for the population under study.

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Walvick, Ronn P. "Magnetic Resonance Imaging of Neural and Pulmonary Vascular Function." Digital WPI, 2010. https://digitalcommons.wpi.edu/etd-dissertations/372.

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"Magnetic resonance imaging (MRI) has emerged as the imaging modality of choice in a wide variety experimental and clinical applications. In this dissertation, I will describe novel MRI techniques for the characterization of neural and pulmonary vascular function in preclinical models of disease. In the first part of this dissertation, experimental results will be presented comparing the identification of ischemic lesions in experimental stroke using dynamic susceptibility contrast (DSC) and a well validated arterial spin labeling (ASL). We show that DSC measurements of an index of cerebral blood flow are sensitive to ischemia, treatment, and stroke subregions. Further, we derived a threshold of cerebral blood flow for ischemia as measured by DSC. Finally, we show that ischemic lesion volumes as defined by DSC are comparable to those defined by ASL. In the second part of this dissertation, a methodology of visualizing clots in experimental animal models of stroke is presented. Clots were rendered visible by MRI through the addition of a gadolinium based contrast agent during formation. Modified clots were used to induce an experimental embolic middle cerebral artery occlusion. Clots in the cerebral vasculature were visualized in vivo using MRI. Further, the efficacy of recombinant tissue plasminogen activator (r-tPA) and the combination of r-tPA and recombinant annexin-2 (rA2) was characterized by clot visualization during lysis. In the third part of this dissertation, we present results of the application of hyperpolarized helium (HP-He) in the characterization of new model of experimental pulmonary ischemia. The longitudinal relaxation time of HP-He is sensitive to the presence of paramagnetic oxygen. During ischemia, oxygen exchange from the airspaces of the lungs to the capillaries is hindered resulting in increased alveolar oxygen content which resulted in the shortening of the HP-He longitudinal relaxation time. Results of measurements of the HP-He relaxation time in both normal and ischemic animals are presented. In the final part of this dissertation, I will present results of a new method to measure pulmonary blood volume (PBV) using proton based MRI. A T1 weighted, inversion recovery spin echo sequence with cardiac and respiratory gating was developed to measure the changes in signal intensity of lung parenchyma before and after the injection of a long acting intravascular contrast agent. PBV is related to the signal change in the lung parenchyma and blood before and after contrast agent. We validate our method using a model of hypoxic pulmonary vasoconstriction in rats."

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Ni, Chih-Wen. "Discovery of mechanosensitive microrna and messenger RNA in mouse arterial endothelium and in cultured endothelial cells." Diss., Georgia Institute of Technology, 2010. http://hdl.handle.net/1853/34674.

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Atherosclerosis is a major contributor to cardiovascular disease and accounts for an estimated one third of deaths overall. In order to address the hemodynamic components of disease pathogenesis, researchers have focused on mechanotransduction of flow-dependent shear stress in the vascular endothelium as a source of novel pathological mechanisms. Understanding how unidirectional, laminar blood flow protects vessels from atherogenesis, while disturbed, oscillatory blood flow promotes it, stands to provide enormous insight into disease pathogenesis and may provide powerful, specific new therapies for cardiovascular disease intervention. The overall objective of this dissertation was to determine which microRNAs (miRNAs) and mRNAs are regulated by different flow conditions in vascular endothelial cells in vitro and in mouse carotid artery endothelium in vivo, and to identify which miRNAs mediate flow-dependent vascular inflammation. The overall hypothesis of this project was that oscillatory shear (OS) and laminar shear (LS) stress differentially alter the expression of mechanosensitive miRNAs each capable of regulating complex networks of gene expression, which in turn leads to inflammation in endothelial cells. This hypothesis was tested using both in vitro and in vivo approaches, high throughput microarray analyses, and functional validation of specific targets by PCR. The findings from the partial carotid ligation model show that acute exposure to disturbed flow results in accelerated endothelial dysfunction and atherosclerosis in vivo. High-throughput microarrays reveal distinct expression profiles of both miRNAs and mRNAs in mouse endothelium exposed to disturbed flow suggesting the regulatory mechanisms by which miRNAs regulate mRNAs resulting in EC inflammation, the earliest stage of atherosclerosis. This in vivo study provides new insight into the mechanisms of flow induced atherosclerosis. In particular, the upregulation of miR-663 due to OS in HUVEC causes monocyte adhesion, but not endothelial apoptosis, in an ICAM-1 dependent manner. miR-663 regulates a group of genes including transcriptional factors and inflammatory genes which may also mediate OS-induced EC inflammation. Collectively, revealing the profiles of miRNAs and mRNAs regulated by hemodynamic flow provides a better understanding in vascular diseases and provide potential target for developing effective preventative therapeutic approaches in cardiovascular diseases.

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Hollabaugh, Kimberly Marie. "Analysis of oxygen uptake kinetics during exercise in subjects with peripheral arterial disease an application of non-linear mixed-effects regression modeling procedures for repeated measurement data /." Oklahoma City : [s.n.], 2010.

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Acevedo, Lipes Andrea Milena. "Deep Learning System for the Automatic Classification of Normal and Dysplastic Peripheral Blood Cells as a Support Tool for the Diagnosis." Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/671387.

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Clinical pathologists identify visually many morphological features to characterize the different normal cells, as well as the abnormal cell types whose presence in peripheral blood is the evidence of serious diseases. Disadvantages of visual morphological analysis are that it is time consuming, needs expertise to perform an objective review of the smears and is prone to inter-observer variability. Also, most of the morphological descriptions are given in qualitative terms and there is a lack of quantitative measures. The general objective of this thesis is the automatic recognition of normal and dysplastic cells circulating in blood in myelodysplastic syndromes using convolutional neural networks and digital image processing techniques. In order to accomplish this objective, this work starts with the design and development of a Mysql database to store information and images from patients and the development of a first classifier of four groups of cells, using convolutional neural networks as feature extractors. Then, a high- quality dataset of around 17,000 images of normal blood cells is compiled and used for the development of a recognition system of eight groups of blood cells. In this work, we compare two transfer learning approaches to find the best to classify the different cell types. In the second part of the thesis, a new convolutional neural network model for the diagnosis of myelodysplastic syndromes is developed. This model was validated by means of a proof of concept. It is considered among the first models that have been built for diagnosis support. The final work of the thesis is the integration of two convolutional networks in a modular system for the automatic classification of normal and abnormal cells. The methodology and models developed constitute a step forward to the implementation of a modular system to recognize automatically all cell types in a real setup in the laboratory.
Los especialistas de laboratorio identifican visualmente muchas características morfológicas para identificar las diferentes células normales, así como los tipos de células anormales, cuya presencia en sangre periférica es evidencia de enfermedades graves. Algunas de las desventajas del análisis morfológico visual incluyen que toma mucho tiempo, necesita experiencia para realizar una revisión objetiva de los frotis y es propenso a la variabilidad entre observadores. Además, la mayoría de las descripciones morfológicas se proporcionan en términos cualitativos. Debido a lo expuesto anteriormente, es necesario establecer medidas cuantitativas. El objetivo general de esta tesis es el reconocimiento automático de células normales y células displásicas circulantes en sangre en síndromes mielodisplásicos mediante redes neuronales convolucionales y técnicas de procesamiento digital de imágenes. Para lograr este objetivo, este trabajo comenzó con el diseño y desarrollo de una base de datos Mysql para almacenar información e imágenes de pacientes y el desarrollo de un primer clasificador de cuatro grupos de células, utilizando redes neuronales convolucionales como extractores de características. Luego, se compila un conjunto de datos de alta calidad de alrededor de 17.000 imágenes de células sanguíneas normales y se utiliza para el desarrollo de un sistema de reconocimiento de ocho grupos de células sanguíneas. En este trabajo, comparamos dos enfoques de aprendizaje por transferencia para encontrar el mejor para clasificar los diferentes tipos de células. En la segunda parte de la tesis se desarrolla un nuevo modelo de red neuronal convolucional para el diagnóstico de síndromes mielodisplásicos. Este modelo fue validado mediante prueba de concepto. Se considera uno de los primeros modelos que se han construido para apoyar el diagnóstico. El trabajo final de la tesis es la integración de dos redes convolucionales en un sistema modular para la clasificación automática de células normales y anormales. La metodología y los modelos desarrollados constituyen un paso adelante hacia la implementación de un sistema modular para reconocer automáticamente todos los tipos de células en una configuración real en el laboratorio.

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Melo, Michele Nakahara. "Processo de punção de vasos e trauma vascular periférico em uma unidade de pronto atendimento." Universidade Federal de Juiz de Fora (UFJF), 2017. https://repositorio.ufjf.br/jspui/handle/ufjf/5883.

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Introdução: O uso dos vasos sanguíneos, apesar de ser reconhecido como útil e benéfico à prática clínica, pode causar iatrogenias, efeitos adversos e comprometer a segurança, o tratamento e o conforto dos usuários. As manifestações de alteração no sítio de inserção dos cateteres intravasculares periféricos (CIVPs) ou nas áreas adjacentes são conhecidas como trauma vascular. Objetivo: produzir tecnologia assistencial leve-dura na modalidade de bundle para subsidiar implementação de intervenções de enfermagem sobre o processo de punção de vasos periféricos e a prevenção de trauma vascular numa Unidade de Pronto Atendimento (UPA) a partir de um diagnóstico situacional, com vistas à estruturação do cuidado de enfermagem baseado em evidências. Métodos e técnicas: Foram referenciais: 1) Políticas Públicas em Urgência/Emergência; 2) Processo de punção de vasos periféricos numa UPA; 3) Teoria das Representações Sociais (Abric) e 4) Teoria de Neuman. Pesquisa de método misto (qualiquanti), operacionalizada em procedimentos sequenciais e simultâneos utilizando intervenções complexas, segundo Medical Research Council (MRC). Cenário: UPA de porte III em Minas Gerais. Foram etapas metodológicas: desenvolvimento (revisão integrativa, ambiência, diário de campo, abordagem estrutural das representações sociais); confiabilidade e pilotagem (coorte e diário de campo); avaliação (construção do bundle, processo educativo e diário de campo) e implementação (educação permanente com segmento e monitoramento e diário de campo). Participaram 56 membros da equipe de enfermagem e 228 usuários do Sistema Único de Saúde (SUS) que tiveram suas veias puncionadas avaliadas numa coorte (252). Dados coletados por triangulação de técnicas e métodos (semiológicos, fotográficos, entrevistas, técnicas projetivas, observação participativa e consulta a acervo eletrônico) com apoio do aplicativo Open Data Kit (ODK). Foram utilizados programas EVOC 2000® e SPSS24®, sendo atendidos requisitos éticos/legais de pesquisa envolvendo seres humanos. Resultados: usuários se apresentaram como homens (58,3%), de baixa escolaridade (56,8%), idosos (55,6%) e alocados no setor amarelo (67,1%); incidência de trauma vascular periférico de 62,3% (predominando endurado, edema e dor) documentados por critérios imagéticos. Houve correlação (p-valor= 0,001-0,040) entre sexo, faixa etária, hipertensão, sangue visível e autoavaliação de ter veia difícil de puncionar com a variável de desfecho (trauma vascular). Produziuse tecnologia assistencial leve-dura na modalidade de bundle, alicerçado em diagnóstico situacional e evidências científicas. Foram utilizadas ferramentas tecnológicas/comunicacionais e didático-pedagógicas (vídeo e protocolo) para subsidiar abordagens individuais e grupais. A revisão integrativa delineou acervos sobre tipos/causas de trauma vascular e intervenções compatíveis com usuários de uma UPA, explicitando perfis modificáveis/não modificáveis por intervenções de enfermagem. Elementos simbólicos retrataram respostas humanas dos usuários e profissionais que norteiam demandas de cuidados e lacunas na percepção de como os mesmos concebem, enfrentam, valoram, experienciam a temática e lidam com ela. Concepção coletiva dos profissionais alicerçada numa técnica fragmentada desconectada da relação dialógica sensível e singular que deve presidir qualquer ato profissional. Conclusões/Considerações finais: a complexidade da temática e o distanciamento do enfermeiro de seu protagonismo no direcionamento da atuação da equipe de enfermagem e das atividades assistências/gerenciais possibilitaram negar a hipótese de nulidade de H1 e a hipótese de nulidade de H2. Foram contribuições: diagnóstico situacional, criação do bundle e abordagem educativa. Recomenda-se: investimento institucional em educação permanente da equipe de enfermagem e de materiais apropriados, criação de um protocolo institucional de notificação de eventos adversos e realização de uma coorte após a implementação do bundle e a replicação da investigação em outras UPAs.
Introduction: The use of blood vessels, despite being recognized as useful and beneficial to clinical practice, can cause iatrogenic, adverse effects and compromise the safety, treatment and comfort of the users. The manifestations of change in the insertion site of the peripheral intravascular catheters or adjacent areas are known as vascular trauma. Objectives: to produce light-hard assistance technology in the bundle modality to support the implementation of nursing interventions on the peripheral vessel puncture process and prevent the vascular trauma in an Emergency Department (ED) based on a situational diagnosis, with a view to the structuring of evidence-based nursing care. Methods and techniques: Reference was made to: 1) Public Policies in Emergency; 2) Procedure of puncture of peripheral vessels in a UPA; 3) Theory of Social Representations (Abric) and 4) Theory of Neuman. Mixed-method research, operationalized in sequential and simultaneous procedures using complex interventions, according to the Medical Research Council (MRC). Scenario: UPA of size III in Minas Gerais. There were methodological steps: Development (integrative review, ambience, field diary, structural approach to social representations); Reliability and Piloting (cohort and field diary); Evaluation (bundle construction, educational process and field diary) and Implementation (permanent education with segment and monitoring and field diary). Participants were 56 members of the nursing team and 228 users of the Sistema ùnico de Saúde (SUS) who had their punctured veins evaluated in a cohort (252). Data collected by triangulation of techniques and methods (semiological, photographic, interviews, projective techniques, participatory observation and electronic collection) with the support of the Open Data Kit (ODK), EVOC 2000® and SPSS24® programs were used, and ethical/legal research requirements involving human beings were met. Results: users presented as: men (58.3%), with low schooling (56.8%), elderly (55.6%) and allocated in the yellow sector (67.1%); incidence of peripheral vascular trauma of 62.3% (predominantly enduring, edema and pain) documented by imaging criteria. There was a correlation (p-value = 0.001-0.040) between sex, age, hypertension, visible blood and self-evaluation of having a difficult-to-puncture vein with outcome variable (vascular trauma). Light-hard care technology was developed in bundle modality, based on situational diagnosis and scientific evidence. Technological / communicational and didactic-pedagogical tools (video and protocol) were used to subsidize individual and group approaches. The integrative review delineated collections on types/causes of vascular trauma and interventions compatible with ED users, explaining modifiable/non-modifiable profiles by nursing interventions. Symbolic elements portrayed human responses from users and practitioners who drive care demands and gaps in the perception of how they conceive, confront, value, experience, and deal with the issue. Collective conception of professionals based on a fragmented technique disconnected from the sensitive and singular dialogical relationship that should preside any professional act. Conclusions / final considerations: the complexity of this issue and the distance of the nurses from their role in directing the nursing staff and assisting/management activities made it possible to deny the hypothesis of nullity of H1 and the hypothesis of nullity of H2. Contributions were: situational diagnosis, bundle creation and educational approach. It is recommended: institutional investment in continuing education of the nursing team and appropriate materials, creation of an institutional protocol for reporting adverse events and completion of a cohort after the implementation of the bundle and replication of this research in other EDs.

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Sanfins, Milaine Dominici. "Neuropatia auditiva/dessincronia auditiva: um estudo em alunos de três escolas especiais para deficientes auditivos da cidade de São Paulo." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-19092014-101620/.

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Introdução: A Neuropatia auditiva/Dessincronia auditiva (NA) é um transtorno que foi identificado há apenas 20 anos, os pacientes que possuíam este transtorno eram diagnosticados como deficientes auditivos como conseqüência da falha no diagnóstico. Com o surgimento do registro das Emissões Otoacústicas e sua presença no repertório de testes de avaliação auditiva, foi possível ao clínico fazer o diagnóstico de NA. Assim sendo, é possível que alguns indivíduos que foram diagnosticados como portadores de uma perda auditiva neurossensorial, tivessem, na verdade, NA. Objetivos: O objetivo deste estudo foi caracterizar o tipo e grau da deficiência auditiva em uma população de deficientes auditivos da cidade de São Paulo; verificar a época da suspeita pelos pais da deficiência auditiva bem como do diagnóstico audiológico nestes indivíduos; identificar os participantes cujas avaliações comportamentais são incompatíveis com as avaliações eletrofisiológicas, visando identificar casos de Neuropatia Auditiva e realizar estudo qualitativo de casos dos participantes com incompatibilidade de respostas nas avaliações comportamentais e eletrofisiológicas. Método: Foram avaliados 89 deficientes auditivos de três escolas especiais da cidade de São Paulo e 11 do setor de Audiologia Educacional da Faculdade de Medicina da Universidade de São Paulo através de alguns testes audiológicos: imitanciometria, audiometria tonal limiar (ATL), emissões otoacústicas (EOA) e potencial evocado auditivo do tronco-encefálico (PEATE). Resultados: Dos 100 participantes deste estudo, 99% apresentaram uma deficiência auditiva do tipo neurossensorial e em 50% o grau predominante da deficiência auditiva foi profundo, um deles não conseguiu realizar a ATL. A média de idade da suspeita dos pais foi de 15,52 meses e o diagnóstico clínico foi de 25,07 meses, em todos os grupos a suspeita dos pais foi anterior ao diagnóstico. Apenas um participante apresentou avaliações comportamentais incompatíveis com as eletrofisiólogicas, todavia, no decorrer da pesquisa o quadro foi modificado, sendo que a flutuação da audição foi o fator mais marcante observado. Conclusões: Os resultados sugerem que a NA é um transtorno raro mesmo na população dos deficientes auditivos e alertam para a necessidade de acompanhar longitudinalmente os casos de suspeita do transtorno
Introduction: Auditory Neuropathy/Auditory Dys-synchrony (AN) is a disorder identified only 20 years ago. Due to diagnosis failure, patients with this disorder were diagnosed as hearing impaired. AN diagnosis was made possible upon the appearance of OAE\'s recordings and its presence in hearing evaluation battery. Therefore, it is possible that some individuals who have been diagnosed as suffering from sensorioneural hearing loss had indeed AN. Purpose: The purpose of this study was to characterize the type and degree of auditory impairment in a population of the hearing impaired in the city of São Paulo; to verify when parents had the suspicious of the hearing impairment and when was the audiological diagnosis done in these individuals; to identify the subjects whose behavioral evaluations are not compatible with the electrophysiological evaluations in order to identify Auditory Neuropathy events and carry out a qualitative study of the cases of subjects with incompatibility of responses in the behavioral and electrophysiological evaluations. Method: 89 hearing impaired individuals from three school for the deaf in the city of São Paulo, and 11 from the Educational Audiology Division of the Medicine School of the University of São Paulo were evaluated in some audiological tests: imitanciometry, audiometer evaluation (AE), otoacoustic emissions (OAE) and Auditory Brainstem Response (ABR). Results: Out of the 100 subjects in this study, 99% presented a sensorioneural hearing loss, and in 50% the predominant degree of auditory loss was profound, one of the subjects was not able to perform AE. The average age of parents suspicion was 15.52 months and the clinical diagnosis was 25.07 months, in all the groups the parents suspicion was prior to the formal diagnosis. Only one subject presented behavioral evaluations incompatible with the electrophysiological, however, in the course of the research the chart was changed, whereas the hearing fluctuation was the most remarkable factor observed. Conclusions: The results suggest that AN is a rare disorder even in the hearing impaired community and alert the need of long term follow up in the cases of suspected disorder

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Zerati, Antonio Eduardo. "Prevalência de síndrome metabólica em pacientes com claudicação intermitente e sua correlação com o nível de obstrução arterial." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/5/5132/tde-18022011-115810/.

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INTRODUÇÃO: O termo Síndrome Metabólica denomina um conjunto de fatores de risco cardiovascular associado à resistência à insulina e a um aumento da morbidade e da mortalidade. A síndrome metabólica está relacionada a diversas doenças, especialmente aquelas ligadas à aterosclerose, como a doença arterial periférica. A claudicação intermitente é sintoma característico de um estágio inicial da doença arterial periférica, no qual o conhecimento dos seus fatores predisponentes, entre os quais a síndrome metabólica, torna-se importante para a instituição do tratamento médico adequado, a fim de prevenir ou retardar a progressão da aterosclerose. OBJETIVO: O objetivo deste estudo transversal foi determinar a prevalência da síndrome metabólica em pacientes com claudicação intermitente e sua correlação com a idade, gênero, localização da obstrução arterial e associação com doença arterial coronária sintomática. MÉTODO: Foram estudados 170 pacientes com doença arterial obstrutiva dos membros inferiores de etiologia aterosclerótica cuja única manifestação clínica era dor tipo claudicação intermitente. A idade média foi de 65 anos (33-89 anos). Havia 117 homens (68.8%) com idade média de 65.6 anos (33-84 anos) e 53 mulheres (31.1%) com idade média de 63.7 anos (35-89 anos). RESULTADOS: A síndrome metabólica foi diagnosticada em 98 pacientes (57.6%), 62 homens (63.3%) e 36 mulheres (36.7%). A idade média dos pacientes com síndrome metabólica foi de 63.5 anos, contra 67.0 anos dos pacientes sem síndrome metabólica (P = .027). Considerando os doentes com 65 anos, a síndrome metabólica esteve presente em 46 (48.9%) indivíduos e em 52 (68.4%) pacientes abaixo de 65 anos (P = .011). CONCLUSÕES: A Síndrome Metabólica é uma comorbidade frequente em indivíduos com claudicação intermitente, com prevalência significativamente mais elevada em indivíduos com idade inferior a 65 anos. Não houve associação entre a Síndrome Metabólica e o sexo dos pacientes com claudicação intermitente. Não houve também relação entre a Síndrome metabólica e doença coronariana sintomática na população estudada. A Síndrome Metabólica não afetou nenhum segmento anatômico arterial preferencialmente nos claudicantes
INTRODUCTION: The metabolic syndrome consists in a group of cardiovascular risk factors referring to insulin resistance, associated with increased cardiovascular morbidity and mortality. Metabolic syndrome is correlated to several illnesses, especially those associated with atherosclerosis, like peripheral arterial disease. Intermittent claudication is a symptom of an early stage of peripheral arterial disease, and the precocious diagnosis of metabolic syndrome is important for adequate medical treatment, in order to prevent or delay the progression of atherosclerosis. OBJECTIVES: The aim of this cross-sectional study is to determine the prevalence of the metabolic syndrome in patients with intermittent claudication and its correlation with age, gender, localization of arterial obstruction and association with symptomatic coronary artery disease. METHODS AND RESULTS: There were studied 170 consecutive patients with intermittent claudication, determined by physical examination, which revealed absence or weakness of pulses on the limb or limbs that were limiting deambulation, and an ankle-brachial index 0.9. The mean age was 65 years (33-89 years). There were 117 men (68.8%) with mean age of 65.6 years (33 84 years) and 53 women (31.1%) with mean age of 63.7 years (35 89 years). Metabolic syndrome was diagnosed in 98 patients (57.6%), 62 men (63.3%) and 36 women (36.7%). The mean age of patients with metabolic syndrome was 63.5 years, against 67.0 years of patients without metabolic syndrome (P= .027). Considering patients with 65 years old, the metabolic syndrome was present in 46 (48.9%) individuals and in 52 (68.4%) patients below 65 years old (P= .011). CONCLUSIONS: The metabolic syndrome is frequent among patients with intermittent claudication, with a significant higher prevalence in claudicants < 65 years of age. The metabolic syndrome was not correlated with sex and symptomatic coronary artery disease. The metabolic syndrome did not affect any specific arterial segment in claudicant patients

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Damiano, Ana Paula. "Efeitos de um programa de exercício físico a curto prazo na claudicação intermitente de pacientes com doença arterial obstrutiva periférica." Universidade do Estado de Santa Catarina, 2008. http://tede.udesc.br/handle/handle/409.

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Intermittent claudication (IC) is the main symptom of peripheral arterial occlusive disease (PAOD) and it can severely affect the walking capacity. This study aimed to investigate the effects of a short-course physical exercise program on intermittent claudication of PAOD patients. Twelve out of the 34 recruited subjects were excluded for several reasons. Twenty-two subjects (14 males, mean age 64.4 ± 10.4 years, ankle-brachial index ≤ 0.8) with varied clinical characteristics were included, and all have participated in Programa de Reabilitação de Doenças Vasculares Periféricas do Núcleo de Cardiologia e Medicina do Exercício (NCME) of the CEFID/UDESC. The physical performance was objectively assessed by means of a 6-minute walk test and subjectively assessed by means of the walking impairment questionnaire. The primary walking test was carried out in order to assess the initial and absolute claudication distances, and lasted up to 15 minutes. The final test lasted up to 30 minutes, if necessary. The results showed that 3 out of the 22 participants had no claudication, being able to walk up to one hour without pain. The mean improvement of the initial claudication distance for the 19 remaining participants was 74.15% (67.6 ± 61.4m, p<0.05). Eleven patients (50%) did not report absolute claudication pain during the primary test; 3 patients, with prior absolute claudication pain, completed the final walking test without reporting pain, and the 8 remaining patients, who still reported absolute claudication pain, had a mean improvement of 48.61% (84.3 ± 58.8m, p<0.05) in walking distance. Regarding the distance walked in 6 minutes, the mean improvement of the 22 patients was 17% (41.1 ± 62.5, p<0.05). It was also possible to notice mean improvement (n = 22) of 14.30% (p<0.05) in walking capacity impairment; 17.56% (p<0.05) in walking distance; 4.59% (p=0.258) in walking speed and 5.49% (p=0.468) in stair climbing. In conclusion, a short-course physical exercise program is effective in PAOD and IC patients. Throughout the walking test, the initial and absolute claudication distances and the distance walked in 6 minutes were significantly improved. The walking impairment questionnaire showed considerable improvements related to walking impairment and walking distance, however, concerning walking speed and stair climbing, the improvements were not statistically significant.
A claudicação intermitente (CI) é o principal sintoma da doença arterial obstrutiva periférica (DAOP) e pode comprometer severamente o desempenho de caminhada. O objetivo do estudo foi investigar os efeitos de um programa de exercício físico a curto prazo na claudicação intermitente de pacientes com DAOP. Dos 34 indivíduos selecionados, 12 foram excluídos por diversos motivos. Os 22 incluídos (14 do gênero masculino, média de idade 64,4 + 10,4 anos, índice tornozelo braquial < 0,8), todos participantes do Programa de Reabilitação de Doenças Vasculares Periféricas do Núcleo de Cardiologia e Medicina do Exercício (NCME) do CEFID/UDESC, apresentavam características clínicas heterogêneas. O desempenho físico foi avaliado objetivamente por meio do teste de caminhada de 6 minutos e subjetivamente pelo questionário de dificuldade para caminhar. O teste inicial de caminhada, destinado à avaliação das distâncias de claudicação inicial e absoluta, foi prolongado até 15 minutos e o final, quando necessário, até 30 minutos. Os resultados demonstraram que, dos 22 participantes do estudo, 3 deixaram de sentir a claudicação, caminhando até uma hora no programa de exercícios sem referir dor. Nos 19 pacientes restantes, a melhora média da distância de claudicação inicial foi de 74,15% (67,6 ± 61,4m, p<0,05). Dos 22 pacientes incluídos no estudo, 11 (50%) não apresentaram dor da claudicação absoluta no teste inicial; 3 pacientes, antes com dor da claudicação absoluta, completaram o teste de caminhada final sem essa manifestação e nos restantes (8 pacientes), que ainda apresentavam dor da claudicação absoluta, foi observada melhora média na distância caminhada de 48,61% (84,3 ± 58,8m, p<0,05). Quanto à distância percorrida em 6 minutos, a melhora média dos 22 pacientes foi de 17% (41,1 ± 62,5, p<0,05). Foi ainda constatado melhora média (n = 22) de 14,30% (p<0,05) na dificuldade para caminhar; 17,56% (p<0,05) na distância de caminhada; 4,59% (p = 0,258) na velocidade de caminhada e 5,49% (p = 0,468) na subida de degraus. Conclui-se que um programa de exercício físico a curto prazo é eficiente no tratamento de pacientes com DAOP e CI. Foi possível observar, por meio do teste de caminhada, melhora significativa na distância para claudicação inicial e absoluta e na distância percorrida em 6 minutos. A aplicação do questionário de dificuldade para caminhar demonstrou melhoras significativas relacionadas à dificuldade para caminhar e à distância de caminhada, sendo, entretanto, as melhoras relacionadas à velocidade de caminhada e subida de degraus consideradas estatisticamente não significativas.

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Freitas, Dayana. "Risco cardiovascular na hipertensão do avental branco: avaliação do Índice Tornozelo Braquial." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-14012013-155532/.

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As alterações vasculares são complicações clínicas secundárias a elevação da pressão arterial que podem comprometer a capacidade funcional e aumentar o risco de mortalidade. Um instrumento utilizado como marcador de doença arterial obstrutiva periférica que vem merecendo amplo interesse clínico e científico é o Índice Tornozelo-Braquial (ITB). Segundo diretrizes para a prática clínica, valores de ITB <=0,9 ou >=1,3 são considerados patológicos e associados a uma alta incidência de morbimortalidade cardiovascular. Este estudo descritivo e de corte transversal teve por objetivo identificar o risco cardiovascular em hipertensos do avental branco por meio da determinação do ITB com uso de esfigmomanômetros oscilométricos automáticos. Foi desenvolvido em um município localizado ao Nordeste do Estado de São Paulo, no período de agosto de 2010 a junho de 2011. Os participantes foram divididos em normotensos, hipertensos e hipertensos do avental branco, classificados de acordo com o diagnóstico médico e resultado da Monitorização Ambulatorial da Pressão Arterial (MAPA). As variáveis investigadas foram: idade, cor da pele, situação familiar conjugal, naturalidade, índice de escolaridade, profissão, peso, estatura, circunferência abdominal, pressão arterial em braços e tornozelos e ITB. O cálculo do ITB foi realizado pela relação da maior pressão arterial sistólica (PAS) da artéria tibial posterior com a maior pressão sistólica das artérias braquiais. As análises descritivas foram realizadas por meio do pacote estatístico StatisticalPackage for the Social Sciences - SPSS, versão 15.0. Utilizou-se análise de variância (ANOVA) para medidas repetidas e teste Tukey para comparações múltiplas das médias. O grau de relação linear nos escores de PAS e ITB foi verificado mediante a utilização do Coeficiente de Correlação de Pearson. Os resultados foram expressos como médias ± erros padrões das médias (EPM), e as diferenças consideradas estatisticamente significantes para p<0,05. Participaram do estudo 135 indivíduos, sendo 37% normotensos, 37% hipertensos e 26% hipertensos do avental branco. Em todos os grupos, a maioria dos participantes é do sexo feminino, de cor branca, vive com o cônjuge, é natural do estado de São Paulo, exerce atividades domésticas e tem ensino fundamental incompleto. Hipertensos do avental branco apresentam risco intermediário na análise de todas as variáveis clínicas estudadas. Apesar de não ter sido encontrada diferença significante na análise dos valores de ITB na comparação dos grupos, alterações compatíveis com doença arterial obstrutiva periférica e calcificação arterial foram observadas somente nos grupos hipertensão e hipertensão do avental branco. A análise do ITB de menor valor mostrou que 10% dos hipertensos e 5,7% dos hipertensos do avental branco apresentaram ITB<=0,9 e 6% dos hipertensos e 11,4% dos hipertensos do avental branco apresentaram ITB>1,3. Há correlação negativa entre os valores de PAS e ITB nos grupos hipertensão e hipertensão do avental branco. Estes achados remetem à premissa de que a hipertensão do avental branco não deve ser compreendida como uma condição benigna, sendo caracterizada por um quadro clínico que pode evoluir para hipertensão arterial estabelecida. A mensuração do ITB merece importância na abordagem clínica dos pacientes, devendo constituir um instrumento de avaliação do risco cardiovascular valorizado pelos profissionais na rotina dos serviços de saúde.
The vascular changes are secondary clinical complications of high blood pressure which can compromise the functional capacity and increase the risk of mortality. The Ankle-Brachial Index (ABI) is an instrument used as a marker of peripheral occlusive arterial disease which has attracted broad scientific and clinical interest. According to guidelines for clinical practice, ABI values <=0.9 or >=1.3 are considered pathological and associated with a high incidence of cardiovascular morbidity and mortality. This descriptive and cross-sectional study aimed at identifying cardiovascular risk in white coat hypertension by determining the ABI through the use of automatic oscillometric sphygmomanometers. The study was performed in a municipality located in the northeastern of the state of São Paulo, from August 2010 to June 2011. Participants were divided into normotensive, hypertensive, and white coat hypertensive subjects, classified according to the medical diagnosis and outcome of Ambulatory Blood Pressure Monitoring (ABPM). The variables investigated were: age, color of skin, marital family situation, nationality, level of education, occupation, weight, height, waist circumference, ankle-brachial blood pressure and ABI. The calculation of ABI was performed by the ratio between the higher systolic blood pressure (SBP) of the posterior tibial artery and the highest systolic brachial artery. Descriptive analyzes were performed using the Statistical Package for Social Sciences Statistical Package - SPSS, version 15.0. The analysis of variance (ANOVA) was used for repeated measures and Tukey test for multiple comparisons of means. The degree of linear relationship in the scores of SBP and ABI was verified by using the Pearson correlation coefficient. The results were expressed as means ± standard errors of the mean (SEM), and the differences were considered statistically significant at p<0.05. The study included 135 subjects, 37% normotensive, 37% hypertensive and 26% white coat hypertensive subjects. In all groups, most participants are female, white, live with the spouse, from the state of São Paulo, housewives and have incomplete elementary education. White coat hypertensive subjects have intermediate risk in the analysis of all clinical variables studied. Although no significant difference was found in the analysis of ABI values in the comparison of groups, changes consistent with peripheral occlusive arterial disease and arterial calcification was observed only in the groups with hypertensive and white coat hypertensive subjects. The analysis of the lower ABI value showed that 10% of hypertensive subjects and 5.7% of white- coat hypertensive subjects had ABI<=0.9 and 6% of hypertensive subjects and 11.4% of white-coat hypertensive subjects had ABI>1.3 . There is a negative correlation between SBP and ABI in the groups of hypertensive and white coat hypertensive subjects. These findings relate to the premise that white coat hypertension should not be understood as a benign condition, being characterized by a clinical condition that can lead to established hypertension. The measurement of ABI deserves importance in clinical management of patients and should be a tool for assessing cardiovascular risk valued by professionals in the routine of health services.

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VAZQUEZ, JORGE ARTURO. "NERVE FIBER DIAMETER MEASUREMENTS USING HEMATOXYLIN AND EOSIN STAINING AND BRIGHTFIELD MICROSCOPY TO ASSESS THE NOVEL METHOD OF CHARACTERIZING PERIPHERAL NERVE FIBER DISTRIBUTIONS BY GROUP DELAY." DigitalCommons@CalPoly, 2014. https://digitalcommons.calpoly.edu/theses/1293.

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Peripheral neuropathies are a set of common diseases that affect the peripheral nervous system, causing damage to vital connections between various parts of the body and the brain and spinal cord. Different clinical conditions are known to selectively impact various size nerve fibers, which often makes it difficult to diagnose which peripheral neuropathy a patient might have. The nerve conduction velocity diagnostic test provides clinically useful information in the diagnosis of some peripheral neuropathies. This method is advantageous because it tends to be minimally invasive yet it provides valuable diagnostic information. However, this test does not determine characteristics of peripheral nerve fiber size distributions, and therefore does not show any detailed information regarding the nerve fibers within the nerve trunk. Being able to determine which nerve fibers are contributing to the evoked potential within a nerve trunk could provide additional information to clinicians for the diagnosis of specific pathologies of the peripheral nervous system, such as chronic inflammatory demyelinating polyneuropathy or early diabetic peripheral neuropathy. In this study, three rat sciatic nerves are sectioned and stained with hematoxylin and eosin in order to measure the nerve fiber diameters within the nerve trunk. Stained samples are viewed using brightfield microscopy and images are analyzed using ImageJ. Histograms were created to show the frequency of various nerve fiber diameters. The nerve fiber diameters measured during this research are consistent with the range of previously published diameter values and will be used to support continuing research for a novel method to characterize peripheral nerve fiber size distributions using group delay.

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SICCHIERI, LETICIA B. "Estudo e caracterização de marcadores ópticos para a aterosclerose." reponame:Repositório Institucional do IPEN, 2016. http://repositorio.ipen.br:8080/xmlui/handle/123456789/26949.

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O presente trabalho buscou investigar a formação da placa de aterosclerose através de caracterização da autofluorescência do tecido e do plasma na presença de marcadores fluorescentes. Para realizar o estudo, coelhos foram divididos em dois grupos: um grupo controle onde os animais foram submetidos a uma dieta normal e um grupo experimental onde os animais foram submetidos a uma dieta hipercolesterolêmica. Foram realizadas duas experimentações animais: na primeira os animais foram sendo eutanasiados ao longo do experimento e suas artérias foram coletadas. Na segunda os animais foram acompanhados por no máximo 80 dias. Durante o experimento apenas o sangue foi coletado e os animais foram eutanasiados no final do experimento. Dois marcadores fluorescentes foram utilizados no trabalho: o complexo európio-clorotetraciclina (EuCTc) e o corante tioflavina T (ThT). Analisouse inicialmente a fluorescência dos marcadores na presença do plasma dos coelhos tanto para o grupo controle, quanto para o grupo experimental em função dos tempos de dieta. Para o complexo EuCTc observou-se duas bandas de emissão, com excitação em 400 nm, uma característica da clorotetraciclina, em 515 nm e uma em 617 nm característica do íon európio. A análise da banda do íon európio indicou um incremento da banda de emissão do complexo na presença do plasma do grupo experimental em relação ao grupo controle. Para o corante ThT também foi observado um aumento na banda de emissão em 480 nm, com excitação em 413 nm, para o grupo experimental em comparação com o grupo controle. A potencialidade de utilização do complexo EuCTc e EuCTcMg (EuCTc na presença do íon magnésio) para marcação da placa de aterosclerose nas artérias, foi estudada através da análise de microscopia de fluorescência. Observou-se que a emissão do complexo melhora muito a visualização da placa quando comparada com a autofluorescência. Observou-se, através de microscopia de tempo de vida de fluorescência, que há uma transferência de energia entre os fluoróforos presentes na placa e os complexos EuCTc e EuCTcMg. Essa transferência de energia ocasionou em uma diminuição drástica no tempo de vida de fluorescência dos fluoróforos nessa região. Por fim, estudou-se a geração de segundo harmônico do colágeno na placa de aterosclerose, sendo obtidas diferenças na quantidade e organização do colágeno para os diferentes grupos experimentais.
Tese (Doutorado em Tecnologia Nuclear)
IPEN/T
Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

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Filho, José Carlos Jucá Pompeu. "Associação dos achados morfofuncionais cardíacos, renais e vasculares com as alterações do índice tornozelo-braço em pacientes hipertensos diabéticos." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-26102015-152333/.

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Introdução: Inúmeros estudos estabeleceram correlações entre o índice tornozelo-braço (ITB), um marcador de aterosclerose subclínica, e o prognóstico cardiovascular em diferentes populações. No entanto, poucos estudos avaliaram a correlação entre os valores do ITB e lesões cardiovasculares e renais, exclusivamente, em pacientes com hipertensão arterial e diabetes. Objetivo: Estudar a prevalência de alterações morfofuncionais cardíacas, carotídeas, retinianas e renais de acordo com a presença ou não de valores de ITB alterados (ITB <= 0,9 ou ITB > 1,4) em pacientes hipertensos com diabetes tipo 2. Métodos: Foram incluídos no estudo 99 pacientes hipertensos diabéticos com idade entre 50 e 80 anos. A aferição do ITB foi realizada em todos os pacientes por método validado e estes foram classificados em Grupo 1 (ITB normal, n = 49) ou Grupo 2 (ITB alterado, n =50). Todos os pacientes foram submetidos, em até 06 meses, à realização de ecodopplercardiograma, ultrassonografia de carótidas, retinografia colorida, aferição da taxa de filtração glomerular (TFG) e da albuminúria de 24h. Os pacientes foram analisados para a ocorrência ou não de um desfecho-composto ecocardiográfico que incluiu alterações morfológicas e funcionais cardíacas relevantes para a prática clínica. Os pacientes dos grupos 1 e 2 foram também comparados quanto à prevalência de placas carotídeas com ou sem repercussão hemodinâmica, TFG < 60 ml/mim/m2, albuminúria de 24h > 30mg e presença ou não de retinopatia. Por fim, foram comparadas as frequências médias das seguintes lesões de órgãos-alvo de ambos os grupos, considerando-se valor unitário para a presença de cada uma delas: hipertrofia do ventrículo esquerdo, retinopatia hipertensiva, TFG < 60 ml/min/m2 e estenose da artéria carótida interna > 50% do seu diâmetro. Resultados: A média de idade dos pacientes foi 65,4 ± 7 anos, sendo 61,6% deles do sexo feminino. A presença de níveis elevados de pressão arterial sistólica (153,4 ± 18 versus 170 ± 26 mmHg), de albuminúria de 24h > 30mg (55,3% versus 82,6%) e de TFG < 60 ml/min/m2 (12,8% versus 33,3%) foi significativamente maior (p < 0.05) entre os pacientes do Grupo 2. O desfecho-composto ecocardiográfico foi mais prevalente no grupo 2 (84,0% versus 59,2%; p = 0,006) e a frequência média de lesões de órgãos-alvo também foi maior nos pacientes do grupo 2 (0,36 ± 0,31 versus 0,19 ± 0,19; p = 0,001). Análise por regressão logística binária revelou que o ITB foi uma das variáveis preditoras independentes para o desfecho-composto ecocardiográfico (OR = 3,43; IC 95% = 1,07 - 11,0; p = 0,04). A partir da análise por regressão linear obteve-se um modelo final no qual o ITB foi uma das três variáveis preditoras independentes para a estimativa da frequência média de lesões de órgãos-alvo com coeficiente beta = 13,22 (1,81 - 24,63), ao lado da idade e do infarto prévio. Conclusão: Nossos dados mostram que valores de ITB alterados estão associados à maior prevalência de lesões em órgãos-alvo, principalmente alterações ecocardiográficas, em pacientes com hipertensão arterial e diabetes
Introduction: A lot of studies have established strong correlations between the ankle-brachial index (ABI), a marker of subclinical atherosclerosis and cardiovascular prognosis in different populations. However, few studies have assessed the correlation between the values of the ABI and cardiovascular and renal lesions in patients with hypertension and diabetes. Objective: To study the prevalence of cardiac, carotid, renal and retinal morphological and functional changes according to the presence or not of altered ABI values (ABI <= 0.9 or ABI > 1.4) in hypertensive patients with type 2 diabetes. Methods: It was included 99 diabetic hypertensive patients aged between 50 and 80 years. The measurement of the ABI was performed in all patients by validated method and they were classified in Group 1 (normal ABI, n = 49) or group 2 (altered ABI, n = 50). All patients were submitted, up to 6 months, to Doppler echocardiography, carotid ultrasound, color retinography, assessment of glomerular filtration rate (GFR) and 24h albuminuria. Patients were analyzed for the occurrence or not of a composite echocardiographic outcome which included morphological and functional cardiac alterations relevant to clinical practice. Patients in groups 1 and 2 were compared regarding the prevalence of carotid plaques with or without hemodynamic repercussion, TFG < 60 ml/min/m2, 24h albuminuria > 30 mg and the presence or not of retinopathy. Finally, we compared the prevalence of mean frequency of the following end-organ lesions of both groups, considering unit value for each one: left ventricular hypertrophy, hypertensive retinopathy, TFG < 60 ml/min/m2 and internal carotid artery stenosis > 50%. Results: The mean age of the patients was 65.4 ± 7 years, with 61.6% of them female. The presences of elevated levels of systolic blood pressure (153.4 ± 18 versus 170.0 ± 26 mmHg), of 24h albuminuria > 30 mg (55.3% versus 82.6%) and TFG < 60 ml/min/m2 (12.8% vs. 33.3%) were significantly greater (p < 0.05) among the patients of Group 2. The composite echocardiographic outcome was more prevalent in Group 2 (84.0% versus 59.2%, p = 0.006) and the average frequency of subclinical injury of target organs was also greater in patients of Group 2 (0.36 ± 0.31 versus 0.19 ± 0.19; p = 0.001). Binary logistic regression analysis revealed that the ABI was one of the independent predictors of composite echocardiographic outcome (OR = 3.43; IC 95% = 1.07 - 11.0; p = 0.04). From the linear regression analysis it was obtained a final model in which the ABI was one of three independent predictors for the estimation of the average frequency of end-organ damage with ? coefficient = 13.22 (1.81-24.63), besides age and previous myocardial infarction. Conclusion: Our data demonstrates that changed ABI values are associated with higher prevalence of subclinical end-organ lesions, principally changes in echocardiographic parameters, in patients with hypertension and diabetes

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32

Struthers, Kyle Remington. "ISCHEMIA IMPAIRS VASODILATION IN SKELETAL MUSCLE RESISTANCE ARTERY." DigitalCommons@CalPoly, 2011. https://digitalcommons.calpoly.edu/theses/546.

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Functional vasodilation in arterioles is impaired with chronic ischemia. We sought to examine the impact of chronic ischemia and age on skeletal muscle resistance artery function. To examine the impact of chronic ischemia, the femoral artery was resected from young (2-3mo) and adult (6-7mo) mice and the profunda femoris artery diameter was measured at rest and following gracilis muscle contraction 14 days later using intravital microscopy. Functional vasodilation was significantly impaired in ischemic mice (14.4±4.6% vs. 137.8±14.3%, p<0.0001 n=8) and non-ischemic adult mice (103.0±9.4% vs. 137.8±14.3%, p=0.05 n=10). In order to analyze the cellular mechanisms of the impairment, a protocol was developed to apply pharmacological agents to the experimental preparation while maintaining tissue homeostasis. Endothelial and smooth muscle dependent vasodilation were impaired with ischemia, 39.6 ± 13.6% vs. 80.5 ± 11.4% and 43.0 ± 11.7% vs. 85.1 ± 10.5%, respectively. From this data, it can be supported that smooth muscle dysfunction is the reason for the observed impairment in arterial vasodilation.

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33

Jogerst, Gerald J., Shimin Zheng, Elena V. Frolova, and Mee Young Kim. "Late-Life Depressive Symptoms: An International Study." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/43.

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Objectives. Evaluate differences in depressive symptoms, compare sociodemographic and health-related variables associated with depressive symptoms and report level of impact of depressive symptoms on daily activities. Methods. Cross-sectional study using a self-administered questionnaire and Patient Health Questionnaire-9 (PHQ-9) diagnostic survey on 1115 patients aged 60–93 years who attended a primary care clinic in Korea, Russia or USA. Results. At least mild depression (PHQ-9 score of ≥5) occurred in 28% of Koreans, 65% of Russian and 27% of US participants. Russians scored more depressed on all PHQ-9 items (P < 0.01) and more suicidal thoughts (P < 0.001), while Koreans had less feelings of worthlessness (P < 0.001). Depression predictors included poorer self-rated health [odds ratio (OR) 2.47, 95% confidence interval (CI) 1.84–3.33, P < 0.0001], chronic diseases (OR 1.34, CI 1.21–1.48, P < 0.0001), female gender (OR 1.56, CI 1.15–2.12, P = 0.0046) and religious attendance (OR 0.88, CI 0.79–0.97, P = 0.0099) for all subjects. Being employed was protective in Korea (OR 0.41, CI 0.21–0.77, P = 0.0061) and being married (OR 0.42, CI 0.27–0.66, P = 0.0002) and of older age (OR 0.95, CI 0.93–0.98, P = 0.0006) protective in US participants. Vascular disease was associated with depressive symptoms in Russia (OR 3.47, CI 1.23–9.80, P = 0.0187). In regression analyses stratified by country for a given level of depressive symptoms, the Russian sample had less impact on daily activities (Russia R2 = 0.107 versus Korea R2 = 0.211 and US R2 = 0.419) P = 0.029. Conclusions. Depressive symptoms were more common in Russia than in Korea and USA but had less impact on daily functioning. Cultural or environmental factors may account for this finding.

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34

Fidelis, Ronald José Ribeiro. "Avaliação da extensão da oclusão arterial na isquemia crônica de membros inferiores: estudo comparativo da ecografia com Doppler colorido e da arteriografia." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5132/tde-29012007-144331/.

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A arteriografia é um exame radiológico invasivo que permite ver as características da luz das artérias tronculares e de pequenos ramos musculares e colaterais, tornando possível constatar alterações parietais mínimas através da injeção intravascular de meio de contraste. Apesar do grande desenvolvimento tecnológico que experimentou nas últimas décadas, tem limitações para definir a extensão da obstrução e o leito arterial pósobstrução na Doença Arterial Oclusiva de Membros Inferiores (DAO). Alguns estudos já analisaram a arteriografia quanto à visibilização do leito distal em pacientes com DAO femoropoplítea, porém nenhum estudou a extensão do segmento ocluído no território aortoilíaco utilizando a arteriografia intra-operatória com injeção distal de contraste como teste padrão. Este estudo clínico, prospectivo, conduzido no Serviço de Cirurgia Vascular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foi desenvolvido para avaliar a arteriografia pré-operatória em sua capacidade de detectar a real extensão das oclusões arteriais, e o leito arterial distal a estas. A Ecografia com Doppler colorido também foi avaliada nesses mesmos aspectos. A extensão da oclusão foi definida como sendo a distância entre o ponto de oclusão e o ponto de reenchimento (PR) da luz arterial, e o leito distal (LD) definido como o conjunto de todas as artérias que mantêm continuidade com este ponto de reenchimento. Todos os pacientes incluídos foram submetidos, em mesmo intervalo determinado de tempo, a uma Arteriografia com injeção de meio de contraste Proximal à obstrução (AP), uma Ecografia com Doppler colorido (Eco-Doppler) e ao padrão-ouro para diagnóstico do PR e LD, que é a Arteriografia com injeção de contraste Distal à obstrução (AD). Foram estudados 47 membros inferiores, de 33 pacientes. Trinta e quatro casos de doença aortoilíaca e 13 casos de doença arterial infrainguinal femoropoplítea. A AP detectou o verdadeiro PR em apenas 53,2% de toda a amostra, revelando uma reprodutibilidade ruim em relação à AD (k = 0,44, P < 0,001). Ao passo que o Eco-Doppler foi capaz de identificar o PR em 74,5% das vezes, revelando uma boa reprodutibilidade comparada ao teste padrão (k = 0,68, P < 0,001). Na visibilização do leito distal, a AP e o Eco-Doppler identificaram, respectivamente, 125 e 167 das 183 artérias vistas à AD. Esta diferença foi estatisticamente significativa (P = 0,001). Na análise da relação entre as variáveis estudadas e os resultados, o único fator significativamente associado com a discordância entre os métodos foi a localização anatômica da doença arterial. Com estes dados, concluí-se que a arteriografia préoperatória não identifica corretamente o PR e o LD em um número significativo de casos de DAO aortoilíaca. A Ecografia demonstrou neste estudo, uma concordância significativa com arteriografia intraoperatória, tanto na DAO aortoilíaca, quanto na femoropoplítea.
Arteriography is an invasive method of imaging the vascular system that allows assessment of the intraluminal characteristics of the arteries. It detects minimal arterial wall changes with intravascular injections of contrast agents. Dispite significant advances in lasts decades, some pitfalls remain in determining the extension of arterial occlusions and the run-off vessels in cases of arterial occlusive disease in the lower extremities (LEAOD). Some authors have already studied the extension of the disease, by arteriography, in patients with femoropopliteal disease; nevertheless, none of them has so far used the Intraoperative Distal Prebypass Arteriography (IDA) as the goldstandard in patients with disease in the aortoiliac territory. This study is a clinical, prospective trial, developed by the Division of Vascular Surgery at the University of Sao Paulo to analyse the pre-operative arteriography (POA) in its capacity of showing the true extension of the arterial occlusion and the run-off vessels in LEAOD. The Duplex Ultrasound Arterial Mapping (DUAM) was also tested in the same situations. Extension of the arterial occlusion was defined as the length between the point where the contrast agent leaves the main vessel, and the point where the contrast come back to it, in the arterial system, the later called Refilling Point (RP). Run-off was defined as the sum of the distal arteries continuous with the RP. All of the patients included in this study were subjected in a determined time interval to a POA, a DUAM and a IDA. Forty seven lower extremities were studied in 33 patients (34 with aortoiliac, and 13 with femoropopliteal disease). POA detected the true RP in 53% of the instances, with a bad reprodutibility of the gold-standard (k = 0,44, P > 0,001). The DUAM detected the RP 74,5%, with a good results reprodutibliity (k = 0,68, P < 0,001). In the assessment of run-off vessels POA and DUAM have detected, respectively, 125 and 167 of the 183 arteries showed in IDA. This disagreement between POA and DUAM was estastistically significant (P = 0,001). The only clinical characteristic associated with the results was the anatomical location of the arterial disease. We concluded that the POA does not identify the true RP and the run-off vessels in the aortoiliac LEAOD. The DUAM showed a good agreement with the IDA, and so it can be considered a good choice to assess the RP and the run-off in aortoiliac and femoropopliteal LEAOD.

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35

Brand, Martin. "Potential novel approaches to risk identification in advanced peripheral arterial disease." Thesis, 2014.

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Peripheral arterial disease (PAD) is a significant cause of morbidity and mortality in both economically developed and developing countries. Although the risk factors for PAD are well described, patients with PAD who develop critical lower limb ischaemia (CLI) are frequently asymptomatic prior to the development of CLI and the factors that determine outcomes in these patients are unclear. In the present thesis I therefore evaluated a number of potential novel risk approaches in patients with CLI, both for the development of CLI, as well as approaches that may better predict outcomes in CLI. Atherosclerotic disease, the major pathophysiological process responsible for PAD, is now well recognized as causing an increased large artery pulse wave velocity (PWV) and central aortic pulse pressure (PPc). However, through the presence of arterial stenoses proximal to the femoral artery, carotid-femoral PWV may be reduced in advanced PAD. I therefore aimed to determine whether in the context of increases in central aortic pulse pressure (PPc), decreases in carotid-femoral pulse wave velocity (PWV) predicts the presence of advanced PAD. Applanation tonometry and vascular ultrasound were employed to assess carotid-femoral PWV, PPc and carotid intima-media thickness (IMT) in 1030 randomly selected healthy adults from a community sample and 217 patients with CLI. With adjustments for confounders, participants with CLI had an increased carotid IMT (p<0.0001) and PPc (p<0.0001), but a markedly reduced PWV (m/sec)(CLI=4.38±3.14, Community sample=6.78±2.47, p<0.0001). PWV was strongly correlated with PPc (r=0.53, p<0.0001) in the community sample, but not in CLI (r=-0.04). A stiffness mismatch index (PPc/PWV) showed increased values in participants with CLI over the full adult age range assessed. With carotid IMT, PPc or aortic augmentation index in the same regression model, an increase in the stiffness mismatch index (PPc/PWV) was independently associated with CLI (p<0.0001) and a PPc/PWV value>upper 95% confidence interval in the community sample strongly predicted CLI (odds ratio=27.1, p<0.0001). In conclusion, in the context of an increased PPc,carotid-femoral PWV is markedly reduced in CLI. These results suggest that a stiffness mismatch index (PPc/PWV) may be a new risk marker for advanced PAD.As infection with the human immunodeficiency virus (HIV) is common in South Africa, and this is increasingly translating into cardiovascular disease including CLI, it is important to be able to detect those HIV positive patients whom will develop CLI. Although ankle-brachial index may detect PAD, more general screening tools to detect those at risk of cardiovascular events are required. In this regard, carotid IMT measurements may be useful.The extent to which human HIV is associated with increases in IMT independent of conventional cardiovascular risk factors is unclear. Hence, I evaluated whether independent of conventional risk factors, an increased carotid IMT occurs in African HIV infected patients with chronic critical limb ischemia (CLI). Carotid IMT was measured in 217 sequentially recruited patients with CLI, 25 of whom were HIV positive and in 430 randomly selected controls from a community sample. As compared to HIV negative patients with CLI, HIV positive patients were younger (49±10 vs. 64±11 years, p<0.0001) and had a markedly lower prevalence of hypertension and diabetes mellitus (p<0.0001), but a similar proportion of patients smoked (76% vs. 67%). However, as compared to patients with CLI who were HIV negative, HIV positive patients had a similar increase in carotid IMT (HIV positive=0.75±0.14 mm; HIV negative=0.79±0.14 mm; Controls=0.64±0.15, p<0.0001 versus Controls) even after adjustments for age, sex and conventional risk factors (HIV positive=0.75.±0.13 mm; HIV negative=0.73±0.15 mm, Controls=0.66±0.15, p<0.005). IMT was similarly increased in HIV positive patients with CLI as compared to HIV negative patients with CLI when assessed in men, smokers, and black African patients only (p<0.05-0.0001), or in those who were receiving highly active antiretroviral therapy (n=12, 0.74±0.10 mm) as compared to those not receiving therapy (0.75±0.15 mm). As compared to controls,the age- sex- and conventional risk factor-adjusted odds of having an IMT≥0.8 mm was similarly increased in patients with CLI who were HIV positive (odds ratio=8.89, CI=2.79-28.32, p=0.0002) as those who were HIV negative (odds ratio=2.70 CI=1.51-4.81, p<0.001).In conclusion, these results suggest that despite being of a younger age, with or without conventional risk factor adjustments, marked increases in carotid IMT in HIV is a risk factor for CLI. Thus, carotid IMT measurements may be a useful screening tool to detect those patients with HIV at risk of CLI. Although asymptomatic decreases in left ventricular (LV) ejection fraction (EF) predict long-term mortality and decreased patency of endovascular interventions in patients undergoing vascular surgery, in patients with chronic critical lower limb ischemia (CLI), the prevalence of asymptomatic decreases in EF and the characteristic features thereof are unclear. I performed echocardiography in 93 sequentially recruited patients with CLI without symptoms of heart failure and 698 randomly recruited participants from a community sample.As compared to the community sample, patients with CLI had markedly reduced multivariate adjusted EF (CLI=56±12%, Community sample=67±11%, p<0.0001), LV midwall fractional shortening (FSmid)(p<0.0001), stroke volume index (SV)(p<0.0001), cardiac output index (CO)(p<0.05), and increased total peripheral resistance index (TPR)(p<0.05). In contrast to only 1/698 community participants, 26/93 (28%) patients with CLI had an EF<40%, of which only 5 had a previous myocardial infarction; and CLI was associated with a reduced EF independent of clinical evidence of coronary artery disease (CAD) and additional confounders (odds ratio=250, p<0.0001). In patients with CLI with an EF<40%, CO, SV and FSmid were all substantially reduced (p<0.0001), pro-brain natriuretic peptide concentrations and E/A were increased (p<0.05), whilst LV end diastolic volume index was marginally increased (p<0.05) as compared to those with an EF≥55%. Pro-brain natriuretic peptide had a poor sensitivity and specificity for the detection of an EF <40%. In conclusion, CLI is associated with a high prevalence of reduced EF independent of clinical evidence of heart failure, CAD and additional confounders, the main mechanism of which is a markedly reduced myocardial systolic function. This translates into decreased CO and increased TPR, alterations that may contribute toward increased mortality or reduced patency of endovascular interventions after vascular surgery.In conclusion, the results of this thesis suggest that longitudinal studies should be conducted to evaluate whether an arterial mismatch index (PPc/PWV) can predict the development of CLI independent of alternative cardiovascular risk factors; whether carotid IMT may be used to predict those at a high risk of cardiovascular events including CLI in HIV positive patients; and whether the presence of asymptomatic low LV EF may predict outcomes after surgery for CLI. Furthermore, the results of this thesis suggest that clarity is required to identify the exact large artery changes that characterize HIV positive patients with advanced PAD in South Africa.

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36

Quigley, Francis G. "Transcutaneous oxygen tension in the assessment of lower limb ischaemia and ulceration." Thesis, 1989. http://hdl.handle.net/2440/110690.

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37

Khalil, Michael. "Development of a Vascular Optical Tomographic Imaging System for the Diagnosis and Monitoring of Peripheral Arterial Disease." Thesis, 2014. https://doi.org/10.7916/D8DF6PCQ.

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The overall goal of this dissertation is to describe the development of a dynamic diffuse optical tomographic (DDOT) imaging system for the diagnosis and monitoring of peripheral arterial disease (PAD) within the lower extremities. PAD affects 8-12 million individuals in the United States and is associated with significant morbidity and mortality. Early detection and monitoring of disease progression is crucial, but remains difficult. This is especially true for diabetic patients, as roughly 30 percent of all diabetic patients over the age of 50 are diagnosed with PAD. Diabetic patients have calcified arteries, which renders them incompressible. This falsely elevates blood pressure readings and causes false negative readings using traditional diagnostic techniques. DDOT offers an attractive opportunity to overcome current shortcomings in assessing PAD. This technology uses harmless near-infrared light to create three-dimensional, time-dependent images of biological tissues. Using DDOT to measure blood-perfusion in the foot should help diagnose and monitor the PAD. To test this hypothesis, I adapted an existing optical tomographic imaging system for the particular application of vascular imaging in the foot. In particular I design and tested various measuring probes that can accommodate different foot sizes and shapes. The result was a patient friendly interface that can be employed in a clinical setting. Using this modified DDOT imager, which we called vascular optical tomographic imaging (VOTI) system, I conducted a 40-subject pilot study to quantify its ability to diagnose PAD. The subjects were recruited into three cohorts, non-diabetic PAD patients (N=10), PAD Patients (N=10) and healthy volunteers (N=20). With this data in hand, I performed a comprehensive data analysis, in which I found imaging features that led to a good separation between the healthy and affected cohorts. In particular I demonstrated that statistically significant difference exist between the amount of blood pooling in the leg during a 1-minute, 60mmHg thigh cuff occlusion within healthy subjects and both affected cohorts (P=0.006, P=0.006). In addition, using receiver operating characteristic (ROC) curve analysis, I identified that the new VOTI system could diagnose PAD with a sensitivity and specificity of over 80%, even within the diabetic patients. This imaging modality was also capable of identifying the severity of the disease with similar accuracy to the existing diagnostic methods while not being inhibited by arterial calcifications. Furthermore, the VOTI system provided spatial information, helping identify which regions of the foot suffered from mal-perfusion. When combined with angiosome theory, the spatial information could help physicians in deciding how to intervene in PAD patients. After completing this first clinical study, I developed a dedicated VOTI system by entirely redesigning the hard and software. This new system has many novelties over its predecessor. First it employs a contact-free patient interface that allows to imaging patients with ulcerations. The illumination fibers used do not need to make physical contact with the patient. Second, instead of using individual silicon photodiodes as detectors, a highly sensitive CCD camera is use to detect transmitted light intensity. The system has two wavelengths of light (660 and 860 nm), which can be illuminated at up to 20 different positions along the surface of the foot. The system is built for dynamic imaging and is capable of imaging at a multispectral-volumetric frame rate speeds of 1 Hz. This set-up allows us to create three-dimensional images of large portions of the foot. This imaging system was tested on phantom studies and healthy volunteers and was shown to be able to image blood flow dynamics within a three-dimensional volume of the foot.

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38

"Serum high-sensitivity C-reactive protein concentration of Chinese chronic-renal-failure patients with atherosclerotic vascular disease or cardiac valve calcification." 2002. http://library.cuhk.edu.hk/record=b5895944.

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Chan Fat-Yiu.
Thesis (M.Sc.)--Chinese University of Hong Kong, 2002.
Includes bibliographical references (leaves 85-93).
Abstracts in English and Chinese.
ACKNOWLEDGEMENTS --- p.4
SUMMARY --- p.5
ABBREVIATIONS --- p.9
LIST OF TABLES --- p.11
LIST OF FIGURES --- p.13
Chapter CHAPTER I --- INTRODUCTION --- p.14
Chapter 1.1 --- The Historical Aspects of C-Reaction Protein --- p.15
Chapter 1.2 --- Biochemistry of CRP --- p.16
Chapter 1.3 --- Physiology of CRP --- p.18
Chapter 1.4 --- Current Clinical Applications of Serum CRP Assay --- p.19
Chapter 1.5 --- Recent Findings of CRP --- p.21
Chapter 1.5.1 --- Pathophysiology of atherosclerosis --- p.22
Chapter 1.5.2 --- A nother atherogenic risk factor: hs- CRP --- p.26
Chapter 1.5.3 --- Can hs-CRP replace other risk factors? --- p.30
Chapter 1.5.4 --- Altering hs-CRP result in medication --- p.32
Chapter 1.6 --- Methods of Measurement of CRP Concentration --- p.33
Chapter 1.7 --- Analytical Considerations in the Measurement of hs-CRP --- p.34
Chapter CHAPTER II --- OBJECTIVES AND SIGNIFICANCE --- p.36
Chapter 2.1 --- Objectives --- p.37
Chapter 2.2 --- Issues and Problems --- p.37
Chapter 2.3 --- Significance and Value of this Study --- p.38
Chapter CHAPTER III --- MA TERIALS AND METHODS I Setting up the serum hs-CRP assay on the Hitachi 911 Analyzer --- p.39
Chapter 3.1 --- Materials --- p.40
Chapter 3.1.1 --- Reagents from Roche Diagnostics --- p.40
Chapter 3.1.2 --- Reagents for the Beckman Coulter Array ® Analyzer --- p.40
Chapter 3.1.3 --- In-house reagents --- p.41
Chapter 3.2. --- Apparatus and Equipment --- p.41
Chapter 3.2.1 --- Hitachi 911 Analyzer --- p.41
Chapter 3.2.2 --- Beckman Coulter Array ® 360 Analyzer --- p.42
Chapter 3.3 --- The Tina-quant a C-Reactive Protein (Latex) Ultrasensitive Assay --- p.42
Chapter 3.3.1 --- Priniciple of the Dual-Radius Enhanced Latex (DuREL´ёØ) technology --- p.42
Chapter 3.3.2 --- Assessment of Analytical Performance --- p.45
Chapter CHAPTER IV --- MA TERIALS AND METHODS II Serum hs-CRP in Chinese chronic-renal-failure patients with atherosclerotic vascular disease or cardiac valve calcification --- p.48
Chapter 4.1 --- Patient Recruitment --- p.49
Chapter 4.2. --- Blood Specimens --- p.49
Chapter 4.3 --- Assay Methods --- p.50
Chapter 4.3.1 --- hs-CRP --- p.50
Chapter 4.3.2 --- TC --- p.50
Chapter 4.3.3 --- TG --- p.51
Chapter 4.3.4 --- HDL-C --- p.51
Chapter 4.3.5 --- LDL-C --- p.52
Chapter 4.3.6 --- Apo A-1 --- p.52
Chapter 4.3.7 --- Apo B --- p.53
Chapter 4.3.8 --- Lp(a) --- p.53
Chapter 4.4 --- Ultrasound measurement of carotid artery inter-media thickness --- p.53
Chapter 4.5 --- Statistical analysis --- p.54
Chapter CHAPTER V --- RESUTLSI Setting up the serum hs-CRP assay on the Hitachi 911 Analyzer --- p.55
Chapter 5.1 --- Imprecision --- p.56
Chapter 5.2 --- Linearity --- p.56
Chapter 5.3 --- Recovery --- p.56
Chapter 5.4 --- Detection Limit --- p.57
Chapter 5.5 --- Carry-over --- p.57
Chapter CHAPTER VI --- RESULTS II Serum hs-CRP in Chinese chronic-renal-failure patients with atherosclerotic vascular disease or cardiac valve calcification --- p.63
Chapter 6.1 --- Patient Recruitment --- p.64
Chapter 6.2 --- Chinese chronic-renal-failure patients with AVD --- p.64
Chapter 6.3 --- Chinese chronic-renal-failure patients with CVC --- p.65
Chapter CHAPTER VII --- DISCUSSION I Performance of the serum hs-CRP assay on the Hitachi 911 Analyzer --- p.75
Chapter 7.1 --- "Imprecision, Detection Limit, Linearity, and Recovery of hs-CRP Assay" --- p.76
Chapter 7.1.1 --- Imprecision --- p.76
Chapter 7.1.2 --- Detection Limit --- p.76
Chapter 7.1.3 --- Linearity --- p.76
Chapter 7.1.4 --- Recovery --- p.77
Chapter 7.2 --- Overall Performance --- p.77
Chapter CHAPTER VIII --- DISCUSSION II Serum hs-CRP in Chinese chronic-renal-failure patients with atherosclerotic vascular disease or cardiac valve calcification --- p.79
Chapter 8.1 --- CAPD Patients --- p.80
Chapter 8.2 --- Serum hs-CRP Concentration of AVD and CVC Patients --- p.81
Chapter 8.3 --- Other risk factors in AVD and CVC Patients --- p.82
Chapter 8.4 --- Conclusion --- p.83
REFERENCES --- p.85

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39

Hsu, Chin-Che, and 許晴哲. "Study of the cutaneous microcirculation in the gangrenous peripheral vascular diseases." Thesis, 1995. http://ndltd.ncl.edu.tw/handle/04735890581589452628.

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40

Gunderson, Lisa C. "Physical activity change in peripheral artery disease patients." 2013. http://liblink.bsu.edu/uhtbin/catkey/1739774.

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Abstract:

Access to abstract permanently restricted to Ball State community only.
Access to thesis permanently restricted to Ball State community only.
School of Physical Education, Sport, and Exercise Science

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41

Dzieciuch, Jennifer M. "Decision making of peripheral vascular disease patients threatened with limb loss a research report submitted in partial fulfillment ... Master of Science (Medical-Surgical Nursing) /." 1990. http://catalog.hathitrust.org/api/volumes/oclc/68795151.html.

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42

"Plasma homocysteine, atheromatous vascular disease and platelet function." 2002. http://library.cuhk.edu.hk/record=b6073395.

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Fan Boli.
"January 2002."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2002.
Includes bibliographical references (p. 219-248).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.

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43

Burris, Merrill Jami. "Effects of resistance exercise on functional ability and quality of life in persons with peripheral arterial disease." 2005. http://www.oregonpdf.org.

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44

Maharaj, Rabindranath Ramsuk. "An inter-racial study into the pattern and prevalence of atherosclerotic peripheral vascular disease in the University-based vascular surgical service in Durban." Thesis, 1996. http://hdl.handle.net/10413/8266.

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This study investigates the clinical and major risk factor profiles in Whites, Indians and Blacks with atherosclerotic peripheral vascular disease at the Vascular Service in Durban; and compares them to that for coronary artery disease in the same race groups. The clinical profile for chronic peripheral vascular disease was established in a retrospective study of 2175 patients seen at the Vascular Service during 1981-1986. Atherosclerosis was confirmed in 1974 patients (92,3%) on the basis of clinical, doppler, angiographic and histological evidence. The disease predominantly affected the aorta and distal peripheral vessels. Extracranial cerebrovascular disease occurred less commonly in Blacks than in Whites and Indians. Occlusive disease was the most common pathological type in all race groups. Aneurysmal disease occurred mainly in the aorta with peripheral aneurysms being most common in Blacks. The disease manifested in Blacks at an . earlier age and more aggressively than in Whites and Indians. The risk factor profile for atherosclerotic peripheral vascular disease was established in a prospective study of 302 male patients consisting of 100 Whites, 97 Indians and 105 Blacks on the basis of historical, clinical and haematological data. The sample was randomly selected, and not strictly representative of the clinical pattern in the retrospective study. All patients were confirmed to have atherosclerosis on the basis of the previously mentioned criteria. Smoking was the single most common risk factor in all race groups. Hypertension occurred more commonly in Whites and Indians than in Blacks, while diabetes was commonest in Indians. Insulin resistance did not occur in Blacks, but was possibly present in Whites and Indians. Total cholesterol, LDL cholesterol and triglycerides were raised in Whites and Indians, but not in Blacks. HDL cholesterol was reduced in all 3 race groups. These findings suggest that contrary to the established view, atherosclerotic peripheral vascular disease is an established entity in Blacks seen at the Vascular Service in Durban without a concomitant increase in coronary and extracranial cerebrovascular disease. In Whites and Indians atherosclerosis occurred in all of the vascular beds. This could support the contention that in a socially developing society atherosclerosis affects the aorta and distal peripheral vessels before the coronary vascular bed. Since this occurs in the presence of normal levels of total cholesterol, LDL cholesterol and triglycerides, it does not support the contention that hypercholesterolaemic states are essential for atherosclerotic lesions to develop. On this basis it is postulated that with social transition there is a differential atherosclerotic involvement of the vascular beds due to a differential vascular susceptibility. Smoking is an important socio-environmental risk factor, while at the biochemical level a reduced HDL cholesterol and not a raised total cholesterol, LDL cholesterol or triglyceride could trigger the 'lipid pathway' in atherogenesis. It is further postulated that the differential vascular susceptibility does not exist in a fully developed society once lipid aberrations include a raised total cholesterol, LDL cholesterol and triglycerides. Insulin resistance/hyperinsulinaemia may play a role in the evolution of the disease within the coronary vascular bed.
Thesis (M.D.)-University of Natal, Durban, 1996.

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45

"Homocysteinaemia (heterozygous state) in the Chinese population." Chinese University of Hong Kong, 1994. http://library.cuhk.edu.hk/record=b5887189.

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by Cheng Sau-kwan.
Thesis (M.Sc.)--Chinese University of Hong Kong, 1994.
Includes bibliographical references (leaves 98-106).
LIST OF TABLES
LIST OF FIGURES
ACKNOWLEDGEMENTS
ABSTRACT --- p.1
Chapter CHAPTER ONE --- p.3
Chapter 1.1 --- Introduction --- p.3
Chapter 1.1.1 --- Sources of homocysteine and origins of deficiency or excess in the human body --- p.3
Chapter 1.1.2 --- Homocysteine metabolism --- p.4
Chapter 1.2 --- Causes of and clinical syndromes in homocysteinaemia --- p.12
Chapter 1.2.1 --- Deficiency of cystathionine β-synthase --- p.12
Chapter 1.2.1.1a --- Homozygous homocysteinaemia --- p.13
Chapter 1.2.1.1b --- Heterozygous hyperhomocysteinaemia --- p.17
Chapter 1.2.2 --- "Deficiency of 5, 10 methylenetetrahydrofolate reductase" --- p.20
Chapter 1.2.3 --- Defects of cobalamin synthesis --- p.21
Chapter 1.3 --- Standardised oral methionine load test --- p.23
Chapter 1.4 --- Treatment and prospects for homocysteinaemia --- p.25
Chapter 1.4.1 --- Homozygous homocysteinaemia --- p.25
Chapter 1.4.2 --- Heterozygous homocysteinaemia --- p.27
Chapter 1.5 --- Pathogenesis of vascular disease in homocystinuria --- p.28
Chapter 1.6 --- Aim of the study --- p.30
Chapter CHAPTER TWO --- p.31
Chapter 2.1 --- Patient's criteria --- p.31
Chapter 2.2 --- Control' s criteria --- p.32
Chapter 2.3 --- Exclusion criteria for patients and controls --- p.32
Chapter 2.4 --- The methionine loading test and additional investigations carried out --- p.33
Chapter 2.5 --- Statistics used for data analyses --- p.35
Chapter CHAPTER THREE --- p.38
Chapter 3.1 --- Sample collection --- p.38
Chapter 3.2 --- Analytical methods for homocysteine determination --- p.39
Chapter 3.2.1 --- Cyanide nitroprusside test --- p.39
Chapter 3.2.2 --- Radioenzymic Assays --- p.40
Chapter 3.2.3 --- Gas chromatography - Mass spectrometry --- p.41
Chapter 3.2.4 --- HPLC with Electrochemical detection --- p.42
Chapter 3.2.5 --- HPLC and postcolumn derivatization --- p.43
Chapter 3.2.6 --- "Precolumn derivatization, HPLC and fluorescence detection" --- p.44
Chapter 3.3 --- The method used in this study --- p.47
Chapter 3.3.1 --- Materials --- p.48
Chapter 3.3.2 --- Reagents --- p.49
Chapter 3.3.3 --- Instrumentation --- p.49
Chapter 3.3.4 --- Sample preparation --- p.50
Chapter 3.3.4.1 --- Reduction --- p.50
Chapter 3.3.4.2 --- Derivatization --- p.50
Chapter 3.3.5 --- Chromatographic conditions --- p.51
Chapter 3.3.6 --- Standard preparation --- p.51
Chapter 3.4 --- Method Optimization --- p.52
Chapter 3.4.1 --- Choice of reducing agent --- p.52
Chapter 3.4.1.1 --- Dithiotreitol (DTT) --- p.52
Chapter 3.4.1.2 --- Sodium borohydride --- p.53
Chapter 3.4.2 --- Choice of precipitating reagent --- p.56
Chapter 3.4.3 --- Optimization of chromatographic conditions --- p.56
Chapter 3.4.3.1 --- "Flow rate, temperature and organic composition of mobile phase" --- p.56
Chapter 3.4.3.2 --- pH of the mobile phase --- p.59
Chapter 3.4.4 --- Confirmation of homocysteine peak --- p.60
Chapter 3.5 --- Analysis of results --- p.60
Chapter 3.6 --- Method validation --- p.60
Chapter 3.6.1 --- Linearity --- p.60
Chapter 3.6.2 --- Precision --- p.63
Chapter 3.6.3 --- Recovery --- p.64
Chapter CHAPTER FOUR --- RESULTS --- p.66
Chapter 4.1 --- The pre- and post-methionine loading plasma homocysteine concentrations in patients and controls --- p.66
Chapter 4.2 --- The frequency distributions of hyperhomocysteinaemia in patients and controls --- p.68
Chapter 4.2.1 --- The distributions of homocysteinaemia in patients and controls --- p.68
Chapter 4.2.2 --- The frequency distributions of fasting hyper-homocysteinaemia in patients and controls --- p.68
Chapter 4.2.3 --- The frequency distributions of post-methionine hyperhomocysteinaemia in patients and controls --- p.73
Chapter 4.2.4 --- The frequency distributions of the abnormal methionine tolerance in patients and controls --- p.75
Chapter 4.3 --- "The frequency distributions of hypertension and hyperlipidaemia in controls and, including smoking,in patients without and with hyperhomocysteinaemia" --- p.77
Chapter 4.3.1 --- The frequency distribution of hypertension and hyperlipidaemia in patients and controls --- p.77
Chapter 4.3.2 --- "The frequency distributions of hyper-lipidaemia, hypertension, smoking and gender in patients with vascular disease with and without hyperhomocysteinaemia" --- p.79
Chapter 4.4 --- "The comparison of the age, haematological and biochemical indices and the blood pressure between the patients and controls" --- p.81
Chapter 4.4.1 --- The comparison of the patients' age at presentation and plasma lipids following recovery from the acute episode with those in controls at the time of methionine loading --- p.81
Chapter 4.4.2 --- The comparison of the age at presentation and the plasma lipids in patients with and without hyperhomocysteinaemia --- p.83
Chapter 4.4.3 --- "The comparison of the B12, serum folate and RBC folate in patients and controls at the time of presentation" --- p.84
Chapter 4.4.4 --- "The comparison of the B12, serum folate and RBC folate levels in patients with and without hyperhomocysteinaemia and in controls" --- p.85
Chapter CHAPTER FIVE --- DISCUSSION --- p.87
REFERENCES --- p.98

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46

(11166657), Jacob Monroe. "Leg Heat Therapy to Improve Walking Tolerance and Vascular Function in Patients with Symptomatic Peripheral Artery Disease." Thesis, 2021.

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Lower extremity peripheral artery disease (PAD) is an increasingly prevalent manifestation of atherosclerosis that substantially limits mobility and increases mortality. Few options currently exists for practical conservative treatment of individuals with PAD. We have previously demonstrated that lower limb heat therapy (HT) can improve leg blood flow and reduce systolic blood pressure in patient with lower extremity PAD. Using three unique clinical trials, we sought to test the hypothesis that repeated exposure to HT would improve walking tolerance and vascular function in patients with lower extremity PAD. In these trials, we have sought to examine the clinical efficacy of HT, the physiological mechanisms which may underpin changes in walking endurance in this population, and also the practicality of employing HT in a home-based setting. The primary finding from these trials was that daily application of leg HT improved walking endurance in patients with lower-extremity PAD. Furthermore, the treatment adherence rate was excellent (<96%) and was not associated with severe adverse events. The changes in walking tolerance were consistently not associated with positive changes in vascular function, suggesting an alternative mechanism should be examined in future studies.

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47

"A randomized study of the effect of hormone replacement therapy on peripheral blood flow in surgically postmenopausal women." 1997. http://library.cuhk.edu.hk/record=b5889286.

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Wan Din.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 155-175).
ABSTRACT --- p.1
ACKNOWLEDGMENTS --- p.3
LIST OF TABLES --- p.5
LIST OF FIGURES --- p.7
LIST OF ABBREVIATIONS --- p.8
Chapter I. --- INTRODUCTION --- p.9
Chapter I.A. --- Menopause --- p.9
Chapter I.A.1. --- Definition of the Menopause --- p.9
Chapter I.A.2. --- Pathophysiology of Ovarian Failure --- p.10
Chapter I.B. --- Effects of the Menopause --- p.13
Chapter I B.1. --- Acute Effects --- p.13
Chapter I.B.2. --- Medium Term Effects --- p.14
Chapter I.B.3. --- Chronic Effects --- p.15
Chapter I.B.3.a. --- Osteoporosis --- p.15
Chapter I.B.3.b. --- Coronary Artery Disease (CAD) --- p.17
Chapter I.C. --- Management of the Menopause --- p.19
Chapter I.C.1. --- Hormone Replacement Therapy --- p.21
Chapter I.C.2. --- Oestrogens --- p.22
Chapter I.C.2.a. --- Oral Oestrogens --- p.22
Chapter I.C.3. --- Progestogens --- p.24
Chapter I.C.3.a. --- Combined Oestrogen and Progestogen Therapy --- p.24
Chapter I.C.4. --- Complications and Contraindications to Hormone Replacement Therapy --- p.26
Chapter II. --- LITERATURE REVIEW --- p.34
Chapter II.A. --- Atherosclerosis --- p.35
Chapter II.B. --- Risk Factors for Coronary Artery Disease --- p.37
Chapter II.B.1. --- Age and Sex --- p.38
Chapter II.B.2. --- Age at Menopause --- p.38
Chapter II.B.3. --- Family History --- p.38
Chapter II.B.4. --- Serum Lipids --- p.39
Chapter II.B.5. --- Blood Pressure --- p.39
Chapter II.B.6. --- Smoking --- p.40
Chapter II.B.7. --- Diabetes Mellitus --- p.40
Chapter II.C. --- The Effect of the Menopause on Risk Factors for Coronary Heart Disease --- p.41
Chapter II.C.1. --- The Effect of the Menopause on Lipids and Lipoproteins --- p.41
Chapter II.C.2. --- The Effect of the Menopause on Glucose and Insulin Metabolism --- p.43
Chapter II.C.3. --- The Effect of the Menopause on Coagulation --- p.44
Chapter II.C.4. --- The Effect of the Menopause on the Arterial Wall --- p.45
Chapter II.D. --- The Risk of Coronary Artery Disease After the Menopause --- p.46
Chapter II.D.1. --- The Effect of the Menopause on Peripheral Vascular Disease (PVD) --- p.47
Chapter II.E. --- The Effect of the Hormone Replacement Therapy on Coronary Artery Disease Risk --- p.49
Chapter II.F. --- The Mechanism of Cardioprotection of Oestrogen --- p.63
Chapter II.F.1. --- The Indirect Effect of the Hormone Replacement Therapy on the Cardiovascular System --- p.64
Chapter II.F.1.a. --- The Effect on Lipids and Lipoproteins --- p.64
Chapter II.F.1.b. --- The Effect on Coagulation and Fibrinolysis --- p.66
Chapter II.F.1.c. --- The Effect on Insulin and Glucose Metabolism --- p.67
Chapter II.F.2. --- The Direct Effects of the Hormone Replacement Therapy on the Cardiovascular System --- p.67
Chapter II.F.2.a. --- The Effect of Oestrogen on Vascular Contractility --- p.68
Chapter II.F.2.b. --- The Effect of Oestrogen on Endothelial Dysfunction --- p.69
Chapter II.F.2.C. --- Other Possible Direct Actions of Oestrogen --- p.72
Chapter II.G. --- The Effects of Oestrogen on Blood Flow --- p.73
Chapter III. --- RESEARCH PLAN --- p.78
Chapter III.A. --- Formation of Research Hypothesis --- p.78
Chapter III B. --- Research Hypothesis --- p.80
Chapter III.C. --- Plan of Studies --- p.81
Chapter III.C.1. --- Pilot Study --- p.81
Chapter III.C.2. --- Randomized Controlled Study --- p.81
Chapter IV. --- METHODOLOGY --- p.84
Chapter IV.A. --- Pilot Study --- p.84
Chapter IV.B. --- Study Population --- p.87
Chapter IV.B.1. --- Recruitment of Cases --- p.88
Chapter IV.B.1.a. --- Patients' Consent --- p.88
Chapter IV.B.1.b. --- Method of Recruitment --- p.88
Chapter IV.B.1.e. --- Research Methodology --- p.89
Chapter IV.C. --- Ethical Considerations --- p.90
Chapter IV.D. --- Samples Size Calculation --- p.92
Chapter IV.E. --- Statistical Analysis --- p.93
Chapter IV.F. --- Physical Principles of the Measurement of Peripheral Resistance --- p.94
Chapter IV.F.1. --- The Arterial Analogue Waveform --- p.97
Chapter IV.F.2. --- Peak Systolic Velocity --- p.98
Chapter IV.G. --- Measurement of Pulsatility Index --- p.100
Chapter IV.G.1. --- Establishment of Methodologies Used to Measure Peripheral Blood Flow --- p.105
Chapter IV.G.2. --- Training of the Investigator --- p.107
Chapter IV.H. --- Assay for Serum Oestradiol --- p.108
Chapter IV.H.1. --- Principles --- p.108
Chapter IV.H.2. --- Reagents --- p.109
Chapter IV.H.3. --- Sample Dilution --- p.111
Chapter IV.H.4. --- Calibration --- p.112
Chapter IV.H.5. --- Quality Control --- p.112
Chapter IV.H.6. --- Assay Validation --- p.113
Chapter V. --- RESULTS --- p.115
Chapter V.A. --- Pilot Study --- p.115
Chapter V.B. --- Study Population --- p.118
Chapter V.B.1. --- Characteristics of the Patients at Recruitment --- p.120
Chapter V.B.2. --- Doppler Measurements --- p.123
Chapter V.B.3. --- Pulsatility Index and Serum Oestradiol --- p.135
Chapter VI. --- DISCUSSION --- p.137
Chapter VI.A. --- Overview --- p.132
Chapter VI.A.1. --- The Pilot Study --- p.133
Chapter VI.B. --- Study Population --- p.136
Chapter VI.C. --- Doppler Ultrasound as a Measurement of Vascular Resistance and Blood Flow --- p.142
Chapter VI.C.1. --- Reliability of Doppler Study --- p.143
Chapter VI.D. --- Pulsatility Index and Hormone Replacement Therapy --- p.146
Chapter VI.E. --- Effects of Oestrogen on Pulsatility Index --- p.150
Chapter VI.F. --- Conclusions --- p.152
Chapter VI.G. --- Future Directions --- p.153
REFERENCES --- p.155
APPENDIX1 --- p.176

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48

Kemp, Arika D. "Peripheral Venous Retroperfusion: Implications for Critical Limb Ischemia and Salvage." Thesis, 2014. http://hdl.handle.net/1805/6452.

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Indiana University-Purdue University Indianapolis (IUPUI)
Peripheral arterial disease is caused by plaque buildup in the peripheral arteries. Standard treatments are available when the blockage is proximal and focal, however when distal and diffuse the same type of the treatment options are not beneficial due to the diseased locations. Restoration of blood flow and further salvaging of the limb in these patients can occur in a retrograde manner through the venous system, called retroperfusion or arteriovenous reversal. Retroperfusion has been explored over the last century, where early side to side artery to venous connections had issues with valve competency prohibiting distal flows, edema buildup, and heart failure. However, more recent clinical studies create a bypass to a foot vein to ensure distal flows, and though the results have been promising, it requires a lengthy invasive procedure. It is our belief that the concerns of both retroperfusion approaches can be overcome in a minimally invasive/catheter based approach in which the catheter is engineered to a specific resistance that avoids edema and the perfusion location allows for valves to be passable and flow to reach distally. In this approach, the pressure flow relations were characterized in the retroperfused venous system in ex-vivo canine legs to locate the optimal perfusion location followed by in-vivo validation of canines. Six canines were acutely injured for 1-3 hours by surgical ligation of the terminal aorta and both external iliac arteries. Retroperfusion was successfully performed on five of the dogs at the venous popliteal bifurcation for approximately one hour, where flow rates at peak pressures reached near half of forward flow (37±3 vs. 84±27ml/min) and from which the slope of the P/F curves displayed a retro venous vasculature resistance that was used to calculate the optimal catheter resistance. To assess differences in regional perfusion, microspheres were passed during retroperfusion and compared to baseline microspheres passed arterially prior to occlusion in which the ratio of retroperfusion and forward perfusion levels were near the ratio of reversed and forward venous flow (0.44) throughout the limb. Decreases in critical metabolites during injury trended towards normal levels post-retroperfusion. By identifying the popliteal bifurication as a perfusion site to restore blood flow in the entirety of the distal ischemic limb, showing reversal of injury, and knowing what catheter resistances to target for further chronic studies, steps towards controlled retroperfusion and thus more efficient treatment options can be made for severe PAD patients.

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49

Lucas, Miguel Nuno Fernandes. "Impacto do exercício físico na prevenção de complicações macrovasculares em pessoas com Diabetes Mellitus tipo 2 : uma revisão sistemática e meta-análise." Master's thesis, 2019. http://hdl.handle.net/10316/89925.

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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: A Diabetes Mellitus (DM) Tipo 2 é um grupo heterogéneo de distúrbios caraterizado por vários graus de insulinorresistência, diminuição da secreção de insulina e aumento da produção de glicose. As complicações macrovasculares da DM são semelhantes a eventos cardiovasculares em não-diabéticos, porém têm uma maior incidência em pessoas com DM. Eventos e mortalidade por doença coronária são até cinco vezes superiores em doentes com DM e o impacto da hiperglicemia crónica nestes casos é pouco claro. O exercício físico diminui a incidência de eventos cardiovasculares na população em geral, contudo, o seu papel nos doentes com DM Tipo 2 não está completamente esclarecido. O objetivo desta revisão sistemática é descrever o impacto do exercício físico, como fator isolado, na prevenção das complicações macrovasculares em pessoas com DM Tipo 2 e sumariar os resultados dos artigos originais publicados nos últimos dez anos.Métodos: Para elaborar esta revisão sistemática foi realizada pesquisa de literatura em dezembro de 2018 na Pubmed e Embase. Foram utilizados termos MeSH e a terminologia Emtree equivalente, com os filtros de “English”, “Portuguese”, “Randomized Controlled Trials” e “Ten years”. Foi feita seleção de artigos por resumos e depois por leitura de texto integral por dois revisores independentes e os resultados finais foram analisados em meta-análise cumulativa.Resultados: Posteriormente à pesquisa de literatura foi realizado screening de 400 artigos. No final, apenas dois artigos foram elegíveis. Nesses dois artigos incluídos na meta-análise (I2 = 46%), o grupo sujeito a intervenção de exercício físico apresenta incidência mais baixa de eventos macrovasculares do que o grupo de controlo, ainda que sem significância estatística (p = 0,310). Contudo, uma meta-análise cumulativa comprova os benefícios do exercício físico na prevenção de eventos macrovasculares (OR = 0,29; p = 0,048). A qualidade ao longo dos estudos foi classificada como moderada.Conclusão: Em períodos de seis a vinte e quatro meses de follow-up, de pessoas com DM Tipo 2, comprovou-se, neste trabalho, a prevenção de eventos macrovasculares num grupo de intervenção por exercício físico, com evidência de qualidade moderada. A informação disponível para o tema deste trabalho foi escassa, pelo que novos estudos longitudinais com follow-up a longo prazo de pessoas com diabetes sem doença cardiovascular aterosclerótica, sujeitos a intervenção por exercício físico, deverão ser realizados.
Introduction: Type 2 Diabetes Mellitus (DM) is a heterogenous group of disorders characterized by various grades of insulin resistance, decrease of insulin secretion and increase of glucose production. Macrovascular complications of DM are similar to cardiovascular events in non-diabetics, however, they have a higher incidence on people with DM. Mortality and events by coronary disease are up to five times higher in patients with DM and the impact of chronic hyperglycaemia is unclear on these cases. Exercise lowers the incidence of cardiovascular events in general population, however its role on patients with Type 2 DM isn’t completely enlightened. The objective of this systematic review is to describe the impact of exercise as a isolated factor, on prevention of macrovascular complications in patients with Type 2 DM and summarize results of original articles published during the last ten years.Methods: To elaborate this systematic review, we performed a literature search on December 2018 on Pubmed and Embase. We used MeSH terms and Emtree equivalent terminology, with the following filters “English”, “Portuguese”, “Randomized Controlled Trials” e “Ten years”. The selection of the studies was done by summaries and after that by reading of the full text by two independent reviewers and the final results were analysed on a cumulative meta-analysis. Results: After the literature search we performed a screening of 400 articles. In the end only two articles were elegible. On these two studies included on meta-analysis (I2 = 46%), the intervention group showed a lower incidence of macrovascular events than the control group, yet without statistical significance (p = 0.310). However, a cumulative meta-analysis demonstrates the benefits of physical exercise in the prevention of macrovascular events (OR = 0.29; p = 0.048). The quality across the studies was classified as moderate.Conclusion: At six weeks and four months of follow up of people with Type 2 DM, the prevention of macrovascular events was proven in an intervention group by exercise therapy, with evidence of moderate quality. There is few information available regarding the subject of this work, suggesting the implementation of new studies with a long term follow-up of people with diabetes, on exercise therapy, without atherosclerotic cardiovascular disease.

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50

Janvier, Marie-Ange. "Optimization and validation of a new 3D-US imaging robot to detect, localize and quantify lower limb arterial stenoses." Thèse, 2010. http://hdl.handle.net/1866/4758.

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Abstract:

L’athérosclérose est une maladie qui cause, par l’accumulation de plaques lipidiques, le durcissement de la paroi des artères et le rétrécissement de la lumière. Ces lésions sont généralement localisées sur les segments artériels coronariens, carotidiens, aortiques, rénaux, digestifs et périphériques. En ce qui concerne l’atteinte périphérique, celle des membres inférieurs est particulièrement fréquente. En effet, la sévérité de ces lésions artérielles est souvent évaluée par le degré d’une sténose (réduction >50 % du diamètre de la lumière) en angiographie, imagerie par résonnance magnétique (IRM), tomodensitométrie ou échographie. Cependant, pour planifier une intervention chirurgicale, une représentation géométrique artérielle 3D est notamment préférable. Les méthodes d’imagerie par coupe (IRM et tomodensitométrie) sont très performantes pour générer une imagerie tridimensionnelle de bonne qualité mais leurs utilisations sont dispendieuses et invasives pour les patients. L’échographie 3D peut constituer une avenue très prometteuse en imagerie pour la localisation et la quantification des sténoses. Cette modalité d’imagerie offre des avantages distincts tels la commodité, des coûts peu élevés pour un diagnostic non invasif (sans irradiation ni agent de contraste néphrotoxique) et aussi l’option d’analyse en Doppler pour quantifier le flux sanguin. Étant donné que les robots médicaux ont déjà été utilisés avec succès en chirurgie et en orthopédie, notre équipe a conçu un nouveau système robotique d’échographie 3D pour détecter et quantifier les sténoses des membres inférieurs. Avec cette nouvelle technologie, un radiologue fait l’apprentissage manuel au robot d’un balayage échographique du vaisseau concerné. Par la suite, le robot répète à très haute précision la trajectoire apprise, contrôle simultanément le processus d’acquisition d’images échographiques à un pas d’échantillonnage constant et conserve de façon sécuritaire la force appliquée par la sonde sur la peau du patient. Par conséquent, la reconstruction d’une géométrie artérielle 3D des membres inférieurs à partir de ce système pourrait permettre une localisation et une quantification des sténoses à très grande fiabilité. L’objectif de ce projet de recherche consistait donc à valider et optimiser ce système robotisé d’imagerie échographique 3D. La fiabilité d’une géométrie reconstruite en 3D à partir d’un système référentiel robotique dépend beaucoup de la précision du positionnement et de la procédure de calibration. De ce fait, la précision pour le positionnement du bras robotique fut évaluée à travers son espace de travail avec un fantôme spécialement conçu pour simuler la configuration des artères des membres inférieurs (article 1 - chapitre 3). De plus, un fantôme de fils croisés en forme de Z a été conçu pour assurer une calibration précise du système robotique (article 2 - chapitre 4). Ces méthodes optimales ont été utilisées pour valider le système pour l’application clinique et trouver la transformation qui convertit les coordonnées de l’image échographique 2D dans le référentiel cartésien du bras robotisé. À partir de ces résultats, tout objet balayé par le système robotique peut être caractérisé pour une reconstruction 3D adéquate. Des fantômes vasculaires compatibles avec plusieurs modalités d’imagerie ont été utilisés pour simuler différentes représentations artérielles des membres inférieurs (article 2 - chapitre 4, article 3 - chapitre 5). La validation des géométries reconstruites a été effectuée à l`aide d`analyses comparatives. La précision pour localiser et quantifier les sténoses avec ce système robotisé d’imagerie échographique 3D a aussi été déterminée. Ces évaluations ont été réalisées in vivo pour percevoir le potentiel de l’utilisation d’un tel système en clinique (article 3- chapitre 5).
Atherosclerosis is a disease caused by the accumulation of lipid deposits inducing the remodeling and hardening of the vessel wall, which leads to a progressive narrowing of arteries. These lesions are generally located on the coronary, carotid, aortic, renal, digestive and peripheral arteries. With regards to peripheral vessels, lower limb arteries are frequently affected. The severity of arterial lesions are evaluated by the stenosis degree (reduction > 50.0 % of the lumen diameter) using angiography, magnetic resonance angiography (MRA), computed tomography (CT) and ultrasound (US). However, to plan a surgical therapeutic intervention, a 3D arterial geometric representation is notably preferable. Imaging methods such as MRA and CT are very efficient to generate a three-dimensional imaging of good quality even though their use is expensive and invasive for patients. 3D-ultrasound can be perceived as a promising avenue in imaging for the location and the quantification of stenoses. This non invasive, non allergic (i.e, nephrotoxic contrast agent) and non-radioactive imaging modality offers distinct advantages in convenience, low cost and also multiple diagnostic options to quantify blood flow in Doppler. Since medical robots already have been used with success in surgery and orthopedics, our team has conceived a new medical 3D-US robotic imaging system to localize and quantify arterial stenoses in lower limb vessels. With this new technology, a clinician manually teaches the robotic arm the scanning path. Then, the robotic arm repeats with high precision the taught trajectory and controls simultaneously the ultrasound image acquisition process at even sampling and preserves safely the force applied by the US probe. Consequently, the reconstruction of a lower limb arterial geometry in 3D with this system could allow the location and quantification of stenoses with high accuracy. The objective of this research project consisted in validating and optimizing this 3D-ultrasound imaging robotic system. The reliability of a 3D reconstructed geometry obtained with 2D-US images captured with a robotic system depends considerably on the positioning accuracy and the calibration procedure. Thus, the positioning accuracy of the robotic arm was evaluated in the workspace with a lower limb-mimicking phantom design (article 1 - chapter 3). In addition, a Z-phantom was designed to assure a precise calibration of the robotic system. These optimal methods were used to validate the system for the clinical application and to find the transformation which converts image coordinates of a 2D-ultrasound image into the robotic arm referential. From these results, all objects scanned by the robotic system can be adequately reconstructed in 3D. Multimodal imaging vascular phantoms of lower limb arteries were used to evaluate the accuracy of the 3D representations (article 2 - chapter 4, article 3 - chapter 5). The validation of the reconstructed geometry with this system was performed by comparing surface points with the manufacturing vascular phantom file surface points. The accuracy to localize and quantify stenoses with the 3D-ultrasound robotic imaging system was also determined. These same evaluations were analyzed in vivo to perceive the feasibility of the study.

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