Retiro de dispositivo de oclusión septal transcateterismo en una paciente con comunicación interventricular / Removal of Transcatheter Septal Occlusion Device in a Patient with Ventricular Septal Defect

Introducción: Las complicaciones asociadas al procedimiento de colocación de un dispositivo de oclusión septal se presentan en menos del 10 por ciento de los casos. La embolización requiere de cirugía cardíaca, por lo que se incrementa el riesgo de la mortalidad. Objetivo: Presentar el caso en una paciente con comunicación interventricular e hipertensión pulmonar severa que se le retiró el dispositivo de oclusión septal transcateterismo. Presentación de caso: Se presentó una mujer de 24 años de edad con comunicación interventricular, insuficiencia cardíaca (New York Heart Association) clase IV e hipertensión pulmonar tipo 2, que se programó para la colocación de dispositivo de oclusión septal, sin embargo, presentó fallo en la colocación del dispositivo y defecto residual de 7 mm, por lo que se realizó el retiro de este 48 h después sin presentar complicaciones. Conclusiones: Aunque el cierre transcateterismo de la comunicación interventricular es una alternativa segura y efectiva a la cirugía, no está exento de complicaciones. En caso de translocación del dispositivo de oclusión septal este debe ser retirado durante el mismo procedimiento, ya que el riesgo de embolización es elevado y en caso de presentarse, el riesgo de muerte se incrementa(AU)

Introduction: Complications associated with the placement procedure of a septal occlusion device occur in less than 10percent of cases. Embolization requires cardiac surgery, which increases the risk of mortality. Objective: To report the case of a patient with ventricular septal defect and severe pulmonary hypertension who had the transcatheter septal occlusion device removed. Case report: We report the case report of a 24-year-old woman with ventricular septal defect, heart failure (New York Heart Association) class IV and type 2 pulmonary hypertension. She was scheduled for placement of a septal occlusion device, however, the placement of the device failed and had a residual defect of 7 mm, so the placement was removed 48 hours later without complications. Conclusions: Although transcatheter closure of the ventricular septal defect is a safe and effective alternative to surgery, it is not free of complications. In case of translocation of the septal occlusion device, it must be removed during the same procedure, since the risk of embolization is high and if it occurs, the risk of death increases(AU)

Cross-cultural validation of a questionnaire to assess spinal pain in children / Validação transcultural de um questionário de avaliação da dor na coluna em crianças / Validación transcultural de un cuestionario para evaluar el dolor de espalda en niños

ABSTRACT Objective: To validate the cross-cultural adaptation of the English version of theYoung Spine Questionnaire (YSQ) to Portuguese. The questionnaire enables the evaluation, in children, of back pain prevalence and frequency, restrictions on activity, care-seeking behavior, and the influence that the parents' manifestations of back pain can have. Method: The research was conducted in a school setting, with a sample of 128 children aged 9 to 12 years (63 males and 65 females). The questionnaire was completed at two different moments. Test-retest reliability was used to evaluate the degree of reproducibility, and the intraclass correlation coefficient (ICC) between the two sets of observed values was estimated for p<0.05. Cronbach's alpha coefficient was used to assess the degree of reliability (internal consistency) of the questionnaire. Results: For most of questions, the ICC ranged between 0.527 and 0.870, with reasonable to excellent correlation to the reproducibility index. The exceptions were foritem c) in two of the first three questions, where the ICC values (0.149 and 0.277) were lower. The value of Cronbach's alpha calculation was 0.8, indicating high internal consistency. Conclusion: It was demonstrated that the cross-cultural adaptation of the YSQ had content validity, was well-understood, and suitable for use in studies with Portuguese children between 9 and 12 years of age. Level of evidence II; Development of diagnostic criteria.

RESUMO: Objetivo: Objetivo: Validar a adaptação transcultural da versão inglesa do "The Young Spine Questionnaire" (YSQ), para a língua portuguesa. O questionário permite avaliar, em crianças, a taxa de prevalência e a frequência de dor na coluna, as restrições de atividade, o comportamento de procura de cuidados e a influência que pode ter a dor de coluna manifestada pelos pais. Método: A pesquisa foi realizada em contexto escolar, com uma amostra de 128 crianças dos 9 aos 12 anos (63 do sexo masculino e 65 do sexo feminino). O questionário foi preenchido em dois momentos distintos. Para avaliar o seu grau de reprodutibilidade utilizou-se o Teste-Reteste, estimando-se o coeficiente de correlação intraclasse (ICC) entre os dois conjuntos de valores observados, para p<0,05. Também se recorreu ao coeficiente Alfa de Cronbach, para encontrar o grau de confiabilidade (consistência interna) do questionário. Resultados: Na maioria das questões o intervalo do ICC situou-se entre 0,527 e 0,870, correspondente a uma correlação situada entre razoável a excelente para índice de reprodutibilidade. A exceção foram dois dos itens c) das três primeiras questões, em que o ICC apresentou valores inferiores (0,149 e 0,277). O valor do cálculo do Alfa de Cronbach resultou em 0,8, apresentando elevada consistência interna. Conclusão: Ficou demonstrado que a adaptação transcultural do YSQ tem validade de conteúdo e é bem compreendida para ser utilizada em estudos com crianças portuguesas dos 9 aos 12 anos de idade. Nível de evidência II; Desenvolvimento de critérios de diagnóstico.

RESUMEN: Objetivo: Validar la adaptación transcultural de la versión inglesa del "The Young Spine Questionnaire" (YSQ) al portugués. El cuestionario permite evaluar, en los niños, la tasa de prevalencia y frecuencia del dolor de espalda , las restricciones de actividad, el comportamiento de búsqueda de atención y la influencia que puede tener el dolor de espalda manifestado por los padres. Método: La investigación se llevó a cabo en un entorno escolar, con una muestra de 128 niños de 9 a 12 años (63 niños y 65 niñas). El cuestionario se completó en dos momentos diferentes. Para evaluar su grado de reproducibilidad, se utilizó el "Test-Retest", estimando el coeficiente de correlación intraclase (CCI) entre los dos conjuntos de valores observados, para p <0,05. También se utilizó el coeficiente Alfa de Cronbach, para conocer el grado de confiabilidad (consistencia interna) del cuestionario. Resultados: En la mayoría de las preguntas, el CCI osciló entre 0,527 y 0,870, lo que corresponde a una correlación situada entre razonable y excelente para el índice de reproducibilidad. Las excepciones fueron dos de los ítems c) de las tres primeras preguntas, donde el ICC mostró valores más bajos (0,149 y 0,277). El valor del cálculo del Alfa de Cronbach dio como resultado 0,8, lo que demuestra una alta consistencia interna. Conclusión: Se demostró que la adaptación transcultural del YSQ tiene validez de contenido y es adecuada para ser utilizada en estudios con niños portugueses de entre 9 y 12 años. Nivel de evidencia II; Desarrollo de criterios diagnósticos.

Mental health and coping strategies in graduate students in the COVID-19 pandemic.

OBJECTIVE: to verify the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19). METHOD: an electronic cross-sectional and correlational survey was conducted with 331 Brazilian graduate students, aged 20-64 years old, who answered an online form containing a sociodemographic data questionnaire, a coping strategies scale, and the DASS-21 scale. Descriptive analysis, Mann-Whitney U or Kruskal-Wallis tests, and Spearman's correlation were performed. RESULTS: the main results indicated that maintaining work and study routines, as well as a religious practice, is correlated with lower scores of depression, anxiety, and stress symptoms, as well as with coping strategies that can act as protective factors. CONCLUSION: the new coronavirus pandemic has strained public health and increased the need for studies aimed at understanding the impact of the event on the mental health of the population. It is suggested that employment and religiousness should be considered in interventions with graduate students.

Mental health and coping strategies in graduate students in the COVID-19 pandemic / Salud mental y estrategias de afrontamiento en estudiantes de postgrado durante la pandemia de COVID-19 / Saúde mental e estratégias de coping em pós-graduandos na pandemia da COVID-19

Objective: to verify the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19). Method: an electronic cross-sectional and correlational survey was conducted with 331 Brazilian graduate students, aged 20-64 years old, who answered an online form containing a sociodemographic data questionnaire, a coping strategies scale, and the DASS-21 scale. Descriptive analysis, Mann-Whitney U or Kruskal-Wallis tests, and Spearman's correlation were performed. Results: the main results indicated that maintaining work and study routines, as well as a religious practice, is correlated with lower scores of depression, anxiety, and stress symptoms, as well as with coping strategies that can act as protective factors. Conclusion: the new coronavirus pandemic has strained public health and increased the need for studies aimed at understanding the impact of the event on the mental health of the population. It is suggested that employment and religiousness should be considered in interventions with graduate students.

Objetivo: verificar la relación de los síntomas de depresión, ansiedad y estrés con las estrategias de afrontamiento en estudiantes de postgrado en el contexto de la pandemia ocasionada por el nuevo coronavirus (COVID-19). Método: se realizó un estudio electrónico de investigación transversal y correlacional con 331 estudiantes de postgrado brasileños de 20 a 64 años de edad, que respondieron un formulario en línea que incluía un cuestionario sobre datos sociodemográficos, una escala de estrategias de afrontamiento y la escala DASS-21. Se realizó un análisis descriptivo, al igual que las pruebas U de Mann-Whitney, de Kruskal-Wallis y de correlación de Spearman. Resultados: los resultados principales indicaron que mantener rutinas de trabajo y estudio, al igual que profesar una religión, están correlacionados con puntajes más bajos en términos de síntomas de depresión, ansiedad y estrés, al igual que con estrategias de afrontamiento que pueden servir como factores de protección. Conclusión: la pandemia ocasionada por el nuevo coronavirus ha sobrecargado a la salud pública e incrementado la necesidad de estudios dirigidos a comprender el efecto del fenómeno sobre la salud mental de la población. Se sugiere que tener empleo y profesar una religión deberían ser factores a considerar en intervenciones con estudiantes de postgrado.

Objetivo: verificar a relação entre sintomas de depressão, ansiedade, estresse e as estratégias de coping em pós-graduandos no contexto da pandemia do novo coronavírus (COVID-19). Método: pesquisa eletrônica transversal e correlacional conduzida com 331 estudantes de pós-graduação brasileiros, com idades entre 20 e 64 anos que responderam a um formulário online contendo um questionário de dados sociodemográficos, uma escala de estratégias de coping e a escala DASS-21. Foram realizadas análises descritivas, análises U de Mann-Whitney ou Kruskal-Wallis e análises de correlação Spearman. Resultados: os principais resultados indicaram que a manutenção de uma rotina laboral e de estudos, bem como a prática religiosa estão correlacionadas a menores escores de sintomas de depressão, ansiedade e estresse, bem como com estratégias de enfrentamento que podem funcionar como fatores protetivos. Conclusão: a pandemia do novo coronavírus prejudicou a saúde pública e aumentou a necessidade de estudos voltados para a compreensão do impacto desse evento na saúde mental da população. Sugere-se que a inserção no mercado de trabalho e a religiosidade sejam consideradas em intervenções com pós-graduandos.

Epigallocatechin 3-Gallate Has a Neuroprotective Effect in Retinas of Rabbits with Ischemia/Reperfusion through the Activation of Nrf2/HO-1.

Retinal ischemia-reperfusion (rI/R) generates an oxidative condition causing the death of neuronal cells. Epigallocatechin 3-gallate (EGCG) has antioxidant and anti-inflammatory properties. Nonetheless, its correlation with the pathway of nuclear factor erythroid 2-related factor 2/heme oxygenase-1 (Nrf2/HO-1) for the protection of the retina is unknown. We aimed to evaluate the neuroprotective efficacy of single-doses of EGCG in rI/R and its association with Nrf2/Ho-1 expression. In albino rabbits, rI/R was induced and single-doses of EGCG in saline (0-30 mg/kg) were intravenously administered to select an optimal EGCG concentration that protects from retina damage. To reach this goal, retinal structural changes, gliosis by glial fibrillary acidic protein (GFAP) immunostaining, and lipid peroxidation level by TBARS (thiobarbituric acid reactive substance) assay were determined. EGCG in a dose of 15 mg/kg (E15) presented the lowest levels of histological damage, gliosis, and oxidative stress in the studied groups. To determine the neuroprotective efficacy of E15 in a timeline (6, 24, and 48 h after rI/R), and its association with the Nrf2/HO-1 pathway, the following assays were done by immunofluorescence: apoptosis (TUNEL assay), necrosis (high-mobility group box-1; HMGB1), Nrf2, and HO-1. In addition, the Ho-1 mRNA (qPCR) and lipid peroxidation levels were evaluated. E15 showed a protective effect during the first 6 h, compared to 24 and 48 h after rI/R, as revealed by a decrease in the levels of all damage markers. Nuclear translocation Nrf2 and HO-1 staining were increased, including Ho-1 mRNA levels. In conclusion, a single dose of E15 decreases the death of neuronal cells induced by oxidative stress during the first 6 h after rI/R. This protective effect is associated with the nuclear translocation of Nrf2 and with an elevation of Ho-1 expression.

Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil / Conhecimento e uso do cigarro eletrônico entre estudantes da Universidade Federal de Mato Grosso

ABSTRACT Objective: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. Methods: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. Results: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. Conclusions: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use.

RESUMO Objetivo: Analisar a prevalência do conhecimento e experimentação do cigarro eletrônico (CE) entre universitários, bem como as características associadas ao conhecimento desse tipo de dispositivo. Métodos: Estudo transversal, utilizando-se questionário específico, onde foram entrevistados 489 estudantes da Universidade Federal de Mato Grosso (Campus Cuiabá) no ano de 2015. Estimou-se a prevalência e foram analisadas as principais características relacionadas ao conhecimento e uso do CE. Resultados: A prevalência de conhecimento do CE foi de 37%, e a taxa de experimentação foi de 2,7%. Verificou-se associação entre o conhecimento do CE com o estado civil, estado laboral do estudante, nível de escolaridade dos pais e presença de fumantes na família. Conclusões: Foi alta a proporção de universitários que conhecem o CE. Apesar de ser pequena a prevalência dos que o experimentaram, torna-se preocupante um possível aumento do consumo desse tipo de dispositivo. Medidas devem ser direcionadas aos jovens dentro das instituições universitárias a fim de promover a conscientização e prevenção do uso do CE.

Electronic cigarette awareness and use among students at the Federal University of Mato Grosso, Brazil.

OBJECTIVE: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. METHODS: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. RESULTS: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. CONCLUSIONS: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use.

Fatty acid extraction from sewage sludge using a porous polyethylene sorbent obtained from agricultural covers.

Fatty acids from a sewage sludge of a wastewater treatment plant were extracted using a porous polyethylene (pPE) material prepared using agricultural plastic films. The pPE fatty acid extraction profile and yield from the sewage sludge was compared to toluene as extraction solvent. The chemical composition of the extracted fatty acids were the same in both cases, but when the extraction yield was normalized by the used mass of pPE or toluene, pPE resulted six times more efficient than toluene. The pPE bulk density and porosity obtained using different biodiesel:vegetable oil mixtures ranged between 0.24 g cm-3-0.40 g cm-3 and 58-74%, respectively. Critical surface tension of the pPE was (26.9 ±â€¯1.8) dyn cm-1 while for the original polyethylene film it was (19.9 ±â€¯3.1) dyn cm-1. Biodiesel and oleic acid were used as models of hydrophobic substances for extraction studies. pPE Maximum sorption capacities were: 6.8 g biodiesel g-1 pPE and 9.7 g oleic acid g-1 pPE. Sorption capacity remained practically constant after ten biodiesel sorption/extraction cycles. Pesticide (trifluralin) residues in the pPE were analyzed to assure that xenobiotic presence can be removed during the manufacturing process, finding that less than 0.84% of an initially present pesticide remained in the pPE.

Maitotoxin Is a Potential Selective Activator of the Endogenous Transient Receptor Potential Canonical Type 1 Channel in Xenopus laevis Oocytes.

Maitotoxin (MTX) is the most potent marine toxin known to date. It is responsible for a particular human intoxication syndrome called ciguatera fish poisoning (CFP). Several reports indicate that MTX is an activator of non-selective cation channels (NSCC) in different cell types. The molecular identity of these channels is still an unresolved topic, and it has been proposed that the transient receptor potential (TRP) channels are involved in this effect. In Xenopus laevis oocytes, MTX at picomolar (pM) concentrations induces the activation of NSCC with functional and pharmacological properties that resemble the activity of TRP channels. The purpose of this study was to characterize the molecular identity of the TRP channel involved in the MTX response, using the small interference RNA (siRNA) approach and the two-electrode voltage-clamp technique (TEVC). The injection of a specifically designed siRNA to silence the transient receptor potential canonical type 1 (TRPC1) protein expression abolished the MTX response. MTX had no effect on oocytes, even at doses 20-fold higher compared to cells without injection. Total mRNA and protein levels of TRPC1 were notably diminished. The TRPC4 siRNA did not change the MTX effect, even though it was important to note that the protein level was reduced by the silencing of TRPC4. Our results suggest that MTX could be a selective activator of TRPC1 channels in X. laevis oocytes and a useful pharmacological tool for further studies on these TRP channels.

Human and soil exposure during mechanical chlorpyrifos, myclobutanil and copper oxychloride application in a peach orchard in Argentina.

The objective of this study was to measure the impact of the mechanized chlorpyrifos, copper oxychloride and myclobutanil application in a small peach orchard, on humans (operators, bystanders and residents) and on the productive soil. The mean Potential Dermal Exposure (PDE) of the workers (tractor drivers) was 30.8mL·h-1±16.4mL·h-1, with no specific pesticide distribution on the laborers body. Although the Margin of Safety (MOS) factor for the application stage were above 1 (safe condition) for myclobutanil and cooper oxycloride it was below 1 for chlorpyrifos. The mix and load stage remained as the riskier operation. Pesticide found on the orchard soil ranged from 5.5% to 14.8% of the total chlorpyrifos, copper oxychloride and myclobutanil applied. Pesticide drift was experimentally measured, finding values in the range of 2.4% to 11.2% of the total pesticide applied. Using experimental drift values, bystander (for one application), resident (for 20 applications) and earthworm (for one application) risk indicators (RIs) were calculated for the chlorpyrifos plus copper oxychloride and for myclobutanil treatments for different distances to the orchard border. Earthworm RI was correlated with experimental Eisenia andrei ecotoxicological assays (enzymatic activities: cholinesterases, carboxylesterases and glutathione S-transferases; behavioral: avoidance and bait-lamina tests) with good correlation.

Reduction of no-reflow and reperfusion injury with the synthetic 17ß-aminoestrogen compound Prolame is associated with PI3K/Akt/eNOS signaling cascade.

A high proportion of primary percutaneous coronary interventions performed in the setting of acute myocardial infarction, concur with inadequate myocardial perfusion at the microvascular level. This phenomenon, known as "no-reflow" contributes to reperfusion injury, poor prognosis and to unfavorable clinical outcome. In this study, we evaluated the hypothesis that the synthetic 17ß-aminoestrogen Prolame, may confer cardioprotection and prevent against no-reflow. In an open-chest model of 30-min ischemia and 90-min reperfusion, male Wistar rats were randomly assigned to different groups: Control, Prolame, Prolame followed by the nitric oxide synthase inhibitor (L-NAME), and 17ß-estradiol. Areas of risk, infarct size and no-reflow were determined by planimetry with triphenyltetrazolium chloride and thioflavin-S stains. Structural damage of the vasculature was measured as capillary compression in clarified tissue after intra-atrial injection of Microfil. Hemodynamic function was obtained at the end of stabilization, ischemia and reperfusion; nitric oxide (NO·) content was determined indirectly using the Griess reaction. Activation of the eNOS signaling cascade was determined by western blot. Prolame reduced the infarcted area, decreased the zones of no-reflow and capillary compression by activating the PI3K/Akt/eNOS signaling pathway in correlation with NO· increase. Prolame also activated endothelial cells augmenting NO· production, which was inhibited by ICI182780 (a selective estrogen receptor down-regulator), supporting the notion that the cardioprotective effect of Prolame involves the preservation of endothelium through the activation of estrogen receptor downstream signaling. Our results provide evidence that Prolame has potential therapeutic application in patients with AMI, as it prevents from both vascular and cardiac tissue damage.

Arrhythmogenic effect of a crude extract from sea anemone Condylactis gigantea: possible involvement of rErg1 channels.

Sea anemones possess a number of peptide toxins that target ion channels which provide powerful tools to study the molecular basis of diverse signaling pathways. It is also acknowledged that currents through Erg1 K(+) channels in cardiac myocytes are important for electrical stability of the heart and alterations in its activity has been linked to the onset of a potentially life-threatening heart condition named long QT syndrome type 2. Here, we report that a crude extract from sea anemone Condylactis gigantea significantly increases the QT interval and has arrhythmogenic effects in the rat heart. Furthermore, a bioassay-guided purification procedure allowed the isolation of a chromatographic fraction containing a major component with a molecular mass of 4478 Da from the crude extract, which causes a significant inhibition of whole-cell patch-clamp currents through recombinant Erg1 channels, responsible of the rapid delayed rectifying current crucial for electrical activity in the heart. Further studies could provide relevant information on the molecular mechanism of C. gigantea peptide toxins which represent promising tools in studying the physiology of diverse ion channels.

Effect of glycine on the cyclooxygenase pathway of the kidney arachidonic acid metabolism in a rat model of metabolic syndrome.

The kidneys are organs that can be severely impaired by metabolic syndrome (MS). This is characterized by the association of various pathologies such as hypertension, dyslipidemia, and type-2 diabetes. Glycine, a nonessential amino acid, is known to possess various protective effects in the kidney, such as a decrease in the deterioration of renal function and a reduction of the damage caused by hypoxia. In a rat model of MS, the effect of glycine on the cyclooxygenase (COX) pathway of arachidonic acid (AA) metabolism was studied in isolated perfused kidney. MS was induced in Wistar rats by feeding them a 30% sucrose solution for 16 weeks. The addition of 1% glycine to their drinking water containing 30% sucrose, for 8 weeks, reduced high blood pressure, triglyceride levels, insulin concentration, homeostatis model assessment (HOMA) index, albuminuria, AA concentration in kidney homogenate, renal perfusion pressure, prostaglandin levels, PLA2 expression, and COX isoform expression, compared with MS rats that did not receive the glycine supplement. Glycine receptor expression decreased significantly with MS, but glycine treatment increased it. The results suggest that in the MS model, 1% glycine treatment protects the kidney from damage provoked by the high sucrose consumption, by acting as an anti-inflammatory on the COX pathway of AA metabolism in kidney.

Method to observe hemodynamic and metabolic changes during hemodiafiltration therapy with exercise.

Intradyalitic exercise programas are important to improve patient's hemodynamic stability. Blood pressure and metabolic changes are correlated when heat accumulation is due to increment of the body core temperature (+1.0 °C). However, increase in temperature could be controlled by lowering dialysate's temperature using two main modalities techniques (isothermic and thermoneural) with different patient's thermal balance consequences, not yet well studied. In this work, a new method to observe the main physiological parameters (hearth rate variability (HRV), blood pressure, BTM dialysate temperature control and substrate utilization by indirect calorimtery) which are involved in hemodiafitration (HDF), are displayd. An experiment was carried out in a group of 5 patients waiting kidney transplant. In each patient, EE was assessed as well as the HRV during isothermic and thermoneutral modalities as a manner of cross and prospective study (a) at before therapy, (b) during therapy and (c) at the end of the HDF therapy. Power extraction was also measured by a BTM (Blood Temperature Monitor from Fresenius Inc), in order to determine how the dialysate temperature was controlled. The results showed important method's advantages which place the BTM performance as unstable control system with the possibility to produce undesirable HRV changes as the vagotonical response. However more patient cases are needed in order to identify the real advantage of this new method.

Active metabolic weight estimation using bioimpedance, indirect calorimetry and the clino-ortho maneuver.

The resting energy expenditure (REE) and substrate utilization are computed by indirect calorimetry technique (ICT). The REE represents 80-85% of the total energy expenditure (TEE) but only accounts for the 7% of the actual body weight (ABW). The TEE is produced by the organs plus muscles, whereas the REE accounts only for the main organs. An important problem comes up when the REE is computed throughout the fat free mass (FFM) computation or anthropometric measurements because they do not explain the tremendous catabolic variability by ICT when subjects show the same body composition. Therefore, the aim of this work is to develop a method to compute the metabolic active weight (MAW) as a new form that may help to understand the catabolic activity of the body composition. The premise was the clino-ortho maneuver can split the ABW in two parts: one in which the MAW reflects the FFM catabolism while the second part was not considered since there is not energy requirement in it. The experiment design studied 37 young volunteers undergoing the clino-ortho maneuver during fast and postprandial conditions. The results showed REE increments of 21% during phase I (fast), while in phase II (postprandial) only 14% was achieved in ortho-postprandial. Therefore, the computed MAWs were 65.5Kg and 58Kg, respectively, when the ABW average was 70 Kg and the FFM was 50 Kg. One first conclusion was that the 15.5 Kg of the MAW above the FFM could explain a catabolic equivalence which can be exclusively related to the fast-ortho position which can help to classify exclusively the dynamic over activity of the FFM.