Orientador: Marcone Lima Sobreira / Resumo: Introdução: A Síndrome de Klippel Trenaunay (SKT) é uma anomalia vascular caracterizada por ser uma doença rara, com prevalência estimada em 1 caso para cada 100.000 pessoas, diagnosticada clinicamente pela presença de pelo menos dois dos seguintes achados: malformação capilar, malformações venosas e hipertrofia dos tecidos afetados. A literatura científica respalda o manejo dos sintomas e tratamento das veias varicosas em alguns casos selecionados. A melhor abordagem terapêutica é crucial para esses pacientes, tornando-se necessário o melhor conhecimento da história natural da doença, o que justifica o estudo do perfil genético desses pacientes, visto que alguns autores revelaram o papel crucial dos microRNAs na regulação da angiogênese, que parece ser o ponto-chave da SKT. Objetivos: Determinar o perfil global de expressão de miRNA’s em pacientes com SKT em comparação com amostras de sangue de pessoas saudáveis, sem a síndrome. Métodos: A amostra foi constituída por pacientes adultos (> 18 anos) com diagnóstico clínico de SKT, acompanhados no Ambulatório de Malformações Vasculares do Serviço de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Botucatu da Faculdade de Medicina de Botucatu/ UNESP. Como referência, foram utilizadas amostras de sangue de adultos saudáveis (> 18anos), doadores de sangue do Hemocentro da Faculdade de Medicina de Botucatu/ UNESP Botucatu. Resultados: Entre os pacientes com SKT, foram encontrados 3 miRNA com expressão diminuída em compa... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Klippel Trenaunay Syndrome (KTS) is a vascular malformation characterized by being a rare disease, with a prevalence estimated in 1 case per 100,000 people, diagnosed clinically by the presence of at least two of the following findings: capillary malformation, venous malformations, and hypertrophy of affected tissues. The scientific literature supports the management of symptoms, treatment of varicose veins in selected cases and, rarely, amputations. The best therapeutic approach is crucial for these patients, making it necessary to have a better knowledge of the natural history of the disease, which justifies the study of the genetic profile of these patients, since some authors have revealed the crucial role of microRNAs in the regulation of angiogenesis, which seems to be the key point of KTS. Objectives: To determine the overall expression profile of miRNA’s in patients with KTS compared to blood samples from healthy people without the syndrome. Methods: The sample consisted of adult patients (> 18 years) with clinical diagnosis of KTS, followed at the Vascular Malformation Outpatient Service of the Vascular and Endovascular Surgery Service of Botucatu Medical School, Botucatu Medical School / UNESP. Blood samples from healthy adults (> 18 years old), blood donors from the Botucatu Medical School / UNESP Botucatu Blood Center were used as reference. Results: Among the patients with SKT, 3 miRNA’s with decreased expression were found compared to subjects with... (Complete abstract click electronic access below) / Doutor

Dissertation (MD)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Acute renal failure still is, with the exception of cardiac deaths, the most important pathological process associated with perioperative mortality in patients operated for abdominal aortic aneurysms. The intraoperative change in renal blood flow (RBF) and glomerular function have been investigated in human and animal models, particularly over the past 15 years. Despite large variation in study populations, measurement techniques and study designs in general, a significant body of evidence has developed which suggests infrarenal aortic clamp-induced renal ischemia to be the cause of postoperative acute renal failure when this complication does occur. It is rather surprizing then that, despite some recent studies which have reported on various pharmacological interventions to prevent intraoperative renal ischemia (with variable success), very little has apparently been done to unravel the pathogenesis and exact pathophysiology of this potentially lethal complication. Although a number of investigators suggest the possibility of hormonal involvement (particularly reninangiotensin, antidiuretic hormone (ADH) and catecholamines) in the process, the exact role of these mediators have not been explored (or reported) in a structured fashion. In an initial human study, renal hemodynamics and function were measured from the preoperative period, during the intraoperative phase and at least until 4 hours after aortic unclamping. To investigate the possibility of a temporal relationship between renal changes and fluctuations in hormonal concentrations, plasma concentrations of relevant hormones were determined at every sampling period where renal parameters were measured. The decrease in RBF and glomerular filtration rate (GFR) which we demonstrated to coincide with infrarenal aortic cross clamping, is consistent with results previously published. We demonstrated persistence of the impairment of these parameters as long as 4 hours into the postoperative phase; which has previously only been reported for the period until immediately after aortic unclamping with the abdomen still open. The persistence of a depressed GFR until the time of discharge of patients is cause for concern, particularly in patients with compromised renal function prior to surgery. Of the measured hormones with a potential influence on RBF and nephron function, renin was the only mediator where changes in plasma concentrations coincided with the depression of RBF and GFR after aortic cross clamping. The design of our study did not allow us to conclude whether the concomitant increase in angiotensin II was primarily responsible for the change in renal hemodynamics, or whether the raised renin (and angiotensin) levels were stimulated by the decrease in RBF induced by another mechanism. In another patient group, we demonstrated that the combination of mannitol and dopamine provided no protection against the deleterious effects of aortic cross clamping. In fact, the high urine volumes produced under the influence of these agents (which did not correlate with RBF at the corresponding periods), is likely to prompt a false sense of security. Given the lack of any objective benefit afforded by these agents, their use in these clinical circumstances should be discouraged. The animal studies were aimed at elucidation of the exact role of angiotensin in the pathogenesis and pathophysiology of the renal changes associated with infrarenal aortic clamping, as well as the interaction of angiotensin with other modulators for which an interactive relationship had been described previously under other experimental and/or clinical circumstances. The first study showed that, although renin (and thus angiotensin) concentrations were high after aortic unclamping, the hormone had no pathogenic or pathophysiological role of significance in the observed renal changes during this period (since blocking angiotensin II activation by the prevention of renin release, or by inhibiting the conversion enzyme, did not prevent a substantial decrease in RBF or GFR during that period). Preventing angiotensin II activation did, however, prevent renal changes during aortic clamping. This beneficial effect did not establish a primary role for angiotensin during that period, since the favourable influence could also (at least partially) be explained by prevention of the permissive influence of angiotensin on other vasoconstrictors and/or other vasodilatory influences of ACE inhibition and [1- blockade which are unrelated to angiotensin. This study did indicate that (at least partially) different mechanisms are responsible for the renal changes seen during aortic clamping, and after aortic unclamping. The second study explored the role of calcium in the renal pathophysiological changes during aortic clamping and after unclamping. The protective influence effected by the administration of a Ca2 + -blocker suggest the dependence of the renal vasoconstrictive and glomerular pathophysiological process( es) on the cellular influx of Ca2 + through voltage-gated channels. It unfortunately provides no definitive insight into the primary instigators of these processes. However, it does offer a clinically useful method of preventing these changes and protecting the kidney against ischemic injury during abdominal aortic surgery. The third component of the animal studies demonstrates the importance of the protective effect of renal prostaglandins during the specific experimental (and probably also the clinical) circumstances. Again, it does not provide definitive information on the mediators responsible for the renal changes, since the deleterious effects of numerous endogenous substances have previously been shown to be counterbalanced by intrarenal synthesis of prostaglandins under various experimental and clinical circumstances. The extent of the pathophysiological and ultrastructural changes which occurred under the influence of a NSAID does, however, suggest that these drugs should not be used under these clinical circumstances. The last component of the study provides evidence that angiotensin only plays a secondary/supplementary role in the renal pathophysiological process even during aortic clamping. This may explain the contradictory evidence regarding the potential beneficial effect of ACE inhibition (on renal hemodynamics and glomerular function) during abdominal aortic surgery (Licker et al. 1996, Colson et al. 1992a). Based on our studies, ACE inhibition can not be supported for this purpose. / AFRIKAANSE OPSOMMING: Akute nierversaking is met die uitsondering van kardiale sterftes, steeds die belangrikste patologiese proses wat geassosieer is met perioperatiewe mortaliteit in pasiënte wat opereer word vir abdominale aorta aneurismes. Die intraoperatiewe veranderinge in renale bloedvloei (NBV) en glomerulêre funksie is die afgelope 15 jaar ondersoek en gerapporteer in pasiënte- sowel as diere-modelle. Ten spyte van groot variasies in studie-populasies, meettegnieke en ontwerp van studies in die algemeen, dui 'n wesenlike hoeveelheid getuienis daarop dat infrarenale klemming van die aorta renale isgemie induseer, wat die oorsaak is van postoperatiewe akute nierversaking wanneer hierdie komplikasie voorkom. Dit is verbasend dat, ten spyte van sommige onlangse studies wat rapporteer oor 'n verskeidenheid farmakologiese ingrepe om intraoperatiewe renale isgemie te voorkom (met wisselende sukses), baie min oënskynlik gedoen is om die patogenese en die presiese patofisiologie van hierdie potensieel dodelike komplikasie te ontrafel. Hoewel verskeie outeurs die moontlikheid van hormonale betrokkenheid (veral renienangiotensien, antidiuretiese hormoon en katekolamiene) in hierdie proses suggereer, is die presiese rol van hierdie mediators nog nie op 'n gestruktureerde wyse ondersoek (of rapporteer) nie. In ons aanvanklike pasiënte-studie is renale hemodinamika en -funksie gemeet vanaf die preoperatiewe periode, gedurende die intra-operatiewe fase en tot minstens vier uur na ontklemming van die aorta. Serumkonsentrasies van relevante hormone is bepaal tydens elke metingsperiode waar renale parameters gemeet is, ten einde die moontlikheid van 'n temporale verwantskap tussen renale veranderinge en variasies in hormoonkonsentrasies te ondersoek. Die vermindering in NBV en glomerulêre filtrasiespoed (GFS) wat ons aangetoon het om saam te val met infrarenale aortaklemming, stem ooreen met resultate wat tevore deur ander navorsers publiseer is. Ons het aangetoon dat die inkorting van hierdie parameters voortduur tot minstens vier uur na aorta-ontklemming. Hierdie veranderinge is tevore slegs rapporteer vir periodes tot kort na aorta-ontklemming voor sluiting van die buikwond. Die feit dat die GFS steeds verlaag is met ontslag van hierdie pasiënte, skep rede tot kommer, veral in pasiënte wat alreeds ingekorte nierfunksie het voor die chirurgiese prosedure. Van die gemete hormone wat moontlik 'n invloed sou kon uitoefen op NBV eh nefronfunksie, was renien die enigste waarvan verandering in plasmakonsentrasies saamgeval het met die onderdrukking van NBV en GFS na aortaklemming. Die ontwerp van ons studie het ons nie toegelaat om 'n besliste uitspraak te maak of die geassosieerde verhoging in angiotensien II primêr verantwoordelik was vir die verandering in renale hemodinamika, of dat die verhoogde renien (en angiotensien) bloedvlakke moontlik sekondêr stimuleer is deur die verandering in NBV wat deur 'n ander meganisme induseer is. In 'n ander pasiëntegroep het ons aangetoon dat die kombinasie van mannitol en dopamien geen beskerming verleen het teen die nadelige effekte van aorta-klemming nie. Die groot volumes uriene wat uitgeskei is onder die invloed van hierdie middels (wat nie korreleer het met NBV tydens ooreenstemmende periodes nie), het inderwaarheid 'n ontoepaslike gerustheid uitgelok. Weens die ooglopende gebrek aan objektiewe voordeel wat verleen word deur hierdie middels, behoort hulle gebruik tydens hierdie kliniese omstandighede ontmoedig te word. Die doel van die diere studies was die identifisering van die presiese rol van angiotensien in die patogenese en patofisiologie van die renale veranderinge geassosieer met infrarenale aortaklemming, sowel as die interaksie van angiotensien met ander modulators waarvoor 'n interaktiewe verwantskap voorheen beskryf is onder eksperimentele en/of kliniese omstandighede. Die eerste studie het getoon dat alhoewel renien (en dus angiotensien) konsentrasies hoog was na aorta-ontklemming, die hormone geen betekenisvolle patogenetiese of patofisiologiese rol in die waargenome renale veranderinge gedurende hierdie periode het nie (aangesien blokkade van angiotensien aktivering deur voorkoming van renien vrystelling, of deur inhibisie van angiotensien omsettingsensiem (AOE), nie 'n daling in NBV of GFS kon voorkom nie). Voorkoming van angiotensien II aktivering het egter wel renale verandering voorkom gedurende aortaklemming. Dié voordelige effek het nie 'n primêre rol vir angiotensien gedurende die periode bevestig nie, aangesien die gunstige invloed ook (ten minste gedeeltelik) verduidelik kon word deur die voorkoming van die fassiliterende invloed van angiotensien op ander vasokonstriktore en/of ander vasodilator-invloede van die onderdrukking van AOE en ïs-blokkers (wat geen verband het met angiotensien of die blokkade daarvan nie). Die studie het aangetoon dat (ten minste gedeeltelik) verskillende meganismes verantwoordelik is vir renale veranderinge wat gesien is gedurende aortaklemming en na -ontklemming. Die tweede studie het die rol van kalsium in die renale patofisiologiese veranderinge gedurende aortaklemming en na ontklemming ondersoek. Die beskermende invloed wat deur die toediening van Ca2 + -blokkers bewerkstellig is, het bevestig dat die renale vasokonstriktoriese en glomerulêre patofisiologiese prosesse afhanklik is van sellulêre influks van kalsium deur spannings-afhanklike kannale. Dit het ongelukkig geen definitiewe insig verleen ten opsigte van die primêre inisieerders van die proses nie. Dit verskaf nogtans 'n bruikbare kliniese metode om daardie veranderinge te voorkom en die niere teen isgemiese besering gedurende abdominale aorta-chirurgie te beskerm. Die derde komponent van die diere-studies demonstreer die belangrikheid van die beskermende effek van renale prostaglandiene tydens die spesifieke eksperimentele (en waarskynlik ook die kliniese) omstandighede. Weereens gee dit nie definitiewe inligting oor die bemiddelaars wat verantwoordelik is vir die renale veranderinge nie, aangesien die skadelike effekte van verskeie endogene stowwe voorheen aangetoon is om beperk of voorkom te word deur die intrarenale vrystelling van prostaglandiene. Die omvang van die patofisiologiese en ultrastrukturele veranderinge wat ontstaan het onder die invloed van nie-steroïed anti-inflammatoriese middels (wat gebruik is om prostaglandien sintese te inhibeer), dui aan dat hierdie middels vermy moet word onder soortelyke kliniese omstandighede. Die laaste komponent van die studie verskaf 'n sterk aanduiding dat angiotensien slegs 'n sekondêre/aanvullende rol speel in die renale patofisiologiese proses, selfs gedurende aortaklemming. Dit mag die weersprekende getuienis oor die potensiële voordeel van AOE onderdrukking (op renale hemodinamika en glomerulêre funksie) gedurende abdominale aortachirurgie (Licker et al. 1996, Colson et al. 1992a) verklaar. Gebaseer op ons studies, kan AOE onderdrukking nie ondersteun word vir hierdie doel nie.

The thesis explores chronic leg ulceration experienced by young people who inject drugs (PWID). The applied health research study, in two phases, used a sequential explanatory mixed methods design. Phase 1 involved a survey of 200 people who injected drugs to investigate the prevalence of skin problems and leg ulceration, together with the identification of risk factors for ulceration. Phase 2 involved a series of fifteen qualitative semi-structured interviews that explored the results relating to risk factors with a sample of PWID who had experienced leg ulceration, and investigated participants’ perceptions of appropriate harm reduction methods. Main findings There were three research questions in this study: 1) What is the extent of skin problems and chronic leg ulceration in young people who inject drugs? The study identified a high prevalence of leg ulceration as 15%. 60% of the sample had experienced a skin problem. Each reported skin complication is clearly defined. 2) What causes chronic leg ulceration in young people who inject drugs? Leg ulceration experienced by PWID in this study was directly linked to deep vein thrombosis (DVT), as well as injecting in the groin and the leg. DVT was strongly associated with groin and leg injecting. The acceptance amongst injectors of the groin and leg as a site of choice has occurred with a lack of awareness of the long-term consequences of damage to the limb. 3) What are appropriate harm reduction measures in young people who inject drugs? Harm reduction methods related to the development of leg ulceration have been absent across schools and drug services. Training for healthcare workers which enables them to identify risk factors should be developed, and harm reduction information related to leg ulceration should be included in drug education within schools, and instigated within drugs services. This applied health research has led to a number of practice-focused recommendations surrounding clinical care including early detection of venous insufficiency and accessible services to prevent, assess, and treat venous disease in PWID. The original contribution to knowledge is three-fold: 1. Leg ulcers have been found to be highly prevalent in young people who inject drugs. 2. Ulceration is predominantly caused by venous thrombosis due to injecting in the legs or groin. 3. Harm reduction related to the development of venous disease has lacked impact and effect.

Contexte : Le récepteur hormone folliculo-stimulante (FSHR) est exprimé par les cellules de l'endothélium vasculaire dans un large éventail de tumeurs humaines primaires. Notre but était d'évaluer l'intérêt de FSHR comme marqueur des vaisseaux sanguins tumoraux associés aux sarcomes, les sous-types moléculaires du cancer du sein et des métastases ainsi que comme biomarqueur prédictif de la réponse au traitement anti-angiogénique. Méthodes : Nous avons utilisé l'immunohistochimie comme technique de révélation. Ceci implique la production d'un anticorps monoclonal hautement spécifique anti-FSHR (produit chez la souris) et l'hybridation in situ pour détecter FSHR dans des échantillons de tissus provenant de patients atteints de sarcomes (308 patients), les sous-types moléculaires du cancer du sein (84 patients), et des métastases (203 patients). Pour évaluer FSHR comme marqueur prédictif du traitement anti-angiogénique du cancer du rein métastatique avec le sunitinib, nous avons utilisé la microscopie confocale à immunofluorescence. Nous avons également co-localiser FSHR avec le facteur von Willebrand, un marqueur des cellules endothéliales vasculaires (50 patients).RésultatsFSHR est exprimé dans les 11 sous-types de patients atteints de sarcomes ont analysés et dans 75% des tumeurs métastatiques examinées, ainsi que dans tous les sous-types moléculaires des cancers du sein. Dans cadre de l'étude du cancer du rein métastatique, le pourcentage de vaisseaux marqués FSHR était en moyenne cinq fois plus élevé pour les patients qui ont répondu au traitement par rapport au groupe stable et presque huit fois plus élevé que dans le groupe non-réponse (57%, 11% et 7 %, respectivement).ConclusionsNos résultats montrent que, en plus des cancers signalés précédemment, FSHR peut être considéré comme marqueur tumoral pour les sarcomes et les métastases. En outre, FSHR peut être utilisé, avec une sensibilité et une spécificité élevée, en tant que biomarqueur prédictif de la réponse au traitement par sunitinib des patients atteints de cancer du rein métastatique. / Background : Follicle Stimulating Hormone receptor (FSHR) is expressed by the vascular endothelium in a wide range of human primary tumors. Our purpose was to further evaluate FSHR as marker of tumor blood vessels associated with sarcomas, breast cancer molecular subtypes, and metastases as well as predictive biomarker of response to antiangiogenic treatment.MethodsWe used immunohistochemistry involving a highly specific mouse monoclonal anti-FSHR antibody and in situ hybridization to detect FSHR in tissue samples from patients with sarcomas (308 patients), breast cancer molecular subtypes (84 patients), and metastases (203 patients). To evaluate FSHR as predictive marker of antiangiogenic treatment of metastatic kidney cancer with sunitinib, we used immunofluorescence confocal microscopy to co-localize FSHR with von Willebrand factor, a marker of vascular endothelial cells (50 patients).ResultsFSHR is expressed in all 11 subtypes of sarcoma patients analysed, in 75% of metastatic tumors examined as well as in all different molecular subtypes of breast cancers. In metastatic kidney cancer patients the percentage of FSHR stained vessels was on average fivefold higher for the patients who responded to the treatment in comparison with the stable group and almost eightfold higher than in the non-responsive group (57%, 11%, and 7%, respectively).ConclusionsOur results suggest that, in addition to the cancers previously reported, FSHR can be considered as tumor marker for sarcomas and metastasis. Moreover, FSHR can be used, with high sensitivity and specificity, as predictive biomarker for the response to sunitinib treatment of patients with metastatic kidney cancer.

Le traumatisme crânien (TC) est la première cause de visite aux urgences pour la population pédiatrique. Indépendamment du niveau de sévérité du TC, les patients pédiatriques souffrent sur le long-terme de troubles cognitifs et émotionnels, cependant les mécanismes moléculaires et cellulaires sous-jacents sont encore peu connus, et il n’existe pas de traitement efficace disponible à ce jour. L’unité neurovasculaire est composée de vaisseaux sanguins, neurones et astrocytes. Les astrocytes sont essentiels à une variété de fonctions physiologiques assurées par cette unité tels que l’homéostasie cérébrale et le couplage neurovasculaire. Suite à une lésion, les astrocytes deviennent « réactifs », et cette « astrocytopatie » peut impacter leur rôle physiologique et empirer les conséquences de la lésion.Nous avons étudié le rôle de l’astrocytopatie dans le TC juvénile et fait l’hypothèse que : (1) les astrocytes réactifs contribuent à la propagation de l’œdème via les jonctions serrées connexines après un TC juvénile modéré ; (2) l’astrocytopatie se développe également après un TC juvénile léger avec des changements calciques qui pourraient contribuer à (3) une altération de la réactivité vasculaire, tout cela impactant sur les conséquences comportementales qui font suite à la lésion.Nous avons montré que :(1) Réduire l’astrocythopatie en sous-régulant la connexine 43 permettait d’améliorer les conséquences comportementales après un TC modéré juvénile, mais n’impactait pas la propagation de l’œdème.(2) Les astrocytes devenaient réactifs et subissaient des changements morphologiques après un TC juvénile léger avec des perturbations dans les signaux purinergiques-calciques liés à des changements dans l’expression du canal aqueux aquaporine 4 (AQP4).(3) Une dysfonction vasculaire majeure s’était développée après le TC juvénile léger avec des changements fonctionnels et morphologiques des vaisseaux intraparenchymaux parallèles aux altérations comportementales et précédant les dommages axonaux après la lésion.Ce travail apporte un nouvel aperçu de la pathophysiologie du TC juvénile et ouvre des possibilités pour développer des thérapies ciblant l’astrocytopatie après une lésion. / Traumatic brain injury (TBI) is the first cause for emergency department visits in the pediatric population. Regardless of the severity of TBI, pediatric patients suffer long-term cognitive and emotional impairments but the underlying cellular and molecular mechanisms are still poorly understood and there are no effective treatments available. The neurovascular unit is composed by blood vessels, neurons and astrocytes. Astrocytes are crucial for various physiological functions of this unit such as brain homeostasis and neurovascular coupling. In injuries astrocytes become “reactive”, and this “astrocytopathy” can impact their physiological roles and worsen the outcome after injury.We investigated astrocytopathy in juvenile TBI and hypothesized that: (1) reactive astrocytes contribute to spread of edema through connexin gap junctions after juvenile moderate TBI; and that (2) astrocytopathy also develops after juvenile mild TBI with calcium changes that could contribute to (3) impaired vascular reactivity, all of which impacts the behavioral outcome after injury.We have shown that:(1) Reducing astrocytopathy by downregulating the gap junction protein connexin 43 improved the behavioral outcome after juvenile moderate TBI, but did not impact the spread of edema.(2) Astrocytes became reactive and underwent morphological changes after juvenile mild TBI with disturbances in purinergic-calcium signaling related to expression changes of the water channel aquaporin 4 (AQP4).(3) Major vascular dysfunction developed after juvenile mild TBI with functional and morphological changes of the intraparenchymal vessels that paralleled behavioral impairments and preceded axonal damage after injury.This work brings new insights in the pathophysiology of juvenile TBI and opens prospects for developing therapeutics targeting astrocytopathy after injury.

A engenharia de tecido pulpar tem como objetivo substituir a polpa dentária inflamada ou necrosada por um tecido saudável e funcional, capaz de formar nova dentina para reparar a estrutura dentária perdida. Assim, os objetivos deste trabalho foram: avaliar a habilidade de diferenciação de célulastronco de dentes decíduos exfoliados humanos (SHED) em odontoblastos funcionais, demonstrando a formação de tecido mineralizado in vivo; e estudar o efeito de VEGF em SHED com relação à estimulação de vias de sinalização celular (STAT3, AKT e ERK), proliferação, migração, formação de estruturas tubulares e diferenciação em células endoteliais. O início do processo de mineralização de SHED tratadas com dexametasona, ácido ascórbico \'beta\' - glicerofosfato pôde ser detectado por meio da produção da enzima fosfatase alcalina a partir da segunda semana de cultura, mas a expressão de RNAm para DSPP só foi observada após 28 dias de indução. Utilizando-se o modelo de fatias de dentes e matrizes condutivas implantadas no dorso de camundongos imunodeprimidos, demonstrou-se a diferenciação de SHED em células semelhantes a odontoblastos, as quais tiveram imunomarcação positiva com o anticorpo DMP-1. A deposição de dentina, seguindo um ritmo centrípeto de crescimento, numa taxa de 14,1 µm por dia também foi demonstrada por meio da marcação com tetraciclina. O tratamento das SHED com VEGF estimulou a fosforilação de ERK e AKT e a diminuiu a fosforilação de STAT3 em um período de uma hora, provavelmente por meio de sua ligação com os receptores VEGFR-1 e NP-1 presentes nestas células. Além disso, VEGF intensificou a organização das SHED em estruturas tubulares, havendo diferença estatisticamente significativa entre os grupos tratado e não tratado a partir do 5o dia de tratamento. Entretanto, VEGF não estimulou a proliferação nem a migração destas células. Os resultados de RT-PCR mostraram que SHED cultivadas em fatias de dentes e matrizes condutivas expressaram VEGFR-2 já após o primeiro dia de estímulo com VEGF. Ademais, os quatro marcadores de células endoteliais (VEGFR-1, VEGFR-2, CD31 e Caderina-VE) foram observados após 21 dias sob estímulo de VEGF, resultado ainda mais evidente aos 28 dias. In vivo, observou-se que SHED transfectadas com o gene LacZ foram capazes de formar estruturas semelhantes a vasos sangüíneos quando implantadas em camundongos, mas a presença de sangue no seu interior não pôde ser observada após 21 dias de implante. Portanto, SHED podem ser estimuladas a se diferenciar em odontoblastos funcionais, capazes de produzir estrutura mineralizada semelhante à dentina. Ademais, VEGF interfere nas vias de sinalização STAT3, ERK e AKT e estimula a formação de estruturas tubulares e a diferenciação de SHED em células endoteliais, mas não a proliferação e migração de SHED. Acreditamos que tecnologia igual ou semelhante à empregada neste estudo poderá eventualmente fornecer ferramentas clínicas para tratamentos endodônticos que visem à regeneração de um tecido pulpar completo e formação de tecido dentinário num futuro não muito distante. / Dental pulp tissue engineering aims to replace the inflamed or necrotic pulp by a healthy and functionally competent tissue able to form new dentin in order to repair lost structure. The purposes of this work were: to evaluate the differentiation ability of stem cells from human exfoliated deciduous teeth (SHED) into functional odontoblasts, showing the formation of mineralized tissue in vivo; and to study the effect of VEGF on SHED with regards to the stimulation of cell signaling pathways (STAT3, AKT and ERK), the proliferation, migration, capillary sprouting, and the differentiation into endothelial cells. The beginning of the mineralization process of SHED treated with dexamethasone, ascorbic acid and beta-glycerophosphate could be detected through the production of alkaline phosphatase after the second week of culture, but the expression of DSPP mRNA was only observed after 28 days of induction. Using the tooth slice and scaffold model implanted in the dorsum of immunocompromised mice, the differentiation of SHED into odontoblast-like cells, which were immunostained with DMP-1 antibody, was demonstrated. Dentin deposition following a centripetal rhythm, in a rate of 14.1 µm per day, was also shown through the tetracycline labeling. VEGF treatment of SHED stimulated the ERK and AKT phosphorilation, and decreased the phosphorilation of STAT3 over 1 hour period, presumably due to its binding to VEGFR-1 and NP-1 receptors in these cells. In addition, VEGF enhanced SHED organization into tubular structures, with statistically significant difference between the treated group and the non-treated one after the 5th day of treatment. However, VEGF did not stimulate proliferation and migration of these cells. RT-PCR results demonstrated that SHED seeded in the tooth slices and scaffolds expressed VEGFR-2 after the first day of VEGF stimulation. Moreover, the four endothelial cell markers (VEGFR-1, VEGFR-2, CD31 and VE-Cadherin) were observed after 21 days of VEGF stimulation, and this result was even clearer after 28 days. In vivo, SHED transduced with LacZ gene were able to give rise to blood vessel-like structures when implanted in immunocompromised mice, but the presence of blood flow was not observed after 21 days of implantation. Therefore, SHED can be stimulated to differentiate into functional odontoblasts, which in turn are able to produce mineralized structure resembling dentin. Furthermore, VEGF interferes with the STAT3, ERK and AKT signaling pathways, and stimulates the formation of tubular structures and the differentiation of SHED into endothelial cells, but does not stimulate SHEDs proliferation and migration. We believe that the same technology employed in this study or a similar one can eventually provide clinical tools for the endodontic treatments aiming at regenerating a complete pulp tissue and forming a dentin tissue in a near future.

Trinta dias após a indução do diabetes, em aortas com endotélio (E+) de ratas diabéticas (DB), a Rmáx ao cloreto de potássio (KCl) foi reduzida e a resposta à noradrenalina (NA) foi semelhante as controles (CT). A retirada do endotélio (E-) potencializou a resposta ao KCl e NA, porém essa potencialização foi de menor magnitude em DB. A Rmáx à NA em aortas E+: não foi alterada após o seqüestro de ânion superóxido ou inibição da síntese de óxido nítrico (NO) em DB, nas CT esta resposta foi reduzida e aumentada, respectivamente, e foi reduzida apenas nas DB após o bloqueio dos receptores para endotelina (ET). A mobilização de cálcio (Ca2+) em resposta à NA foi reduzida em aorta E+ e E- de DB. Em aortas de ratas diabéticas, as alterações no aparato contrátil, como por exemplo. A redução da mobilização de Ca2+, podem ser responsáveis pela redução da resposta contrátil e a redução da modulação do NO sobre a resposta à NA ou o aumento da liberação de ET pelo endotélio podem ser os responsáveis pela manutenção da resposta à NA. / Thirty days after induction of diabetes, in aortas with endothelium (E+) of diabetic female rats (DB), the maximum response (Rmax) to potassium chloride (KCl) was reduced and the Rmax to noradrenaline (NE) was similar to controls (CT). The endothelium (E-) removal increased the response to KCl and NE, but this increase was of a lower magnitude in DB than in CT. In aortas E+, the Rmax to NA: was not altered by superoxide anion scavenger or nitric oxide (NO) synthesis inhibition in DB, whereas in CT this response is reduced or increased, respectively, and was reduced only in DB after endothelin (ET) receptor blockade. The mobilization of the calcium (Ca2+) in response to NE was reduced in aortas E+ and E- of the DB. In aortas of DB, the alterations in the contractile apparatus, for example, reduction of the Ca2+ mobilization may be responsible for the reduction of the vasoconstriction. The reduction of NO modulation upon the response to NE or the increase of the ET release can be the responsible for the maintenance of the contractile response to NE.

Doenças vasculares são um problema mundial, que representa 28% das mortes no mundo e 66% do total de doenças que acometem os brasileiros. Dessa forma, há um grande interesse em pesquisar formas de prevenção e tratamento dessas doenças. Algumas medidas são relevantes no auxílio de diagnóstico, tal como: tamanho médio dos ramos, diâmetro médio das seções transversais dos vasos e padrões de divisão de ramos. Calcular essas medidas de forma manual é uma tarefa demorada e trabalhosa. Assim, esta Tese tem como objetivo, propor um método computacional de rastreamento e extração de atributos em redes vasculares a partir de imagens 3D de angiografia por ressonância magnética e por tomografia computadorizada. Trata-se de uma abordagem de rastreamento e identificação de bifurcações que difere das técnicas anteriores, utilizando a Transformada de Hough para identificar o diâmetro do vaso em cortes transversais num dado ponto ao longo de um vaso sanguíneo. Mais detalhadamente, essa abordagem utiliza um campo vetorial advindo do cálculo de uma matriz formada por derivadas parciais de segunda ordem, obtida da intensidade luminosa da imagem, para identificar a direção de um ramo de vaso. Além disso, durante o processo de rastreamento de um ramo de vaso, são calculados vários descritores de forma com o objetivo de classificar regiões como pertencentes a uma bifurcação ou não. Em adição a estes descritores, desenvolvemos uma nova medida chamada de variância do raio que permite distinguir, bifurcações, não-bifurcações e segmentos de vaso com stents (aparelho metálico usado para aumentar o diâmetro dos vasos). Para a classificação de bifurcações, criamos a medida de bifurcação, que trata-se de uma combinação linear de todos os descritores de forma apresentados neste trabalho. Testes foram realizados para atestar a eficácia da abordagem proposta, utilizando tanto imagens sintéticas quantoimagens reais. Os resultados mostraram que o método é capaz de rastrear 91% de uma rede vascular sintética variando o ponto de inicialização e 76% variando o nível de ruído. Também foi observado por meio de testes que o método proposto consegue rastrear vasos e identificar bifurcações em imagens reais sem avaliação numérica. Essa abordagem permite a extração da relação hierárquica entre os ramos em uma rede vascular e a extração do padrão de divisão dos vasos, o que contribui sobremaneira para o estudo do comportamento do fenômeno da angiogênese e no auxílio no diagnóstico de anomalias vasculares. / Vascular diseases are a main health problem, representing 28% of deaths worldwide and 66% of all diseases affecting the Brazilian population. Thus, it is important that researches in prevention and treatment of this type of disease increase. Moreover, there are several demands, such as computational tools capable of analyzing and extracting attributes from non-invasive images. The scope of this work is the analysis and extraction of data from magnetic resonance angiography and computed tomography angiography images by highlighting blood vessels. In this context, this thesis aims the development of a novel computational tracking and feature extraction method for vascular networks from 3D images. Our approach presents the following steps: First, identify the vessel cross-sections along it using the Hough transform. Then, compute a matrix composed of second order partial derivatives of image intensity to identify the direction of the vessel. Perform a feature analysis of the vessel contour to classify the bifurcation point, and finally, identify the direction of the new branch in a bifurcation point. The main contribution of this Thesis is the two new measures developed, called radius ratio and bifurcation measure, the radius ratio is capable to distinguish between a region with bifurcation, stents or without both of them. The bifurcation measure is a linear combination that allows to classify a region as bifurcation or not. Tests were performed in order to verify the proposed approach effectiveness, using both synthetic images and real images. The results showed the method is capable to track 91% of synthetic vascular networks varying the seed point and 76% varying the level of noise. Also, we performed tests in real images and by visual evaluation, we could observed that the proposed method was able to track vessels and identify bifurcations from different parts of the body. This approach allows to calculate, in the future, the density of bifurcations in a vascular network, the distance between them, the stenosis and aneurysms grading and characterize specific vessels. In addition, the vascular networks extraction allows the study of the angiogenesis phenomena and vascular anomalies.

Les perspectives d'évolution des techniques chirurgicales sont de plus en plus demandeuses de modèles permettant de prédire déplacements et contraintes au sein des tissus. De tels modèles permettent par exemple de mieux focaliser un traitement sur une zone de tissu affectée par une pathologie. L'un des principaux obstacles posés par la plupart des modèles existants adaptés à la description du comportement mécanique des tissus vivants concerne la difficulté de mesure de leurs paramètres. Il en résulte une difficulté à les déterminer, ainsi qu'à comprendre leur influence. L'adoption d'une modélisation multiéchelles permet d'apporter une réponse satisfaisante à ce problème. En effet, elle autorise la prise en compte et lacombinaison de phénomènes simples qui ont lieu à différentes échelles, et fait ainsi intervenir des paramètres physiques et mesurables. Dans l'étude proposée, nous nous focalisons sur le comportement mécanique des parois des veines en pont, qui peuvent parvenir à rupture lors d'un choc appliqué à la tête. Nous proposons pour commencer des observations par microscopie optique, microtomographie X et microscopie confocale biphotonique visant à caractériser la structure de la paroi vasculaire à différentes échelles. Un essai mécanique est combiné à l'une des observations. Nous proposons ensuite une nouvelle modélisation multiéchelles du comportement mécanique de cette paroi vasculaire. Cette modélisation combine des modèles simples à trois échelles et reproduit ainsi le comportement mécanique global de la paroi vasculaire. Pour finir, le modèle est intégré à une modélisation par éléments finis afin de permettre l'étude de géométries complexes. / Modeling the mechanical behavior of living tissues gets nowadays more and more importance. Indeed, mechanical models can be integrated within assisted surgery devices to help for example the surgeon to better focus on an area affected by pathology.One of the main drawbacks of existing numerical models for the mechanical behavior of living tissues concerns the difficulty to measure their parameters, which makes their determination difficult. Adopting a multiscale modeling approach seems to be an answer to this issue. It allows taking into account the global complexity of the behavior by considering simple phenomena that occur at each scale. By this way, the parameters of the model deal with physical characteristics and remain measurable.In the present study, we focus on the mechanical behavior of bridging vein walls. These veins can break when the head is submitted to a shock loading. We start by some experimental observations using optical microscopy, X-ray microtomography and multiphoton confocal microscopy. These observations allow getting a detailed knowledge about the vein wall constitution. Additionally a mechanical tensile test is combined with one of these observations. Then we propose a new multiscale approach for the description of the mechanical behavior of vessel walls. It combines simple models associated with three scales and describes in this way the overall mechanical behavior of the vein wall. The evolution of the material structure at different scales is taken into account and contributes to the global hyperelastic mechanical behavior of the tissue. Finally, our model is implemented in a finite element code in order to study complex geometries.

Finally, the system of vascular interventional radiology simulator is discussed by integrating all presented techniques and designing a trackball mouse based hardware sensors. Training experiments demonstrate that the presented techniques benefit rapid development of realistic and interactive vascular interventional radiology simulators. / Fourth, in order to clearly visualize vascular networks and the placement of instruments while treating the lesion, a physics-based simulation for angiography procedure is presented based on navier-stokes equation and semi-lagrangian method. The multi-scale vessel grid is reconstructed for flow distribution, and point sprites based rendering is adopted to preserve real-time visualization of the procedure. The experiments demonstrate that our results are more realistic compared to previous methods and are closer to the real angiography procedure. / In order to build a high fidelity interventional simulator for physician training and surgery planning, accurate reconstruction of three dimensional vascular network, real-time simulation of angiographic medium propagation and physics-based simulation of interaction between surgical instruments and vessel wall are absolutely indispensable. Thus, first, a methodology for geometric vascular modeling is proposed. As the reconstructed models are essential for many subsequent applications such as deformable modeling and visualization, a series of methods are proposed based on the parallel transport frames in order to maintain high mesh quality of these models. An improved bifurcation modeling method and two novel trifurcation modeling methods are developed based on 3D Bezier curve segments in order to ensure the continuous surface transition at furcations. To solve the twisting problem caused by frame mismatch of two successive furcations, a frame blending scheme is implemented. A curvature based adaptive sampling scheme combined with a mesh quality guided frame tilting algorithm is developed to construct an evenly distributed, non-concave and self-intersection free surface mesh. In terms of surface mesh quality criteria, our methodology can generate vascular models with better mesh quality than previous methods. / Second, we extend our geometric modeling method for illustrative visualization of vasculature, which is an indispensable component in medical education and training. Illustration of vasculature accentuates depth perception and provides a specific manner to identify the branching pattern and topology of vascular structure, which is crucial for therapy planning and real surgery in order to give an effective treatment. With advanced GPU acceleration techniques including render to texture (RTT) , framebuffer object (FBO) and fast image convolution, a real-time visualization can be achieved. / Third, an interactive simulation of angioplasty procedure is reported. To achieve an efficient modeling of soft tissue deformation and virtual device mechanics, mass spring models are adopted to construct the deformable models of vessel wall and stent. By designing a quasi-equilateral triangular mesh model of blood vessel and stent, a linear spring coefficients setting method is adopted to achieve the same accuracy compared with finite element method. With the employment of Physics Processing Unit (PPU), a real-time simulation of the interaction between blood vessel wall and surgical device is developed for vascular interventional radiology simulation. / Vascular diseases have been the leading cause of death worldwide. Interventional procedures are an increasingly promising therapy for treating vascular diseases, which are usually done by a guidewire-catheter combination under the fluoroscopic guidance. However, due to the complicated vascular network, bending of surgical instruments and the risk of vessel injury, these techniques need to be performed by highly trained and experienced specialists. Virtual reality based training of these procedures offers high flexibility and cost effective alternative. Furthermore, it allows training evaluation and accelerates learning process without risk to patients, therefore has distinct advantages than traditional training methods on animals or cadavers. / Guo, Jixiang. / Advisers: Pheng-Ann Heng; Tien-Tsin Wong. / Source: Dissertation Abstracts International, Volume: 73-06, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 97-111). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.