Desenvolvimento de métodos de processamento e inteligência computacional no ECG ambulatorial

A monitorização ambulatorial do eletrocardiograma (ECG) permite seguir as atividades cotidianas do paciente durante períodos de 24 horas (ou ainda maiores) possibilitando o estudo de casos que pudessem ter episódios arrítmicos fatais. Entretanto, o maior desafio tecnológico que este tipo de monitorização enfrenta é a perda de informação pela presença de ruídos e artefatos quando o paciente se move. A análise do intervalo QT de despolarização e repolarização ventricular do eletrocardiograma superficial é uma técnica não invasiva com um grande valor para a diagnose e prognósticos de cardiopatias e neuropatias, assim como para a predição da morte cardíaca súbita. A análise do desvio padrão do intervalo QT proporciona informação sobre a dispersão (temporal ou espacial) da repolarização ventricular, entretanto a influencia do ruído provoca erros na detecção do final da onda T que são apreciáveis devido ao fato dos valores pequenos do desvio padrão do QT tanto para sujeitos patológicos e quanto para os sãos. O objetivo geral desta tese é melhorar os métodos de processamento do sinal de ECG ambulatorial usando inteligência computacional, especificamente os métodos relacionados com a detecção do final da onda T, e os de reconhecimento morfológico de batimentos que invalidam a análise da variabilidade do intervalo QT. É proposto e validado (em termos de exatidão e precisão) um novo método e algoritmo para estimar o final da onda T baseado no calculo de áreas de trapézios, empregando sinais da base de dados QT da Physionet. O desempenho do método proposto foi testado e comparado com um dos métodos mais usados para detectar o final da onda T: o método baseado no limiar na primeira derivada. O método de inteligência computacional sugerido combina a extração de características usando o método de análise de componentes principais não lineares e a rede neural de tipo perceptron multicamada. O método de áreas de trapézios teve um bom desempenho em condições ruidosas e não depende de nenhum limiar empírico, sendo adequado para situações com níveis de elevados de ruído de banda larga. O método de reconhecimento morfológico de batimentos foi avaliado com sinais ambulatoriais com e sem artefatos pertencentes a bases de dados de prestigio internacional, e mostrou um bom desempenho.

As figuras de pensamento: estratégia do enunciador para persuadir o enunciatário

Este trabalho pretende estudar as figuras de pensamento da retórica clássica como uma das estratégias empregadas pelo enunciador para persuadir o enunciatário, para fazê-lo crer em seu discurso. Essas figuras retóricas dividem-se em dois grupos: as que se constroem a partir de procedimentos da sintaxe discursiva e as que se produzem a partir de mecanismos da semântica discursiva. As primeiras têm sua origem num desacordo entre as instâncias do enunciado e da enunciação, quando, por exemplo, se afirma algo no enunciado e se nega na enunciação, enquanto as segundas resultam de uma combinação, na sucessividade do sintagma, de figuras do discurso em disjunção. Com as figuras de pensamento, o enunciador diz sem ter dito, simula moderação para dizer de maneira enfática, finge ênfase para afirmar de maneira atenuada, apresenta uma nova combinação de figuras do discurso para levar o enunciatário a assumir o que lhe está sendo comunicado.

Natural and anthropogenic influence on soil erosion in a rural watershed in the Brazilian southeastern region

Human activities have been driven land cover, provoking acceleration of the erosive process and alteration on the soil characteristics. To explore the effects of human disturbance, we investigated the influences of natural and anthropogenic features on soil quality and soil erosion indicators (EI) within a Brazilian rural watershed located in Bauru Municipality, State of So Paulo. A pre-established set of soil EI was used to evaluate the influence of anthropogenic land cover categories on the presence and severity of erosion, related with spatial variations of soil attributes. On-site visits were carried out to measure the occurrence and the intensity of eleven separate EI values and to collect undisturbed topsoil samples for subsequent analyses. We registered 17 occurrences of EIs, distributed in ten locals. Occurrence and intensity of EIs were related to degree of sheet erosion. The EI qualities were more strongly associated with land cover management practices than to local topographic features. The occurrence of EIs and characteristics of soil and soil organic matter (SOM) were not significantly self-correlated. Although land cover class seems to influence soil properties and SOM attributes, we observed that the granulometric composition of the soils also contributes to the structural characteristics of the soil and consequently to the dynamic loss and gain of soil carbon. Sites covered with natural remnant vegetation (NRV) store 96.5 Mg ha(-1) of C and grassy and tilled soils stored more C than NRV, 100.1 and 142.4 Mg ha(-1), respectively. Due to the influence of soil texture over the soil C dynamic, we observe that in Bauru, pastured areas have high potential for sequestration of C if factors such as fire and/or erosion were avoided or effectively controlled. Results from this study show that human disturbance substantially affects soil properties within of southeastern region of Brazil.

Genetic and phenotypic parameters of carcass and organ traits of broiler chickens

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Analyse der Einweisungsdiagnose in einer universitären Schmerzambulanz unter dem besonderen Aspekt des Anteils therapiebedürftiger psychischer Störungen bei Patienten mit Rückenschmerzen, Morbus Sudeck, Phantomschmerzen sowie

Es wurde eine retrograde Analyse von Patientenakten der Schmerzambulanzder Klinik für Anästhesiologie der Universitätsklinik Mainz durchgeführt, indie alle Patienten mit bestimmten Einschlußkriterien derBehandlungsjahrgänge1996 und 1997 aufgenommen wurden.Dies waren die vier Diagnosegruppen multilokuläre Schmerzen,Rückenschmerzen, Phantomschmerz und Morbus Sudeck (SRD). Das Ziel dervorliegenden Arbeit war die Frage nach der Häufigkeit von Psychotherapie alsergänzende Therapieempfehlung seitens der Schmerzambulanz herauszuarbeiten.Psychotherapie (ambulant, stationär, Bestandteil vonRehabilitationsaufenthalten) in vielgestaltiger Weise wurde häufigerempfohlen, 1. je länger die Schmerzerkrankung bestand,2. je jünger die Patienten waren,3. je länger sie arbeitsunfähig waren,4. wenn belastende biographische Ereignisse festgestellt werden konnten5. je höher das Chronifizierungsstadium nach Gerbershagen war. Im Einzelnenspielten die zeitlichen Aspekte der Erkrankung, Lokalisationseinflüsse sowieAspekte vorheriger Behandlungen und schmerzbedingter Krankenhausaufenthalteeine besondere Rolle.6. wenn Patienten nicht berentet waren.

Idrogenazione selettiva del 5-idrossimetilfurfurale in fase omogenea: studio dell'attività catalitica del complesso di Shvo

Il presente lavoro di tesi è frutto di una collaborazione fra il Dipartimento di Chimica Fisica ed Inorganica (gruppo del Prof. Valerio Zanotti – Mattia Vaccari, Dr. Rita Mazzoni) ed il Dipartimento di Chimica Industriale e dei Materiali (gruppo del Prof. Angelo Vaccari – Dr. Thomas Pasini, Dr. Stefania Albonetti, Prof. Fabrizio Cavani) e si inserisce il un progetto volto a valutare l’attività e la selettività del catalizzatore di idrogenazione di Shvo 1, verso l’idrogenazione selettiva del doppio legame polare del 5-idrossimetilfurfurale (HMF) in fase omogenea. L’HMF è un composto di natura organica facilmente ottenibile dalle biomasse, il quale può essere impiegato come building block per ottenere prodotti ad alto valore aggiunto per la chimica fine o additivi per biocarburanti aventi un elevato potere calorifico. In particolare la nostra attenzione si è rivolta alla produzione del 2,5-diidrossimetilfurano (BHMF), un importante building block per la produzione di polimeri e schiume poliuretaniche. Il lavoro di tesi da me svolto ha riguardato la messa a punto di una nuova metodologia sintetica per la preparazione del catalizzatore di Shvo e lo studio della sua attività catalitica nella riduzione di HMF a BHMF. Il comportamento del catalizzatore è stato monitorato studiando la resa in BHMF in funzione di tutti i parametri di reazione: temperatura, pressione di H2, solvente, rapporto molare substrato/catalizzatore, concentrazione, tempo. Successivamente è stata valutata la possibilità di riciclare il catalizzatore recuperando il prodotto di estrazione con acqua, per precipitazione o eseguendo la reazione in miscela bifasica (toluene/H2O). The present work is a collaboration between the Department of Physics and Inorganic Chemistry (group of Prof. Valerio Zanotti - Mattia Vaccari, Dr. Rita Mazzoni) and the Department of Industrial Chemistry and Materials (Group of Prof. Angelo Vaccari - Dr. Thomas Pasini, Dr. Stefania Albonetti, Prof. Fabrizio Cavani), and it’s a project devoted to evaluate the activity and selectivity of the Shvo catalyst, in the selective hydrogenation of polar double bond of 5 -hydroxymethylfurfural (HMF) in homogeneous phase. The HMF is an organic compound easily obtained from biomass, which can be used as a building block for fine chemicals abd polymer production or additives for biofuels with a high calorific value. In particular, our attention turned to the production of 2.5-bishydroxymethylfuran (BHMF), an important building block for the production of polymers and polyurethane foams. This thesis has involved the development of a new synthetic methodology for the preparation of Shvo’s catalyst and the study of its catalytic activity in the reduction of HMF to BHMF. The behavior of the catalyst was monitored by studying the yield in BHMF as a function of all the reaction parameters: temperature, pressure of H2, solvent, substrate to catalyst molar ratio, concentration, time. Subsequently it was evaluated the possibility of recycling the catalyst recovering the product of extraction with water, by precipitation or performing the reaction in biphasic mixture (toluene/H2O).

Synthese von MUC1-Glycopeptid-Konjugaten mit fluorierten Analoga des Thomsen-Friedenreich-Antigens

Krebserkrankungen gehen oft mit der Überexpression von mucinartigen Glycoproteinen auf der Zelloberfläche einher. In vielen Krebserkrankungen wird aufgrund der fehlerhaften Expression verschiedener Glycosyltransferasen das transmembranständige Glycoprotein MUC1, mit verkürzten Glycanstrukturen, überexprimiert. Das Auftreten der verschiedenen tumor-assoziierten Antigene (TACA) korreliert meist mit dem Fortschreiten des Krebs und der Metastasierung. Daher stellen TACAs interessante Zielmoleküle für die Entwicklung einer aktiven Tumorimmuntherapie zur spezifischen Behandlung von Adenokarzinomen dar. In dieser Arbeit galt das Interesse dem epithelialen Mucin MUC1, auf Basis dessen ein synthetischer Zugang zu einheitlichen Antitumorvakzinen, welche aus mucinanalogen Glyco-peptid¬konjugaten des MUC1 und Carrierproteinen bestehen, hergestellt werden sollten.rnUm eine tumorspezifische Immunantwort zu erhalten, müssen die selbst schwach immunogenen MUC1-Antigene über einen nicht-immunogenen Spacer mit einem geeigneten Trägerprotein, wie Tetanus Toxoid oder Rinderserumalbumin (BSA), verbunden werden. rnDa ein Einsatz von Glycokonjugaten in Impfstoffen durch die metabolische Labilität der O-glycosidischen Bindungen eingeschränkt ist, wurden hierzu erstmals fluorierte Vetreter von MUC1-analogen Glycopeptiden verwendet, in denen das Kohlenhydrat-Epitop durch den strategischen Einbau von Fluor¬atomen gegenüber einem raschen Abbau durch Glycosidasen geschützt werden soll. Dazu wurden auf Basis des literaturbekannten Thomsen-Friedenreich-Antigens Synthesestrategien zur Herstellung eines 2’F- und eines 2’,6’-bisfluorierten-Analogons erarbeitet. rnSchlüsselschritte in der Synthese stellten neben der elektrophilen Fluorierung eines Galactalvorläufers auch die -selektive 3-Galactosylierung des TN-Antigen-Bausteins zum 2’F- und 2’,6’-bisfluorierten-Analogons des TF-Disaccharids dar. Durch entsprechende Schutzgruppentransformationen wurden die beiden Derivate in entsprechende Glycosyl¬amino-säure-Bausteine für die Festphasensynthese überführt.rnNeben den beiden Analoga des TF-Antigens wurde auch erstmals ein 2F-Analogon des 2,6-Sialyl-T-Antigens hergestellt. Dazu wurde der entsprechende 2’F-TF-Baustein mit Sialinsäure-xanthogenat nach bereits bekannten Syntheseprotokollen umgesetzt. Aufgrund von Substanzmangel konnte die Verbindung nicht zur Synthese eines MUC1-Glycopeptid-Analogons herangezogen werden.rnDer Einbau der hergestellten Glycosylaminosäure-Bausteine erfolgte in die aus 20 Amino-säuren bestehende vollständige Wiederholungseinheit aus der tandem repeat-Sequenz des MUC1, wobei die entsprechenden Glycanseitenketten stets in Position 6 eingeführt wurden. Um die erhaltenen Glycopeptide für immunologische Studien an Carrier-Proteine anbinden zu können und so ggf. zu funktionsfähigen Impfstoff-Konjugaten zu gelangen, wurden diese stets N-terminal mit einem nicht-immunogenen Triethylenglycol-Spacer verknüpft. Die anschließende Funktionalisierung mit Quadratsäurediethylester erlaubte die spätere chemoselektive Konjugation an Trägerproteine, wie Tetanus Toxoid oder BSA.rnIn ersten immunologischen Bindungsstudien wurden die synthetisierten BSA-Glycopeptid-Konjugate mit Serum-Antikörpern aus Vakzinierungsstudien von MUC1-Tetanus Toxoid-Konjugaten, die (i) eine natürliche TF-Antigenstruktur und (ii) ein entsprechendes TF-Antigenderivat mit Fluorsubstituenten an C-6 des Galactosamin-Bausteins und C-6’ des Galactoserests tragen, untersucht.rn

Chronic impact of topiramate on acid-base balance and potassium in childhood

Topiramate, which is commonly prescribed for seizure disorders and migraine prophylaxis, sometimes causes metabolic acidosis and hypokalemia. Since the effects of topiramate on acid-base balance and potassium levels have not been well explored in children, acid-base balance, anion gap and potassium were assessed in 24 patients (8 females and 16 males) aged between 4.6 and 19 years on topiramate for more than 12 months and in an age-matched control group. Plasma bicarbonate (21.7 versus 23.4 mmol/L; P<0.03), carbon dioxide pressure (39.7 versus 43.2mm Hg; P<0.05), and potassium (3.7 versus 4.0 mmol/L; P<0.03) were on the average lower and chloride (109 versus 107 mmol/L; P<0.03) higher in patients treated with topiramate than in controls. Blood pH, plasma sodium and the anion gap were similar in patients on topiramate and in controls. In patients on topiramate no significant correlation was observed between the dosage of this agent and plasma bicarbonate or potassium as well as between topiramate blood level and the mentioned electrolytes. In conclusion long-term topiramate treatment is associated with a mild, statistically significant tendency towards compensated normal anion gap metabolic acidosis and hypokalemia.

The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy

An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.

Cavernous malformations of the central nervous system in children: presentation, treatment and outcome of 20 cases

Cavernous malformations (CM) of the central nervous system are vascular malformations responsible for symptoms such as seizures, headache, and neurological deficits: 25% of cases already present in childhood.

Non-traumatic spinal cord ischaemia in childhood - Clinical manifestation, neuroimaging and outcome

Spinal cord ischaemia is rare in childhood and information on clinical presentation and outcome is scarce.

Pontocerebellar hypoplasia type 2: variability in clinical and imaging findings

We report 24 children (14 girls) who presented with the typical neuroimaging findings of pontocerebellar hypoplasia (PCH) to describe the clinical spectrum of type 2. Twenty-one presented with the classical form described by Barth; characteristic features (15/21) were breathing and/or sucking problems during neonatal period and early onset hyperkinetic movement disorder. Eighteen were normocephalic at birth, but all developed microcephaly during infancy. Development was severely affected with none of the children being capable of sitting, walking, or talking. Social contact and visual fixation were persistently poor. Dyskinetic movement disorder was present in all, in some together with mild spasticity. Seizures occurred in 14 (in 7 as neonates). Eight children died (age 1 day-6 years). Neuroimaging showed an absent or severely flattened pons, different degrees of vermian hypoplasia, with cerebellar hemispheres (wing-like structures) being equally or more affected. Three (all girls) were less severely affected clinically and did not develop the dyskinetic movement disorder, motor and cognitive development were somewhat better. Microcephaly was also a prominent sign. Severity of pontocerebellar neuroimaging findings did not differentiate between the typical and atypical clinical group and did not correlate with clinical outcome.