17 research outputs found
Pathogenesis of chronic Chagas cardiomyopathy: the role of coronary microvascular derangements
No full textThere is ample experimental and clinical evidence of functional and structural microvascular abnormalities occurring in patients with Chagas cardiomyopathy, possibly due to the inflammatory process and/or autonomic disturbances caused by Trypanosoma cruzi infection. Those microvascular derangements are likely to constitute at least an ancillary factor that potentiates and amplifies the chronic inflammation in myocardial tissue. It is possible to devise appropriate therapeutic interventions aimed at reverting or slowing the progression of the microvascular abnormalities to positively affect the natural history of Chagas cardiomyopathy
Avaliação do comportamento de aerogeradores de velocidde fixa e variável integrados em redes elétricas fracas
No full textTese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia Elétrica.Esta tese apresenta propostas para o aumento da margem de estabilidade transitória pós-falta de sistemas elétricos com grande integração de parques eólicos, que incluem o uso do controle do ângulo de passo nos sistemas eólicos de velocidade fixa, e dos geradores assíncronos duplamente excitados com conversores estáticos bidirecionais conectados ao enrolamento do rotor (DFIG) nos esquemas eólicos de velocidade variável. O modelo físico dos parques eólicos, consistindo de um grande número de turbinas eólicas, foi implementado através de uma ferramenta de simulação dinâmica original, desenvolvida no ambiente computacional MATLABTM. O primeiro estágio no processo de simulação foi modelar os componentes individuais do sistema com um grau apropriado de complexidade. Para validação dos modelos desenvolvidos e do software foram realizadas simulações computacionais utilizando uma rede elétrica de distribuição do IEEE, em duas configurações distintas. A partir dos resultados obtidos, foi demonstrado que a estabilidade pós-falta dos aerogeradores pode ser aumentada pela redução temporária da potência mecânica das turbinas nos sistemas eólicos de velocidade fixa. Através do uso do controle do ângulo de passo, o balanço entre os torques mecânico e elétrico é mantido, o que resulta no aumento da estabilidade transitória dos geradores eólicos. Para redes elétricas com grande integração de parques eólicos, é demonstrada a diferença significativa existente entre os comportamentos transitórios dos sistemas eólicos de velocidade variável que adotam o DFIG, em relação aos sistemas eólicos de velocidade fixa com geradores de indução em gaiola. Esta diferença de comportamento se deve à capacidade dos dois reguladores de corrente do rotor do DFIG em controlar o torque elétrico e a potência reativa da máquina eólica. Tal aspecto é claramente observado após a ocorrência de faltas severas na rede, como curto-circuito. É também considerada a influência dos geradores eólicos de velocidade fixa e variável, na margem de estabilidade transitória dos geradores síncronos conectados à rede elétrica.Os resultados apresentados confirmam a eficácia das estratégias de controle adotadas
A dinâmica das capacidades em empresas brasileiras: um estudo no período de 2015 a 2017
No full textThis thesis aims to clarify the relevance of capabilities in explaining the performance of firms in a context of economic crisis following the proposal of a capabilities based theory that has been discussed in the field of business strategy. The joint analysis of dynamic and ordinary capacities is used in different periods of the 2015-2017 triennium and their evolution is also adopted as a way of evaluating the correlations between the four fundamental constructs of the study: (1) dynamic capabilities, (2) ordinary capabilities, (3) performance and (4) dynamics of the external environment. A qualitative study with 85 companies that have formal and informal boards of directors was carried out through the application of a structured questionnaire to professional directors who confirmed themselves as respondents with a high level of training and knowledge. The data analyzes were based on descriptive statistics and the conclusions were complementary to some current studies of relevance. Even in the dynamic environment marked by the Brazilian economic crisis, the levels of ordinary capabilities are well above the levels of dynamic capabilities. In addition, there is evidence of the relevance of dynamic capabilities even in cases with less dynamic external environments and a deficit in the development of dynamic capacities even in companies with higher management level in Brazil. The idea of ambidexterity is strengthened as a mechanism of adaptation and influence on the forces of the environmental selection mechanism, since dynamic and ordinary capacities together could explain the performance of the companies of the sample more effectively than a theory based only on dynamic capabilities.O presente trabalho visa compreender a relevância das capacidades na explicação do desempenho das firmas em um contexto de crise econômica diante das propostas de uma teoria baseada em capacidades que tem se moldado no campo da estratégia empresarial. A análise conjunta de capacidades dinâmicas e ordinárias é utilizada em períodos distintos do triênio 20152017 e a evolução das mesmas é também adotada como forma de se avaliar as correlações entre os 4 construtos fundamentais do estudo: (1) capacidades dinâmicas, (2) capacidades ordinárias, (3) desempenho e (4) dinâmica do ambiente externo. Um estudo qualitativo com 85 empresas que possuem conselhos de administração formais e informais foi realizado por meio da aplicação de questionário estruturado a conselheiros de administração profissionais os quais se confirmaram como respondentes com alto nível de formação e conhecimento. As análises das respostas se basearam em estatísticas descritivas e as conclusões foram complementares a alguns estudos atuais de relevância. Pode-se mostrar que, mesmo no ambiente dinâmico marcado pela crise econômica brasileira, os níveis de capacidades ordinárias são bastante superiores aos níveis de capacidades dinâmicas. Além disso, há indícios da relevância das capacidades dinâmicas mesmo em casos com ambientes externos menos dinâmicos e de um déficit no desenvolvimento das capacidades dinâmicas mesmo em empresas com maior nível gerencial no Brasil. A ideia de ambidestria é fortalecida como mecanismo de adaptação e influência sobre as forças do mecanismo de seleção ambiental, uma vez que capacidades dinâmicas e ordinárias juntas puderam explicar o desempenho das empresas da amostra de forma mais efetiva do que uma teoria pautada apenas nas capacidades dinâmicas
Sustained Ventricular Tachycardia Is Associated with Regional Myocardial Sympathetic Denervation Assessed with (123)I-Metaiodobenzylguanidine in Chronic Chagas Cardiomyopathy
No full textCardiac sympathetic denervation and ventricular arrhythmia are frequently observed in chronic Chagas cardiomyopathy (CCC). This study quantitatively evaluated the association between cardiac sympathetic denervation and sustained ventricular tachycardia (SVT) in patients with CCC. Methods: We prospectively investigated patients with CCC and left ventricular ejection fraction (LVEF) greater than 35% with SVT (SVT group: n = 5 15; mean age +/- SD, 61 +/- 8 y; LVEF, 51% +/- 8%) and patients without SVT (non-SVT group: n = 11; mean age +/- SD, 55 +/- 10 y; LVEF, 57% +/- 10%). Patients underwent myocardial scintigraphy with (123)I-metaiodobenzylguanidine ((123)I-MIBG) for the evaluation of sympathetic innervation and resting perfusion with (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) for the evaluation of myocardial viability. A visual semiquantitative score was attributed for regional uptake of each radiotracer using a 17-segment left ventricular segmentation model (0, normal; 4, absence of uptake). A mismatch defect was defined as occurring in segments with a 99mTc-MIBI uptake score of 0 or 1 and a (123)I-MIBG score of 2 or more. Results: Compared with the non-SVT group, the SVT group had a similar (99m)Tc-MIBI summed score (6.9 +/- 7.5 vs. 4.4 +/- 5.2, respectively, P = 0.69) but a higher (123)I-MIBG summed score (10.9 +/- 7.8 vs. 22.4 +/- 9.5, respectively, P = 0.007) and a higher number of mismatch defects per patient (2.0 +/- 2.2 vs. 7.1 +/- 2.0, respectively, P < 0.0001). The presence of more than 3 mismatch defects was strongly associated with the presence of SVT (93% sensitivity, 82% specificity; P = 0.0002). Conclusion: In CCC, the amount of sympathetically denervated viable myocardium is associated with the occurrence of SVT. Myocardial sympathetic denervation may participate in triggering malignant ventricular arrhythmia in CCC patients with relatively well-preserved ventricular function.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), an official governmental research funding agency for Brazilian investigators[2008/04140-3
Segmentation and Registration Methods in Short Axis Cardiac MRI and SPECT Images in Chagas Disease
No full textNeural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report
No full textAnimal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naive patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety (p < 0.001), reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus (p < 0.001, uncorrected), and increased ECD uptake in the right posterior cingulate gyrus (p < 0.001, uncorrected). These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico`[CNPq-Brazil-554490/2005-6]Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[FAPESP-02/13197-2]CNPq (Brazil)FAPESP (Brazil)THC-Pharm (Frankfurt, Germany)STI-Pharm (Brentwood, UK
Improved Endothelial Function and Reversal of Myocardial Perfusion Defects after Aerobic Physical Training in a Patient with Microvascular Myocardial Ischemia
No full textThe objective of this report is to document the effects of an aerobic training program on myocardial perfusion, and endothelial function abnormalities, and on the relief of angina in a patient with microvascular myocardial ischemia. A 53-year-old female patient exhibited precordial pain on effort and angiographically normal coronaries. Her symptoms had been present for 4 yrs despite pharmacologic treatment for the control of risk factors, with myocardial perfusion scintigraphy revealing an extensive reversible perfusion defect. She was submitted to aerobic training for 4 mos, obtaining significant improvement of the anginal symptoms. Additionally, after the aerobic training program, scintigraphy revealed the disappearance of the myocardial perfusion defect, with a marked improvement of endothelium-dependent vasodilatory response and an improved quality-of-life score. These results suggest that aerobic training can improve endothelial function, leading to a reduction of ischemia and an improved quality-of-life in patients with microvascular myocardial ischemia.FAPESP[08/04140-3
Evaluation of hepatobiliary excretion and enterobiliary reflux in rats with biliary obstruction submitted to bilioduodenal or biliojejunal anastomosis
No full textBilioduodenal and biliojejunal anastomoses are effective for the treatment of biliary obstruction. The objective of this study was to compare the effects of these anastomoses on hepatobiliary excretion and enterobiliary reflux. Enterobiliary reflux and biliary excretion were evaluated respectively after oral administration of technetium (Tc-99m) in combination with sodium phytate and intravenous infusion of Tc-99m with diisopropyl-iminodiacetic acid. Enterobiliary reflux occurred to an equal degree in the bilioduodenal and biliojejunal groups. Maximum hepatic activity time (T-max) and radiotracer clearance half-time (T-1/2) were similar in both groups. However, when compared with that found for the sham-operated group, T-max, and T-1/2 were higher in the biliojejunal group (P = 0.02 and P = 0.01, respectively). Histopathological analysis showed marked reduction in ductal proliferation in both groups. These data undermine the theoretical advantages attributed to biliojejunal anastomosis and further the understanding of the pathophysiology of cholangitis that occurs even with patent anastomosis
Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI).
No full textpeer reviewedAims: To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Methods and results: Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Prompt and correct diagnosis of Chagas disease requires specialized clinical expertise to recognize the unique features of this disease. The appropriate and efficient use of cardiac imaging is pivotal for diagnosing the cardiac involvement in Chagas disease, to stage the disease, assess patients' prognosis and address management. Echocardiography is the most common imaging modality used to assess, and follow-up patients with Chagas disease. The presence of echocardiographic abnormalities is of utmost importance, since it allows to stage patients according to disease progression. In early stages of cardiac involvement, echocardiography may demonstrate segmental left ventricuar wall motion abnormalities, mainly in the basal segments of inferior, inferolateral walls, and the apex, which cannot be attributed to obstructive coronary artery arteries. The prevalence of segmental wall motion abnormalities varies according to the stage of the disease, reaching about 50% in patients with left ventricular dilatation and dysfunction. Speckle tracking echocardiography allows a more precise and quantitative measurement of the regional myocardial function. Since segmental wall motion abnormalities are frequent in Chagas disease, speckle tracking echocardiography may have an important clinical application in these patients, particularly in the indeterminate forms when abnormalities are more subtle. Speckle tracking echocardiography can also quantify the heterogeneity of systolic contraction, which is associated with the risk of arrhythmic events. Three-dimensional (3D) echocardiography is superior to conventional two-dimensional (2D) echocardiography for assessing more accurately the left ventricular apex and thus to detect apical aneurysms and thrombus in patients in whom ventricular foreshortening is suspected by 2D echocardiography. In addition, 3D echocardiography is more accurate than 2D Simpson s biplane rule for assessing left ventricular volumes and function in patients with significant wall motion abnormalities, including aneurysms with distorted ventricular geometry. Contrast echocardiography has the advantage to enhancement of left ventricular endocardial border, allowing for more accurate detection of ventricular aneurysms and thrombus in Chagas disease. Diastolic dysfunction is an important hallmark of Chagas disease even in its early phases. In general, left ventricular diastolic and systolic dysfunction coexist and isolated diastolic dysfunction is uncommon but may be present in patients with the indeterminate form. Right ventricular dysfunction may be detected early in the disease course, but in general, the clinical manifestations occur late at advanced stages of Chagas cardiomyopathy. Several echocardiographic parameters have been used to assess right ventricular function in Chagas disease, including qualitative evaluation, myocardial performance index, tissue Doppler imaging, tricuspid annular plane systolic excursion, and speckle tracking strain. Cardiac magnetic resonance (CMR) is useful to assess global and regional left ventricular function in patients with Chagas diseases. Myocardial fibrosis is a striking feature of Chagas cardiomyopathy and late gadolinium enhancement (LGE) is used to detect and quantify the extension of myocardial fibrosis. Myocardial fibrosis might have a role in risk stratification of patients with Chagas disease. Limited data are available regarding right ventricular function assessed by CMR in Chagas disease. Radionuclide ventriculography is used for global biventricular function assessment in patients with suspected or definite cardiac involvement in Chagas disease with suboptimal acoustic window and contraindication to CMR. Myocardial perfusion scintigraphy may improve risk stratification to define cardiac involvement in Chagas disease, especially in the patients with devices who cannot be submitted to CMR and in the clinical setting of Chagas patients whose main complaint is atypical chest pain. Detection of reversible ischemic defects predicts further deterioration of left ventricular systolic function and helps to avoid unnecessary cardiac catheterization and coronary angiography. Conclusion: Cardiac imaging is crucial to detect the cardiac involvement in patients with Chagas disease, stage the disease and stratify patient risk and address management. Unfortunately, most patients live in regions with limited access to imaging methods and point-of-care, simplified protocols, could improve the access of these remote populations to important information that could impact in the clinical management of the disease. Therefore, there are many fields for further research in cardiac imaging in Chagas disease. How to better provide an earlier diagnosis of cardiac involvement and improve patients risk stratification remains to be addressed using different images modalities
Patients with multiple sclerosis do not necessarily consume more alcohol or tobacco than the general population
No full textPeer reviewe
