Acidente vascular cerebral e desporto : um estudo multicêntrico em Portugal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Vascularização arterial da região hipocampal em Hydrochoerus hydrochaeris (capivara)

O objetivo deste trabalho foi de angariar conhecimentos sobre a vascularização arterial da região hipocampal em Hydrochoerus hydrochaeris, descrevendo através da repleção vascular e dissecção anatômica a artéria cerebral caudal e ramos dos ramos terminais da artéria basilar que fazem o aporte sanguíneo para o hipocampo, mapeando seus territórios. Utilizou-se 68 hemisférios cerebrais de Hydrochoerus hydrochaeris, machos e fêmeas, injetados com Látex 603 ou Látex Frasca, pigmentado em vermelho e azul, fixados em solução de formol a 20%. A artéria cerebral caudal originou-se do ramo terminal da artéria basilar rostral à raiz do nervo oculomotor. Logo após sua emergência lançou a artéria tectal rostral em 27,9% dos casos. Em seguida cruzou os pedúnculos cerebrais, dorsalmente aos corpos geniculados e ao pulvinar, emitindo pequenos ramos perfurantes para estas estruturas. Enquanto a artéria cerebral caudal percorreu a superfície do giro para-hipocampal, dorsalmente foram emitidos pequenos ramos que penetraram no sulco hipocampal, rostromedialmente a artéria coroidéia caudal e caudalmente de três a onze ramos corticais. A artéria coroidéia caudal apresentou-se única em 85,3% dos casos, dupla em 13,2% e ausente em 1,5%. A artéria coroidéia caudal apresentou-se única em 85,3% dos casos, dupla em 13,2% e ausente em 1,5%. A artéria coroidéia rostral originou-se do ramo terminal da artéria basilar logo após a emergência da artéria cerebral caudal anastomosando-se com a artéria coroidéia caudal suprindo o plexo corióideo do terceiro ventrículo e os ventrículos laterais. Ao longo de seu curso tanto a artéria coroidéia caudal como a artéria coroidéia rostral lançaram ramos hipocampais que anastomosaram-se entre si e com os ramos emitidos pela artéria cerebral caudal formando verdadeiras redes. Os ramos terminais da artéria cerebral caudal cruzaram o esplênio do corpo caloso para distribuirem-se na superfície caudomedial do hemisfério cerebral. Os limites territoriais da artéria cerebral caudal compreenderam a face caudal do lobo piriforme, a face tentorial, a porção retroesplênica da face medial e também uma estreita área da face dorsolateral do hemisfério cerebral margeando as fissuras longitudinal dorsal e transversa do cérebro. A vascularização arterial do hipocampo da capivara foi suprida por ramos originados da artéria cerebral caudal e pela artéria coroidéia rostral.

Anatomicosurgical arterial segmentation of the cat lungs (Felis catus domesticus, L., 1758)

O objetivo desta pesquisa foi estabelecer os segmentos anátomo-cirúrgicos arteriais, através da lobação e ramificação intralobar arterial, em pulmões de gato. Após a dissecção de vinte pulmões, notou-se que a artéria pulmonar direita geralmente emite um ramo para o lobo cranial e um ramo para o lobo médio, sendo originados juntos em um tronco. Um grande ramo irriga o lobo caudal na maioria dos casos. Dois ramos com origem comum no ramo arterial do lobo caudal irrigam o lobo acessório. A artéria pulmonar esquerda origina um tronco que, na maioria dos casos, emite um ramo para a porção cranial e um ramo para a porção caudal do lobo cranial esquerdo. Pode-se concluir que o pulmão direito é formado por quatro e o esquerdo por dois lobos, ocorrendo variações na ramificação arterial pulmonar.

Ticagrelor, a platelet aggregation inhibitor for the potential prevention and treatment of arterial thrombosis and acute coronary syndromes

Ticagrelor is an orally active ADP P2Y12 receptor antagonist in development by AstraZeneca plc for the reduction of recurrent ischemic events in patients with acute coronary syndromes (ACS). Prior to the development of ticagrelor, thienopyridine compounds, such as clopidogrel, were the focus of research into therapies for ACS. Although the thienopyridines are effective platelet aggregation inhibitors, they are prodrugs and, consequently, exert a slow onset of action. In addition, the variability in inter-individual metabolism of thienopyridine prodrugs has been associated with reduced efficacy in some patients. Ticagrelor is not a prodrug and exhibits a more rapid onset of action than the thienopyridine prodrugs. In clinical trials conducted to date, ticagrelor was a potent inhibitor of ADP-induced platelet aggregation and demonstrated effects that were comparable to clopidogrel. In a phase II, short-term trial, the bleeding profile of participants treated with ticagrelor was similar to that obtained with clopidogrel; however, an increased incidence of dyspnea was observed - an effect that has not been reported with the thienopyridines. Considering the occurrence of dyspnea, and the apparent non-superiority of ticagrelor to clopidogrel, it is difficult to justify a clear benefit to the continued development of ticagrelor. Outcomes from an ongoing phase III trial comparing ticagrelor with clopidogrel in 18,000 patients with ACS are likely to impact on the future development of ticagrelor.

Can venous occlusion plethysmography be used to measure high rates of arterial inflow?

To investigate whether venous occlusion plethysmography (VOP) may be used to measure high rates of arterial inflow associated with exercise, venous occlusions were performed at rest, and following dynamic handgrip exercise at 15, 30, 45, and 60 % of maximum voluntary contraction (MVC) in seven healthy males. The effect of including more than one cardiac cycle in the calculation of blood flow was assessed by comparing the cumulative blood flow over one, two, three, or four cardiac cycles. The inclusion of more than one cardiac cycle at 30 and 60 % MVC, and more than two cardiac cycles at 15 and 45 % MVC resulted in a lower blood flow compared to using only the first cardiac cycle (P < 0.05). Despite the small time interval over which arterial inflow was measured (~1 second), this did not affect the reproducibility of the technique. Reproducibility (coefficient of variation for arterial inflow over three trials) tended to be poorer at the higher workloads, although this was not significant (12.7 ± 6.6 %, 16.2 ± 7.3 %, and 22.9 ± 9.9 % for the 15, 30, and 45 % MVC workloads; P=0.102). There was also a tendency for greater reproducibility with the inclusion of more cardiac cycles at the highest workload, but this did not reach significance (P=0.070). In conclusion, when calculated over the first cardiac cycle only during venous occlusion, high rates of FBF can be measured using VOP, and this can be achieved without a significant decrease in the reproducibility of the measurement.

Arterial traffic congestion analysis using Bluetooth duration data

The aim of this study is to assess the potential use of Bluetooth data for traffic monitoring of arterial road networks. Bluetooth data provides the direct measurement of travel time between pairs of scanners, and intensive research has been reported on this topic. Bluetooth data includes “Duration” data, which represents the time spent by Bluetooth devices to pass through the detection range of Bluetooth scanners. If the scanners are located at signalised intersections, this Duration can be related to intersection performance, and hence represents valuable information for traffic monitoring. However the use of Duration has been ignored in previous analyses. In this study, the Duration data as well as travel time data is analysed to capture the traffic condition of a main arterial route in Brisbane. The data consists of one week of Bluetooth data provided by Brisbane City Council. As well, micro simulation analysis is conducted to further investigate the properties of Duration. The results reveal characteristics of Duration, and address future research needs to utilise this valuable data source.

Arterial travel time estimation : revisiting the classical procedure

Travel time is an important network performance measure and it quantifies congestion in a manner easily understood by all transport users. In urban networks, travel time estimation is challenging due to number of reasons such as, fluctuations in traffic flow due to traffic signals, significant flow to/from mid link sinks/sources, etc. The classical analytical procedure utilizes cumulative plots at upstream and downstream locations for estimating travel time between the two locations. In this paper, we discuss about the issues and challenges with classical analytical procedure such as its vulnerability to non conservation of flow between the two locations. The complexity with respect to exit movement specific travel time is discussed. Recently, we have developed a methodology utilising classical procedure to estimate average travel time and its statistic on urban links (Bhaskar, Chung et al. 2010). Where, detector, signal and probe vehicle data is fused. In this paper we extend the methodology for route travel time estimation and test its performance using simulation. The originality is defining cumulative plots for each exit turning movement utilising historical database which is self updated after each estimation. The performance is also compared with a method solely based on probe (Probe-only). The performance of the proposed methodology has been found insensitive to different route flow, with average accuracy of more than 94% given a probe per estimation interval which is more than 5% increment in accuracy with respect to Probe-only method.