Transoesophageal Echocardiography for Monitoring Liver Surgery: Data from a Pilot Study

A pilot study aimed to introduce intraoperative monitoring of liver surgery using transoesophageal echocardiography (TEE) is described. A set of TEE measurements was established as a protocol, consisting of left atrial (LA) dimension at the aortic valve plane; mitral velocity flow integral, calculation of stroke volume and cardiac output (CO); mitral annular plane systolic excursion; finally, right atrial area. A total of 165 measurements (on 21 patients) were performed, 31 occurring during hypotension. The conclusions reached were during acute blood loss LA dimension changed earlier than CVP, and, in one patient, a dynamic left ventricular (LV) obstruction was observed; in 3 patients a transient LV systolic dysfunction was documented. The comparison between 39 CO paired measurements obtained by TEE and PiCCO2 revealed a statistically significant correlation (P < 0.001, r = 0.83). In this pilot study TEE successfully answered the questions raised by the anesthesiologists. Larger cohort studies are needed to address this issue.

Focal Malignant Liver Lesions: Diagnosis by Dynamic Incremental CT, Early Phase

The purpose of our study was to evaluate the accuracy of dynamic incremental bolus-enhanced conventional CT (DICT) with intravenous contrast administration, early phase, in the diagnosis of malignancy of focal liver lesions. A total of 122 lesions were selected in 74 patients considering the following criteria: lesion diameter 10 mm or more, number of lesions less than six per study, except in multiple angiomatosis and the existence of a valid criteria of definitive diagnosis. Lesions were categorized into seven levels of diagnostic confidence of malignancy compared with the definitive diagnosis for acquisition of a receiver-operator-characteristic (ROC) curve analysis and to determine the sensitivity and specificity of the technique. Forty-six and 70 lesions were correctly diagnosed as malignant and benign, respectively; there were 2 false-positive and 4 false-negative diagnoses of malignancy and the sensitivity and specificity obtained were 92 and 97%. The DICT early phase was confirmed as a highly accurate method in the characterization and diagnosis of malignancy of focal liver lesions, requiring an optimal technical performance and judicious analysis of existing semiological data.

Muscarinic antibodies and heart rate responses to dynamic exercise and to the Valsalva maneuver in chronic chagasic patients

We have studied the cardiac chronotropic responses to the Valsalva maneuver and to dynamic exercise of twenty chronic chagasic patients with normal left ventricular function and no segmental wall abnormalities by two-dimensional echocardiogram. The absolute increase in heart rate of the patients (Δ = 21.5 ± 10 bpm, M±SD) during the maneuver was significantly diminished when compared to controls (Δ = 31.30 ± 70, M±SD, p = 0.03). The minimum heart rate (58.24 ± 8.90 vs. 62.80 ± 10, p = 0.68) and the absolute decrease in heart rate at the end of the maneuver (Δ = 38.30 ± 13 vs. Δ = 31.47 ± 17, p = 0.10) were not different from controls. The initial heart rate acceleration during dynamic exercise (Δ = 12 ± 7.55 vs. Δ = 19 ± 7.27, M±SD, p = 0.01) was also diminished, but the heart rate recovery during the first ten seconds was more prominent in the sero-positive patients (Median: 14, Interquartile range: (9.75-17.50 vs. 5(0-8.75, p = 0.001). The serum levels of muscarinic cardiac auto-antibodies were significantly higher in the chagasic patients (Median: 34.58, Interquartile Range: 17-46.5, Optical Density) than in controls (Median: 0, Interquartile Range: 0-22.25, p = 0.001) and correlated significantly and directly (r = 0.68, p = 0.002) with early heart rate recovery during dynamic exercise. The results of this investigation indirectly suggest that, the cardiac muscarinic auto-antibodies may have positive agonist effects on parasympathetic heart rate control of chagasic patients.

Correlation between the mechanical cycling behavior and microstructure in laser welded joints using NiTi memory shape alloys

Dissertação para obtenção do Grau de Mestre em Engenharia de Materiais

Sustainability of systems interoperability in dynamic business networks

Dissertação para obtenção do Grau de Doutor em Engenharia Electrotécnica e de Computadores

Neuroendocrine Tumours of the Female Genital Tract: a Case-Based Imaging Review with Pathological Correlation

BACKGROUND: Both primary and secondary gynaecological neuroendocrine (NE) tumours are uncommon, and the literature is scarce concerning their imaging features. METHODS: This article reviews the epidemiological, clinical and imaging features with pathological correlation of gynaecological NE tumours. RESULTS: The clinical features of gynaecological NE tumours are non-specific and depend on the organ of origin and on the extension and aggressiveness of the disease. The imaging approach to these tumours is similar to that for other histological types and the Revised International Federation of Gynecology and Obstetrics (FIGO) Staging System also applies to NE tumours. Neuroendocrine tumours were recently divided into two groups: poorly differentiated neuroendocrine carcinomas (NECs) and well-differentiated neuroendocrine tumours (NETs). NECs include small cell carcinoma and large cell neuroendocrine carcinoma, while NETs account for typical and atypical carcinoids. Cervical small cell carcinoma and ovarian carcinoid are the most common gynaecological NE tumours. The former typically behaves aggressively; the latter usually behaves in a benign fashion and tends to be confined to the organ. CONCLUSION: While dealing with ovarian carcinoids, extra-ovarian extension, bilaterality and multinodularity raise the suspicion of metastatic disease. NE tumours of the endometrium and other gynaecological locations are very rare. TEACHING POINTS: • Primary or secondary neurondocrine (NE) tumours of the female genital tract are rare. • Cervical small cell carcinoma and ovarian carcinoids are the most common gynaecological NE tumours. • Cervical small cell carcinomas usually behave aggressively. • Ovarian carcinoids tend to behave in a benign fashion. • The imaging approach to gynaecological NE tumours and other histological types is similar.

Caracterização da actividade física nos idosos e a sua relação com a capacidade física, em pessoas com mais de 75 anos

RESUMO: Objectivo: O presente estudo tem como objectivo caracterizar os níveis de actividade física das pessoas com mais de 75 anos e analisar a sua relação com as diferentes componentes da aptidão física. Enquadramento: A actividade física é indispensável para todos mas, os idosos é quem mais beneficia (Fischer, 2005). Actua na prevenção e na reabilitação, fortalecendo a aptidão física, e a autonomia do idoso, permitindo manter, por mais tempo, a capacidade de execução das actividades de vida diárias (Shephard, 2003). A prática de actividade física contribui por exemplo, para a prevenção de quedas, reforçando a aptidão física e o equilíbrio postural. Por outro lado, o baixo nível de aptidão física repercute-se no aumento da actividade sedentária. Os homens têm uma adesão à actividade física de 45% e as mulheres de 28% (Melo et. al., 2007). Métodos: Este é um estudo observacional, correlacional e transversal. Foram avaliados 66 participantes (média de idade de 80,11 ± 3,83 anos), não institucionalizados. O processo de amostragem foi não probabilístico acidental por conveniência. Todos os idosos deram o seu consentimento informado. A actividade física foi avaliada através do questionário do Yale Physical Activity Survey, e foi desenvolvido um diário, para uma semana-tipo, para averiguar os hábitos de actividades diárias, nas últimas quatro semanas. A aptidão física foi avaliada pela bateria de testes de Rikli e Jones (1999),nomeadamente a força, a flexibilidade, a resistência aeróbia e a agilidade e equilíbrio. Os dados foram analisados através da estatística descritiva e para averiguar as possíveis associações entre a actividade física e a aptidão física, recorreu-se á estatística inferencial. Não tendo sido verificada a normalidade da amostra com o teste kolmogorov-smirnov, foram utilizados testes não paramétricos, nomeadamente o teste U Mann – Whitney e o coeficiente de correlação de Spearman (p≤0,05). Resultados: Constatou-se que os idosos em média praticavam 480, 23 minutos por semana de actividade moderada, cerca 11,04% do seu tempo, superior ao recomendado pela literatura (>150 minutos por semana). A actividade física moderada apresentou relações positivas com a aptidão física, na força dos membros inferiores, na resistência aeróbia e na agilidade e equilíbrio. Os homens têm maior agilidade e equilíbrio (p=0,002) e força dos membros inferiores (p=0,025) que as mulheres. Os homens passam mais tempo em actividade moderada do que as mulheres. Ainda superam no gasto energético em cada actividade que praticam durante a semana. As mulheres passam mais tempo em actividade sedentária e actividade ligeira. Conclusão: Quanto mais tempo de prática de actividade física moderada melhor a força dos membros inferiores, a resistência aeróbia, a agilidade e o equilíbrio dinâmico. Recomenda-se uma reflexão sobre a possível intervenção na estruturação das actividades diárias do idoso e uma intervenção mais direccionada às idosas, na força do membro inferior, na agilidade e na resistência aeróbia.----------------------- ABSTRACT:Purpose: The present study aims to characterize the physical activity levels of people over 75 years and analyze their relationship with the different components of physical fitness. Background: Physical activity is essential for all but the elderly who are more benefit (Fischer, 2005). It works on prevention and rehabilitation, strengthening physical fitness,and independence of older people, maintaining, for longer, the ability to implement the activities of daily living (Shephard, 2003). The physical activity contributes for example, for the prevention of falls by strengthening physical fitness and postural balance. Moreover, the low level of physical fitness level is reflected in the increase of sedentary activity. Men have an adherence to physical activity of 45% and women 28% (Melo et. al, 2007) Methods: This was an observational, cross-sectional and correlational. We evaluated 66 participants (mean age 80.11 ± 3.83 years), not institutionalized. The sampling procedure was non accidental probabilistic convenience. All seniors gave their informed consent. Physical activity was assessed by questionnaire at the Yale Physical Activity Survey was developed and a diary-type for a week, to ascertain the habits of daily activities in the last four weeks. Physical fitness was assessed by the battery of tests Rikli and Jones (1999), including strength, flexibility, endurance and agility and balance. Data were analyzed using descriptive statistics and to investigate possible associations between physical activity and physical fitness, we used will inferential statistics. Not having been verified the sample normality with Kolmogorov-Smirnov test, we used non-parametric tests, including the test U Mann - Whitney and Spearman correlation coefficient (p ≤ 0.05). Results: It was found that older people on average practiced 480, 23 minutes per week of moderate activity, about 11,04% of the time, higher than recommended in the literature (> 150 minutes per week). A moderate physical activity had positive correlations with physical fitness, lower limb strength, endurance and aerobic agility and balance. Men have greater agility and balance (p = 0.002) and lower-limb strength (p = 0.025) than women. Men spend more time in moderate activity than women. Still outweigh the energy expenditure for each activity they practice during the week. Women spend more time in sedentary activity and light activity. Conclusion: The more practice time in moderate physical activity best lower-limb strength,aerobic resistance, agility and dynamic balance. It is recommended that a reflection on the possible intervention in structuring the daily activities of the elderly and a more targeted to the woman elderly, especially lower limb strength, agility and endurance.

Contributo para o desenvolvimento de uma metodologia que avalia a posição da omoplata: fidedignidade intra e interobservador e validade concorrente

RESUMO: Introdução: A relação cinemática entre as articulações do CAO apresenta grande importância na função do MS, e é por isso cada vez mais investigada e descrita. O posicionamento da omoplata ganha um importante papel para compreender as DCAO. É indiscutível o importante papel da omoplata na dinâmica do MS, bem como o posicionamento escapular como parâmetro clínico de disfunção do CAO. Todos estes factores criam a necessidade de desenvolver instrumentos de avaliação da posição da articulação ET. A grande maioria dos testes de avaliação, restringem a sua avaliação às disfunções da articulação GU, não integrando uma avaliação mais dinâmica e interactiva que respeite os pressupostos teóricos inerentes ao REU. È importante também que os métodos de avaliação sejam de fácil aplicabilidade clínica e que avaliem fidedignamente e com validade os outcomes. Objectivos: Contribuir para o desenvolvimento de uma metodologia de avaliação da omoplata em diferentes amplitudes do MS, através do estudo da validade concorrente, da fidedignidade intra e inter-observador. Metodologia: A amostra foi constituída por 20 elementos seleccionados por conveniência, entre o corpo de discentes da ESS-IPS, sem história de disfunção do CAO. Foi realizada uma análise cinemática ao MS de cada sujeito, usando um aparelho de análise por varrimento electromagnético, o FOB. Em cada sujeito foram ainda medidas, as distâncias escapulares em estudo, usando a fita métrica. Cada método de medição foi constituído por dois momento (teste e reteste), em cada momento, as medidas eram recolhidas por dois investigadores distintos. Resultados e Discussão: Foram considerados como positivos os resultados que se apresentassem acima do limiar de 0,5, que classifica uma correlação como moderada a excelente. Os resultados da validade mostram que para o investigador 1 nas medidas M1e M2 apenas houve correlação com valores excelentes a moderados até aos 30º de elevação do MS. Já para M3 apenas aos 30º no plano da omoplata essa mesma correlação não tem valores próximos do cutpoint. Em M4 nenhum valor tem correlação significativa com os valores do FOB, chegando mesmo a haver correlação negativa para os 120º no plano da omoplata. Em M5 apenas os 0º mostram valores correlacionais excelentes a moderados. Para o investigador 2, em M1 e M2 á semelhança do investigador 1, só existem valores de correlação significativos até aos 30º de elevação do MS. Já para M3 todos os valores mostram excelente a moderada correlação á excepção dos 120º no plano frontal. Em M4 este investigador apresenta maus resultados. Já em M5 os valores de correlação são moderados aos 0º e aos 90º. No que diz respeitos aos resultados dos CCI intra-observador,podemos afirmar que foi em M5 que estes valores mais se aproximaram do cut point. M1 e M2 são as medidas onde se encontram resultados menos satisfatórios. É aos 60º que existem valores mais satisfatórios, seguidos pelos 0º e 30º, quando nos aproximamos de graus mais elevados, como 90º e 120º, estes valores tendem a baixar. Quanto á fidedignidade inter-observador para M1 apenas aos 90º e aos 120º houve valores de correlação abaixo do cutpoint. Em M2, só os 60º do plano sagital não teve valores acima do cutpoint, em M3 apenas os 30º plano sagital não obtiveram valores acima do cut-point, o mesmo acontece para M3 aos 30º plano da omoplata e em M5 aos 30º e 120º no plano frontal. Conclusão: Os resultados deste estudo indicam que a metodologia em causa apresenta elevado grau de fidedignidade inter-observador, já no que toca é fidedignidade intra-observador o grau de semelhança não é tão elevado. Também o erro associado á medida não ultrapassou 1,5cm, sendo considerado baixo. Na validade concorrente concluímos que é aos 0º que a metodologia se torna uma opção válida na aferição das distâncias medidas com uma boa a excelente concordância com o FOB. As medidas consideradas como opções válidas, nas diferentes amplitudes, podem funcionar como parâmetros clínicos de caracterização do posicionamento da omoplata, podendo vir a contribuir ainda para a caracterização da orientação da mesma.-------------------- ABSTRACT:Introduction: The kinematic relationship between the joints of the CAO has great importance in the function of MS, which is why more and more investigated and described. The positioning of the blade gets an important role in understanding the DCAO. There is no doubt the important role of the scapula in the dynamics of MS as well as the positioning of scapular dysfunction as a clinical parameter of the CAO. All these factors create the need to develop tools for evaluating the place of articulation ET. Most assessment tests, restrict its assessment to GU joint disorders, not incorporating a more dynamic and interactive way that respects the theoretical assumptions inherent in the REU. It is also important that the methods are easy to apply clinical and reliably to assess the validity and outcomes. Objectives: To contribute to the development of a methodology for evaluating the scapula in different ranges of MS, through the study of concurrent validity, reliability of intra-and inter-observer. Methodology: The sample consisted of 20 selected elements for convenience, between the body of students of IPS-ESS with no history of dysfunction of the CAO. We performed a kinematic analysis of each subject to MS, using a scanning device for electromagnetic analysis, the FOB. In each subject were also measured, the scapular distances under study, using tape measure. Each method of measuring the time consisted of two (test and retest), in each moment, the measures were collected by two different investigators. Results and Discussion: We considered as positive results that were above the threshold of 0.5, which ranks as a moderate to excellent correlation. The results show that the validity for the researcher in an action M1e M2 was only correlated with moderate to excellent values up to 30º of elevation of the MS. As for M3 only to 30º in the plane of the scapula has the same correlation values near the cutpoint. M4 has no value in correlation with the values of the FOB, and even negative correlation to 120 ° in the plane of the scapula. In M5 show only the values 0 ° correlational excellent to moderate. For investigator 2 in M1 and M2 will be like an investigator, there are only significant correlation values up to 30º of elevation of the MS. As for M3 all the values show excellent correlation to moderate with the exception of 120 ° in the frontal plane. In this researcher M4 has bad results. M5 already in the correlation values are moderate to 0º and 90 º. Regarding the results of ICC intra-observer, we can say that M5 was that these values come closest to the cut point. M1 and M2 are measures which are less than satisfactory results. At 60 ° there are more satisfactory values, followed by 0º and 30º, when we approached the highest levels, such as 90 ° and 120 °, these values tend to decrease. The inter-observer reliability for M1 only to 90 º and 120 ºcorrelation values were below the cutpoint. In M2, only 60 of the sagital plane did not have values above the cutpoint in M3 only 30º sagital plane did not obtain values above the cut-point, the same goes for M3 at 30 ° plane of the scapula and M5 at 30 º and 120 º in frontal plane. Conclusion: The results of this study indicate that the methodology in question has a high degree of inter-observer reliability, as far as intra-observer reliability is the degree of similarity is not as high. Also the error of measure did not exceed 1.5 cm, and is considered low. In concurrent validity conclude that it is at 0 ° the methodology becomes a valid option for the measurement of distances measured with a good to excellent agreement with the FOB. The measures considered as valid options in different amplitudes, can function as clinical parameters to characterize the positioning of the shoulder blade and could further contribute to the characterization of the orientation of the same.

Evaluating Dynamic Signage for Emergency Evacuation using an Immersive Video Environment

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Disturbed Correlation Between Arterial Resistance and Pulsatility in Glaucoma Patients

PURPOSE: (i) To investigate whether pulsatility index (PI) and mean flow velocities (MFV) are altered in glaucoma patients. (ii) To evaluate the significance of PI in retrobulbar autoregulation capacity. METHODS: Patients with primary open-angle glaucoma (POAG; n = 49), normal tension glaucoma (NTG; n = 62) and healthy controls (n = 48) underwent colour Doppler imaging measurements of the retrobulbar vasculature. Kruskal-Wallis test was used to compare variables between the three diagnostic groups. Restricted cubic splines were used to determine nonlinearities between the resistive index (RI) and PI correlations. RESULTS: Mean flow velocities (MFV) were lower in both short posterior ciliary arteries (SCPA) and central retinal arteries (CRA) from the two glaucoma groups (p < 0.04 versus healthy controls). No differences were detected in RI or PI in any arteries of the three diagnostic groups (p > 0.08). In healthy individuals, correlations between RI and PI were linear in all arteries. In both POAG and NTG patients, CRA presented a nonlinear curve with a cutpoint at RI 0.77 (p < 0.001) and 0.61 (p = 0.03), respectively, above which the slope increased nearly five- and tenfold (POAG: 1.96 to 10.06; NTG: -0.46-4.06), respectively. A nonlinear correlation in the ophthalmic artery was only observed in NTG patients, with a cutpoint at RI 0.82 (p < 0.001), above which the slope increased from 3.47 to 14.03. CONCLUSIONS: Glaucoma patients do not present the linear relationships between RI and PI observed in healthy individuals. Their nonlinear relations may be indicative of an altered autoregulation and suggest a possible threshold RI could be determined above which autoregulatory disturbances become more relevant.

What is the value of value-at-risk after all?: A conditional approach using quantile regressions

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

Ocular Pulse Amplitude and Doppler Waveform Analysis in Glaucoma Patients

PURPOSE: To determine the correlation between ocular blood flow velocities and ocular pulse amplitude (OPA) in glaucoma patients using colour Doppler imaging (CDI) waveform analysis. METHOD: A prospective, observer-masked, case-control study was performed. OPA and blood flow variables from central retinal artery and vein (CRA, CRV), nasal and temporal short posterior ciliary arteries (NPCA, TPCA) and ophthalmic artery (OA) were obtained through dynamic contour tonometry and CDI, respectively. Univariate and multiple regression analyses were performed to explore the correlations between OPA and retrobulbar CDI waveform and systemic cardiovascular parameters (blood pressure, blood pressure amplitude, mean ocular perfusion pressure and peripheral pulse). RESULTS: One hundred and ninety-two patients were included [healthy controls: 55; primary open-angle glaucoma (POAG): 74; normal-tension glaucoma (NTG): 63]. OPA was statistically different between groups (Healthy: 3.17 ± 1.2 mmHg; NTG: 2.58 ± 1.2 mmHg; POAG: 2.60 ± 1.1 mmHg; p < 0.01), but not between the glaucoma groups (p = 0.60). Multiple regression models to explain OPA variance were made for each cohort (healthy: p < 0.001, r = 0.605; NTG: p = 0.003, r = 0.372; POAG: p < 0.001, r = 0.412). OPA was independently associated with retrobulbar CDI parameters in the healthy subjects and POAG patients (healthy CRV resistance index: β = 3.37, CI: 0.16-6.59; healthy NPCA mean systolic/diastolic velocity ratio: β = 1.34, CI: 0.52-2.15; POAG TPCA mean systolic velocity: β = 0.14, CI 0.05-0.23). OPA in the NTG group was associated with diastolic blood pressure and pulse rate (β = -0.04, CI: -0.06 to -0.01; β = -0.04, CI: -0.06 to -0.001, respectively). CONCLUSIONS: Vascular-related models provide a better explanation to OPA variance in healthy individuals than in glaucoma patients. The variables that influence OPA seem to be different in healthy, POAG and NTG patients.

Patterns in financial markets: Dynamic time warping

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics