Avaliações clínicas e metabólicas de cavalos da raça Árabe submetidos a exercício progressivo em esteira

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito do nitrogênio nas propriedades anelásticas de Nb e ligas Nb-1,0%pZr

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Dinâmica do carbono dissolvido no Rio Acre: variações espaciais e sazonais

Este trabalho teve como principal objetivo estudar a dinâmica do carbono dissolvido ao longo de um trecho do rio Acre, avaliando a influência da área urbana da cidade de Rio Branco, e da descarga de três de seus tributários (Riozinho do Rola, igarapé Judia, igarapé São Francisco), bem como a influência das mudanças hidrológicas sazonais. Foram realizadas campanhas de campo mensais, entre dezembro de 2006 e setembro de 2007, em cinco sítios no rio Acre e um sítio na foz de cada um dos três tributários. A cada amostragem 1 litro de amostra de água era submetida a filtração e dividida em alíquotas para as análises de carbono orgânico dissolvido (COO), carbono inorgânico dissolvido (CIO) e íons maiores (Ca² + , Mg² + , K + , Na + , NH 4 + , HCO 3 -, Cl¯, SO 4 ²¯, NO 3 - , NO 2 - , e PO 4 3-) . Além das coletas foram medidos in situ os parâmetros físico-químicos pH, condutividade elétrica, oxigênio dissolvido e temperatura da água. O pH médio anual no rio Acre variou de 6,46 a 6,54 entre os sítios e a condutividade elétrica apresentou valores médios anuais entre os sítios que variam de 69,93 a 77,84 µS cm¯¹. Nos tributários, os valores médios anuais de pH variaram de 6,10 a 6,51 e a condutividade elétrica apresentou valores médios anuais que variaram entre 54,08 e 153,03 S cm¯¹. Os cátions predominantes no rio Acre e nos tributários foram o Na + e o Ca 2+ e os ânions foram o cr e o sol-. A concentração média anual de COD no rio Acre variou de 4,62 a 5,17 mg l¯¹, sem diferenças significativas entre os sítios de amostragem. Nos tributários as médias anuais, de COD variaram de 3,55 a 6,55 mg r1. As concentrações foram, significativamente maiores no período de cheia, com médias que variaram de 6,26 a 6,39 mg l¯¹ nos sítios do rio Acre. O igarapé São Francisco foi o único tributário que não apresentou diferenças entre os períodos sazonais. O CID teve uma concentração média anual no rio Acre que variou de 527,91 a 598,18 µM, sem diferenças significativas entre os sítios de amostragem. As maiores concentrações foram observada na seca, quando as concentrações médias variaram de 816,31 a 998,52 µM. Nos tributários as concentrações médias anuais de CID variaram de 248,54 a 986,50 µM.Quanto a pressão parcial do CO2 (pCO 2 ) , os sítios no rio Acre apresentam valores médios anuais variando entre 3559 e 4059 ppm, sem diferenças entre os sítios e com os maiores valores ocorrendo no período de cheia. Com base nos resultados, pode-se concluir que a dinâmica do carbono dissolvido no rio Acre não apresenta variações significativas decorrentes das descargas dos tributários nem do lançamento de esgotos. Por outro lado, as mudanças hidrológicas sazonais são os maiores responsáveis pelas alterações nesta dinâmica.

Avaliação dos parâmetros gasométricos dos traumatizados durante o atendimento pré-hospitalar móvel

OBJECTIVE: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. METHODS: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). RESULTS: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). CONCLUSION: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.

Infusão contínua de morfina ou fentanil, associados à lidocaína e cetamina, em cães anestesiados com isofluorano

A técnica de analgesia multimodal, por meio da infusão contínua de fármacos, pode ser empregada para diminuir a incidência de sensibilização central durante a anestesia. Avaliaram-se as características cardiorrespiratórias, durante o procedimento de artroscopia de joelho, em cães anestesiados com isofluorano e monitorados por meio do índice biespectral, submetidos à infusão contínua de morfina ou fentanil, associada à lidocaína e cetamina. Utilizaram-se 16 cães adultos, machos ou fêmeas, os quais foram distribuídos aleatoriamente em dois grupos, denominados MLK - que recebeu morfina (3,3μg/kg/min), lidocaína (50μg/kg/min) e cetamina (10μg/kg/min) ou FLK - em que foi substituída a morfina pelo fentanil (0,03μg/kg/min). Os cães foram pré-tratados com levomepromazina (0,5mg/kg IV), induzidos à anestesia com propofol (5mg/kg) e mantidos com isofluorano, ajustando-se a concentração para obterem-se valores de índice biespectral entre 55 e 65. As mensurações da frequência cardíaca (FC), dos parâmetros eletrocardiográficos (ECG), das pressões arteriais sistólica (PAS), diastólica (PAD) e média (PAM), da tensão de dióxido de carbono expirado (EtCO2), da saturação de oxi-hemoglobina (SpO2), da frequência respiratória (FR) e da temperatura esofágica (T) iniciaram-se 30 minutos após a indução (M0) e continuaram após o início da infusão das soluções, em intervalos de 15 minutos (M15 a M75). Diferenças entre os grupos foram registradas para duração do complexo QRS (M60), para FC e T, entre M30 e M75, com MLK apresentando médias maiores que FLK, que registrou médias maiores que MLK para a SpO2 (M60), para os intervalos QT (M30 e M75) e RR (M0, M60 e M75). Concluiu-se que o emprego de morfina ou fentanil, associados à lidocaína e cetamina, promove efeitos semelhantes e não compromete as características avaliadas.

Alterações metabólicas e morfométricas induzidas por hipóxia em Gallus gallus

Pós-graduação em Zootecnia - FCAV

Efeitos da infusão contínua de tiopental ou propofol em coelhos mantidos em respiração espontânea

Pós-graduação em Cirurgia Veterinária - FCAV

Achados clínicos, hemodinâmicos e hemogasométricos da infusão contínua de propofol associado ou não ao tramadol em ovelhas submetidas à videolaparoscopia

Pós-graduação em Cirurgia Veterinária - FCAV

Nitrogen diffusion in niobium under low pressure

The interaction among heavy interstitial atoms present in metals with bcc structure is studied using anelastic spectroscopy. This technique makes it possible to obtain information on interstitial concentration, precipitation, solubility limit, and diffusion. The diffusion coefficients of nitrogen in niobium were obtained using the relaxation parameters obtained from anelastic spectroscopy measurements for different oscillation frequencies of the system. The results showed the interstitial diffusion of nitrogen present in solid solution in niobium when submitted to different charges of nitrogen at a temperature of 1373 K and a partial pressure in the order of 10-4 Torr. The exponential variation of the pressure experimentally in function of the time was thus obtained.

Histologic and functional evaluation of lungs reconditioned by ex vivo lung perfusion

BACKGROUND: Only about 15% of donor lungs are considered suitable for transplantation (LTx). Ex vivo lung perfusion (EVLP) has been developed as a method to reassess and repair damaged lungs. We report our experience with EVLP in non-acceptable donor lungs and evaluate its ability to recondition these lungs. METHODS: We studied lungs from 16 brain-dead donors rejected for LTx. After harvesting, the lungs were stored at 4 degrees C for 10 hours and subjected to normothermic EVLP with Steen Solution (Vitro life, Goteborg, Sweden) for 60 minutes. For functional evaluation, the following variables were assessed: partial pressure of arterial oxygen (Pao(2)), pulmonary vascular resistance (PVR), and lung compliance (LC). For histologic assessment, lung biopsy was done before harvest and after EVLP. Tissue samples were examined under light microscopy. To detect and quantify apoptosis, terminal deoxynucleotide transferase-mediated deoxy uridine triphosphate nick-end labeling assay was used. RESULTS: Thirteen lima donors were refused for having impaired lung function. The mean Pao(2) obtained in the organ donor at the referring hospital was 193.7 mm Hg and rose to 489 mm Hg after EVLP. During EVLP, the mean PVR was 652.5 dynes/sec/cm(5) and the mean LC was 48 ml/cm H2O. There was no significant difference between the mean Lung Injury Score before harvest and after EVLP. There was a trend toward a reduction in the median number of apoptotic cells after EVLP. CONCLUSIONS: EVLP improved lung function (oxygenation capacity) of organs considered unsuitable for transplantation. Lung tissue structure did not deteriorate even after 1 hour of normothermic perfusion. J Heart Lung Transplant 2012;31:305-9 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.

Small volume of hypertonic saline as the initial fluid replacement in experimental hypodynamic sepsis

Abstract Introduction We conducted the present study to examine the effects of hypertonic saline solution (7.5%) on cardiovascular function and splanchnic perfusion in experimental sepsis. Methods Anesthetized and mechanically ventilated mongrel dogs received an intravenous infusion of live Escherichia coli over 30 minutes. After 30 minutes, they were randomized to receive lactated Ringer's solution 32 ml/kg (LR; n = 7) over 30 minutes or 7.5% hypertonic saline solution 4 ml/kg (HS; n = 8) over 5 minutes. They were observed without additional interventions for 120 minutes. Cardiac output (CO), mean arterial pressure (MAP), portal and renal blood flow (PBF and RBF, respectively), gastric partial pressure of CO2 (pCO2; gas tonometry), blood gases and lactate levels were assessed. Results E. coli infusion promoted significant reductions in CO, MAP, PBF and RBF (approximately 45%, 12%, 45% and 25%, respectively) accompanied by an increase in lactate levels and systemic and mesenteric oxygen extraction (sO2ER and mO2ER). Widening of venous-arterial (approximately 15 mmHg), portal-arterial (approximately 18 mmHg) and gastric mucosal-arterial (approximately 55 mmHg) pCO2 gradients were also observed. LR and HS infusion transiently improved systemic and regional blood flow. However, HS infusion was associated with a significant and sustained reduction of systemic (18 ± 2.6 versus 38 ± 5.9%) and mesenteric oxygen extraction (18.5 ± 1.9 versus 36.5 ± 5.4%), without worsening other perfusional markers. Conclusion A large volume of LR or a small volume of HS promoted similar transient hemodynamic benefits in this sepsis model. However, a single bolus of HS did promote sustained reduction of systemic and mesenteric oxygen extraction, suggesting that hypertonic saline solution could be used as a salutary intervention during fluid resuscitation in septic patients.

Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

Stereoselective pharmacokinetics of ketamine and norketamine after racemic ketamine or S-ketamine administration during isoflurane anaesthesia in Shetland ponies

BACKGROUND: The arterial pharmacokinetics of ketamine and norketamine enantiomers after racemic ketamine or S-ketamine i.v. administration were evaluated in seven gelding ponies in a crossover study (2-month interval). METHODS: Anaesthesia was induced with isoflurane in oxygen via a face-mask and then maintained at each pony's individual MAC. Racemic ketamine (2.2 mg kg(-1)) or S-ketamine (1.1 mg kg(-1)) was injected in the right jugular vein. Blood samples were collected from the right carotid artery before and at 1, 2, 4, 8, 16, 32, 64, and 128 min after ketamine administration. Ketamine and norketamine enantiomer plasma concentrations were determined by capillary electrophoresis. Individual R-ketamine and S-ketamine concentration vs time curves were analysed by non-linear least square regression two-compartment model analysis using PCNonlin. Plasma disposition curves for R-norketamine and S-norketamine were described by estimating AUC, C(max), and T(max). Pulse rate (PR), respiratory rate (R(f)), tidal volume (V(T)), minute volume ventilation (V(E)), end-tidal partial pressure of carbon dioxide (PE'(CO(2))), and mean arterial blood pressure (MAP) were also evaluated. RESULTS: The pharmacokinetic parameters of S- and R-ketamine administered in the racemic mixture or S-ketamine administered separately did not differ significantly. Statistically significant higher AUC and C(max) were found for S-norketamine compared with R-norketamine in the racemic group. Overall, R(f), V(E), PE'(CO(2)), and MAP were significantly higher in the racemic group, whereas PR was higher in the S-ketamine group. CONCLUSIONS: Norketamine enantiomers showed different pharmacokinetic profiles after single i.v. administration of racemic ketamine in ponies anaesthetised with isoflurane in oxygen (1 MAC). Cardiopulmonary variables require further investigation.

Development of Optically Based pH Sensing Hydrogel and Controlled Nitric Oxide Release Polymer

Nitric oxide has the potential to greatly improve intravascular measurements by locally inhibiting thrombus formation and dilating blood vessels. pH, the partial pressure of oxygen, and the partial pressure of carbon dioxide are three arterial blood parameters that are of interest to clinicians in the intensive care unit that can benefit from an intravascular sensor. This work explores fabrication of absorbance and fluorescence based pH sensing chemistry, the sensing chemistries' compatibility with nitric oxide, and a controllable nitric oxide releasing polymer. The pH sensing chemistries utilized various substrates, dyes, and methods of immobilization. Absorbance sensing chemistries used sol-gels, fumed silica particles, mesoporous silicon oxide, bromocresol purple, phenol red, bromocresol green, physical entrapment, molecular interactions, and covalent linking. Covalently linking the dyes to fumed silica particles and mesoporous silicon oxide eliminated leaching in the absorbance sensing chemistries. The structures of the absorbance dyes investigated were similar and bromocresol green in a sol-gel was tested for compatibility with nitric oxide. Nitric oxide did not interfere with the use of bromocresol green in a pH sensor. Investigated fluorescence sensing chemistries utilized silica optical fibers, poly(allylamine) hydrogel, SNARF-1, molecular interactions, and covalent linking. SNARF-1 covalently linked to a modified poly(allylamine) hydrogel was tested in the presence of nitric oxide and showed no interference from the nitric oxide. Nitric oxide release was controlled through the modulation of a light source that cleaved the bond between the nitric oxide and a sulfur atom in the donor. The nitric oxide donor in this work is S-nitroso-N-acetyl-D-penicillamine which was covalently linked to a silicone rubber made from polydimethylsiloxane. It is shown that the surface flux of nitric oxide released from the polymer films can be increased and decreased by increasing and decreasing the output power of the LED light source. In summary, an optical pH sensing chemistry was developed that eliminated the chronic problem of leaching of the indicator dye and showed no reactivity to nitric oxide released, thereby facilitating the development of a functional, reliable intravascular sensor.

Physiological effects of mechanical pain stimulation at the lower back measured by functional near-infrared spectroscopy and capnography

The aim was to investigate the effect of mechanical pain stimulation at the lower back on hemodynamic and oxygenation changes in the prefrontal cortex (PFC) assessed by functional near-infrared spectroscopy (fNIRS) and on the partial pressure of end-tidal carbon dioxide ( PetCO 2) measured by capnography. 13 healthy subjects underwent three measurements (M) during pain stimulation using pressure pain threshold (PPT) at three locations, i.e., the processus spinosus at the level of L4 (M1) and the lumbar paravertebral muscles at the level of L1 on the left (M2) and the right (M3) side. Results showed that only in the M2 condition the pain stimulation elicited characteristic patterns consisting of (1) a fNIRS-derived decrease in oxy- and total hemoglobin concentration and tissue oxygen saturation, an increase in deoxy-hemoglobin concentration, (2) a decrease in the PetCO 2 response and (3) a decrease in coherence between fNIRS parameters and PetCO 2 responses in the respiratory frequency band (0.2-0.5 Hz). We discuss the comparison between M2 vs. M1 and M3, suggesting that the non-significant findings in the two latter measurements were most likely subject to effects of the different stimulated tissues, the stimulated locations and the stimulation order. We highlight that PetCO 2 is a crucial parameter for proper interpretation of fNIRS data in experimental protocols involving pain stimulation. Together, our data suggest that the combined fNIRS-capnography approach has potential for further development as pain monitoring method, such as for evaluating clinical pain treatment.