Charakterisierung des Zytokinprofils in Erwachsenen mit einer latenten oder aktiven Tuberkulose in einem hoch endemischen Gebiet Die Tuberkulose (TB) stellt mit rund 2 Milliarden Infizierten weltweit ein globales gesundheitliches Problem dar. Während die große Mehrheit der infizierten Personen in der Lage sind die Krankheit zu kontrollieren, entwickelt sich bei ungefähr 10 % die aktive Form der TB aus. Der zugrunde liegende immunologische Prozess für diese Verteilung ist bis heute nicht bekannt und im Fokus dieser Arbeit. Das adaptive Immunsystem spielt eine entscheidende Rolle in der Immunabwehr gegen Mycobacterium tuberculosis (M. tuberculosis), dem Erreger der TB. Hierbei sind besonders CD4+ T-Zellen für die erfolgreiche Eingrenzung der Erkrankung verantwortlich. Im Vorfeld konnte bereits mehrmals eine Assoziation zwischen polyfunktionalen CD4+ T-Zellen und einem Schutz gegen verschiedenste Krankheitserreger gezeigt werden. Im Rahmen dieser Doktorarbeit wird versucht die Frage zu beantworten, ob eine erhöhte Frequenz von polyfunktionalen CD4+ T-Zellen auch gegen die Ausbildung einer aktiven TB schützen kann. Zur Bearbeitung dieser Fragestellung wurde das TH1 Zytokinprofil von Patienten mit aktiver TB untersucht und mit dem von gesunden latent infizierten Probanden (LTBI) verglichen. Desweiteren wurden die TB Patienten während der antimikrobiellen Therapie begleitet um Änderungen im Zytokinprofil von CD4+ T-Zellen beobachten zu können. Im Rahmen dieser Arbeit wurde zum ersten Mal die simultane Expression der vier TH1 Zytokine IFNg, TNFa, IL-2 und GM-CSF mit Hilfe der multifarben Durchflusszytometrie untersucht. Nach antigenspezifischer Stimulation konnten sowohl in unbehandelten und behandelten Patienten mit aktiver TB ein großer Anteil an multifunktionale Gedächtnis-T-Zellen nachgewiesen werden, die alle vier Zytokine gleichzeitig exprimierten. Bemerkenswerterweise konnte diese Population ebenfalls in LTBI gezeigt werden. Nach den ersten zwei Monaten der Therapie war der Anteil an multifunktionalen T-Zellen signifikant erhöht welches auf einen positiven Einfluss dieser Zellen auf die Behandlung hinweist. Um detaillierte Information über das Expressionspotential von CD4+ T-Zellen zu gewinnen wurden PBMCs mit einem Superantigen inkubiert. Hierbei unterschied sich das Zytokinprofil zwischen den beiden Studiengruppen signifikant und veränderte sich ebenfalls unter Therapie. Während die Expression von IFNg in TB Patienten niedriger war als in LTBI, war die Frequenz von TNFa, IL-2 und GM-CSF-positiver CD4+ T-Zellen signifikant höher in Patienten mit aktiver TB. Zusammenfassend ist zu sagen, dass sowohl in TB Patienten vor und nach Therapie, als auch in LTBI, multifunktionale CD4+ T-Zellen nachgewiesen werden können. Ein Unterschied in der Frequenz konnte dabei nicht festgestellt werden. Daher kann ein Zusammenhang zwischen der Existenz von multifunktionellen CD4+ T-Zellen und einem Schutz gegen eine mögliche Reaktivierung von der latenten zu der aktiven TB nicht beschrieben werden. / Characterization of the cytokine profile in adults with latent and active tuberculosis from a high endemic country Tuberculosis (TB) is a global health problem with ~2 billion infected people worldwide. The vast majority of infected individuals is able to control TB, while only ~10% develop active disease. The immunologic correlates determining the protection against reactivation of the latent form of active TB remain elusive. The adaptive immune system plays an important role in the response against Mycobacterium tuberculosis (M. tuberculosis), especially CD4+ T cells are crucial for efficient containment of the pathogen. Since polyfunctional CD4+ T cells have been associated with protection against various pathogens, the question was raised if higher frequencies of polyfunctional CD4+ T cells can be linked to protection against reactivation of active TB. To address this the TH1 T cell cytokine profile of active TB patients was analyzed and compared with healthy latently infected individuals (LTBI). Furthermore TB patients were followed up under anti-microbial therapy to monitor changes in the cytokine pattern expressed by CD4+ T cells. Hereby, for the first time, the simultaneous expression of four TH1 cytokines, IFNg, TNFa, IL-2 and GM-CSF, was investigated using multi color flow cytometry. After antigen-specific stimulation multifunctional memory T cells (CD45RO+) co-expressing IFNg, TNFa, IL-2 and GM-CSF were strongly represented in both treated and untreated TB patients. Interestingly, this proportion of polyfunctional memory T cells was also found in LTBI. After the first two months of drug treatment the proportion of antigen-specific polyfunctional T cells was significantly increased, indicating a positive impact of these cells during therapy. To gain detailed information about the potential of CD4+ T cells to produce cytokines we incubated PBMCs with a superantigen. In this case the profile was significantly different between these two groups and it changed during therapy. While the expression of IFNg was significantly lower in CD4+ T cell of TB patients in comparison to LTBI, the expression of TNFa, IL2 and GM-CSF showed significant higher frequencies in memory T cells of TB patients. To conclude, upon antigen stimulation, polyfunctional memory T cells are found in TB patients pre- and post therapy as well as in LTBI. A difference in the frequency between active TB patients and LTBI could not be detected and therefore a correlation with protection against reactivation from the latent to the active form of TB cannot be drawn.

Cytokine steuern die Kommunikation von verschiedenen Zelltypen untereinander und regulieren deren Überleben, Differenzierung und Wachstum. Kommt es zu einer Deregulation der Expression von Cytokinen oder deren Rezeptoren, kann es zu autoimmunen oder malignen Erkrankungen kommen. Ein besonderes Beispiel der aberranten Cytokinexpression ist das klassische Hodgkin Lymphom. Die malignen Hodgkin/Reed-Sternberg (HRS) Zellen des Hodgkin Lymphoms stammen ursprünglich aus Keimzentrums B-Zellen ab, haben aber ihren B-Zell Phänotyp verloren. Des Weiteren exprimieren sie eine Vielzahl von verschiedenen Cytokinen und Cytokinrezeptoren, die ursprünglich nicht in einem Genexpressionsprogramm von B-Zellen vorkommen. In dieser Arbeit wurden zwei dieser Cytokin-Rezeptorsysteme (IL-21/IL-21R und CSF-1/CSF1R) hinsichtlich ihrer Funktionen für die HRS Zellen des Hodgkin Lymphoms charakterisiert. Die Expression des T-Zell assoziierten Cytokins IL-21 konnte in dieser Arbeit erstmals in HRS Zellen nachgewiesen werden. Für die Expression des myeloiden CSF1R zeigen Ergebnisse dieser Arbeit eine neuartige Regulation durch ein Long Terminal Repeat (LTR) Element, welche zu einem bis dahin unbekannten mRNA Transkript des Protoonkogens CSF1R in den HRS Zellen führt. Sowohl für IL-21 als auch für CSF1R konnte in der Doktorarbeit die Expression und Funktionalität des jeweilig korrespondierenden Rezeptors (IL-21R) bzw. Cytokins (CSF-1) nachgewiesen werden. Die Bedeutung dieser B-Zell fremden Gene für die HRS Zellen lag hauptsächlich in der Stimulation von Wachstum und Überleben und der Induktion von wichtigen Signalwegen (z.B. STAT3). Die Ergebnisse der Dissertation können als Ausgangspunkt für neue Strategien in der Diagnostik und der spezifischeren Therapie von Hodgkin Lymphom Patienten dienen. Der außergewöhnliche Mechanismus der Genregulation des CSF1R Gens über ein endogenes LTR Element kann in anderen Tumorentitäten ebenfalls ein Grund für die Aktivierung von Onkogenen sein. / Cytokines in the human body are responsible for cell-cell communication and regulate survival, differentiation and proliferation of different cell types. Deregulation of expression levels of cytokines might contribute to autoimmune diseases or tumor growth. One of the most prominent examples of aberrant cytokine expression is the classical Hodgkin Lymphoma. The malign Hodgkin/Reed-Sternberg (HRS) cells of classical Hodgkin Lymphoma are derived from germinal centre B cells, however they lost their B cell-specific phenotype. Moreover they express a huge variety of cytokines and cytokine receptors, normally not expressed in B cells. Two of these cytokine-receptor systems (IL-21/IL-21R and CSF-1/CSF1R) and their expression and function in HRS cells are subject of this dissertation. The expression of the T cell-associated cytokine IL-21 has been shown for the first time in HRS cells. The results for the myeloid-specific proto-oncogene CSF1R identified a unique, so far unknown mRNA transcript, expressed due to activation of a long terminal repeat (LTR) element. For both, IL-21 and CSF1R, the expression and functionality of the corresponding receptor (IL-21R) or cytokine (CSF-1), respectively, was demonstrated in this dissertation. Protection from apoptosis, proliferation and stimulation of several pathways are the main functional consequences of auto- and paracrine stimulation of HRS cells with either IL-21 or CSF-1. These results might lead to new diagnostic and more specific treatment strategies for Hodgkin Lymphoma patients. Regarding the unusual expression of CSF1R via LTR activation this mechanism might also be the reason for oncogene activation in several other tumor entities.

Il a été montré que les fonctions et la prolongation de la survie cellulaire des neutrophiles humains par les médiateurs de l'inflammation tendent à diminuer avec le vieillissement. Les protéines tyrosines phosphatase (PTPs), comme SHP-1, sont un des mécanismes qui permettent de moduler à la baisse et de terminer ces fonctions inflammatoires qui sont modulées par l'action des cytokines. Nous avons étudié le rôle des PTPs dans l'altération due au vieillissement des fonctions des neutrophiles humains. L'utilisation d'un inhibiteur pharmacologique des PTPs a suggéré une dérégulation de l'activité phosphatasique avec le vieillissement. Cette dérégulation était confirmée aussi dans le cas de l'apoptose mesurée après 18 heures d'incubation. L'activité phosphatasique de SHP-1 purifiée par immunoprécipitation de neutrophiles de sujets jeunes ou âgés stimulés par le GM-CSF est altérée de façon significative après une minute de stimulation chez les sujets âgés. Dans les sujets jeunes SHP-1 est déplacée des radeaux lipidiques après 1 minute de stimulation par le GM-CSF alors que chez les sujets âgés, SHP-1 est présente à tous les temps de stimulation utilisés. Des immunoblots faits avec des anticorps anti-phosphotyrosine et anti-phosphosérine ont montré une augmentation de la phosphorylation en sérine dans les neutrophiles des sujets jeunes après une stimulation au GM-CSF alors que ce n'était pas le cas chez les sujets âgés. Nous avons aussi trouvé des altérations dans l'activation et le recrutement aux radeaux lipidiques de la Src kinase Lyn chez les neutrophiles des sujets âgés. De plus, nous avons démontré que SHP-1 est continuellement recrutée à Lyn chez les sujets âgés alors que cette interaction, qui est observée dans des cellules non stimulées chez les sujets jeunes, est défaite par la stimulation au GM-CSF. En conclusion, les altérations observées dans la modulation de l'activité de SHP-1 par le GM-CSF dans les radeaux lipidiques sont un des facteurs qui contribuent à la diminution des effets du GM-CSF sur les neutrophiles humains avec le vieillissement.

The formation of the mRNP complex is a critical component of translational regulation and mRNA decay. Both the 5 ' and 3 ' UTRs of CSF-1 mRNA are involved in post-transcriptional regulation. In CSF-1 mRNA, a small hairpin loop structure is predicted to form at the extreme 5 ' end (2-21 nt) of the 5 ' UTR. Nucleolin binds the hairpin loop structure in the 5 ' UTR of CSF-1 mRNA and enhances translation, while removal of this hairpin loop nucleolin binding element dramatically represses translation. Thus in CSF-1 mRNA, the hairpin loop nucleolin binding element is critical for translational regulation. In addition, nucleolin interacts with the 3 ' UTR of CSF-1 mRNA and facilitates the miRISC formation which results in poly (A) tail shortening. The overexpression of nucleolin increases the association of CSF-1 mRNA containing short poly (A)(n), <= 26, with polyribosomes. Nucleolin both forms an mRNP complex with the eIF4G and CSF-1 mRNA, and is co-localized with the eIF4G in the cytoplasm further supporting nucleolin's role in translational regulation. The distinct foci formation of nucleolin in the cytoplasm of ovarian and breast cancer cells implicates the translational promoting role of nucleolin in these cancers.

This thesis focuses on how small to medium-sized management consultancies internationalise, as this is an under-researched area. Investigation focuses on identifying the factors that facilitate international market success for these small to medium-sized enterprises (SMEs), the challenges they encounter, and how those challenges have been overcome. The relevance of SME internationalisation theories is explored for SME management consultancies in the UK. The study is exploratory, phenomenological and framed within an interpretive research paradigm. Primary data was gathered qualitatively using multiple (9) case studies, collected principally through semi-structured interviews. This empirical research, one of the first to focus solely on SME management consultancies, finds the owner/founders as the key driver of internationalisation. Their past experience enables an international outlook and brings established networks to firm formation. The findings highlight the relevance of intangible resources: the firms’ skills, competencies and networking capabilities, as integral to successful internationalisation. Additional key critical success factors are niche market specialisation, firm reputation, firm location, ability for service provision modification and the role of technology. There are observed firm size-related differences in the challenges these firms face, with smaller-sized firms being more vulnerable to challenges from the external environment, including the 2008 financial crisis. Firms are able to overcome these challenges with the help of their networks. Other challenges stem from the firm’s service provision: difficulty in finding skilled staff and communication with clients. The findings suggest applicability for other knowledge-intensive firms. The research contributes to closing the gap in literature on how firms successfully provide services internationally and in so doing advances theoretical understanding of SME service internationalisation. This theory-building research demonstrates partial relevance of Stage Theory, Networking Theory, and Born Global Theory, but overall the resource-based view was found as the most relevant to understanding the internationalisation process of SME management consultancies. This sets a foundation for further research on the internationalisation process of other knowledge-intensive firms.

Desenvolveram-se métodos bioanalíticos para determinação de anfotericina B e fluconazol em apenas 200 L de plasma e líquor (LCR) através da cromatografia líquida de alta eficiência (CLAE UV-VIS). A anfotericina B foi determinada através de CLAE-VIS utilizando p-nitrofenol como padrão interno, após purificação das matrizes biológicas com acetonitrila, seguida da análise em coluna Nova Pak C18 (150 x 3,9mm, 4 micron) e fase móvel constituída por tampão acetato 0,1M pH 5,0 e acetonitrila (50:50,v/v) 0,5mL/min em 385nm; o tempo de corrida foi 15 min. Através da validação o método mostrou-se robusto com 0,2-25,0 &#181;g/mL(linearidade, r2 0,9999), LD 0,1 &#181;g/mL, precisão (5,4% e 6,9%), exatidão expressa através do erro sistemático (3,3% e 2,2%): intra e interdias). Os estudos de estabilidade evidenciaram 1,0% para o erro sistemático e 3% de precisão na bandeja (tempo e condição de análise por 24 h), e os ciclos de congelamento evidenciaram boa estabilidade uma vez que todos os ensaios foram realizados em Laboratório de luz amarela. O fluconazol foi determinado através de CLAE-UV utilizando carbamazepina como padrão interno, após purificação das matrizes biológicas pela extração líquido-líquido com diclorometano em meio alcalino, seguido da análise em coluna Nova Pak C18 (150 x 3,9mm, 4 micron) e fase móvel constituída por água UP e acetonitrila (70:30,v/v) 0,5mL/min em 210nm; o tempo de corrida foi 15 min. O método mostrou-se robusto com 0,2-250 &#181;g/mL(linearidade, r2 0,9998), LD 0,1&#181;g/mL, com boa recuperação absoluta (98%) e relativa (100%), precisão 0,5%/1,3%, exatidão expressa através do erro sistemático (1,2%). Evidenciou-se ótima estabilidade para os extratos em bandeja (tempo e condição de análise por 24 h), na longa duração (20&#176; C, 9 meses) e através dos ciclos de congelamento. Investigaram-se 21 pacientes adultos de ambos os sexos portadores de meningite criptocócica com AIDS após internação emergencial em terapia de alta dose com anfotericina B (1mg/Kg) e fluonazol (400 mg, 12/12 horas) durante 12 semanas. O monitoramento das concentrações de anfotericina B e fluconazol no plasma e no LCR forneceram as razões que permitiram estimar a penetração dos antifúngicos no SNC. Obtiveram-se concentrações de anfotericina B, médias (IC95%): 2,30 (0,02-5,08) &#181;g/mL no plasma e 0,30 (0,19-0,36) &#181;g/mL no LCR. As concentrações do fluconazol, médias (IC95%) foram: 31,7 (20,1-43,3) &#181;g/mL no plasma e 19,4 (11,1-27,7) &#181;g/mL no LCR. Com base nos resultados obtidos conclui-se que a penetração da anfotericina B foi insuficiente (10-27%), enquanto que a do fluconazol mostrou-se adequada com valores médios (IC95%) de 67 (47-87) %. / Analytical methods were developed to determine amphotericin B and fluconazole in only 200 L of plasma and in cerebrospinal fluid (CSF) by liquid chromatography (HPLC UVVIS). Amphotericin B was determined by HPLC - VIS using p-nitrophenol as internal standard, after the purification of biological matrices using acetonitrile, followed by chromatographic analysis in a Nova Pak C18 column (150 x 3.9mm, 4 micron) and mobile phase consisting of acetate buffer 0.1M pH 5.0 plus acetonitrile (50:50,v/v) 0.5mL/min at 385nm; the run time required was 15 min. Bioanalytical method validated showed robustness, 0.2-25,0&#181;g/mL (linearity, r2 0.9999), DL 0.1&#181;g/mL, precision (5.4%/6.0%), accuracy expressed as systematic error (3.3%/2.2%). The stability was investigated, error systematic was 1% for the vials on the rack (time and conditions of drug analysis, 24h). Thawing cycles showed good stability after three freezing-thawing cycles. All procedures were performed under yellow light at room temperature. Fluconazole was determined by HPLC - UV using carbamazepine as internal standard, after the purification of biological matrices using liquid-liquid extraction in alkaline medium, followed by chromatographic analysis in a Nova Pak C18 column (150 x 3.9mm, 4 micron) and mobile phase consisting of purified water plus acetonitrile (70:30,v/v) 0.5mL/min at 210nm; the run time required was 15 min. Bioanalytical method validated showed robustness, 0.2-250 &#181;g/mL(linearity, r2 0.9998), DL 0.1&#181;g/mL. Absolute recovery was 98% and relative recovery was 100%, intra/interday precision were 0,5/-1,3%; accuracy expressed as systematic error were 1.2%/1.2%.and relative recovery was 100%. Good stability for the vials on the rack (time and conditions of drug analysis, 24h) and long term stability (at 20o C for 9 months) were demonstrated. Also thawing cycles showed good stability after three freezing-thawing cycles. Twenty one adult patients of both sex were investigated. Inpatients with meningitis by Cryptococcus neoformans with AIDS were under high dose therapy with amphotericin B 1mg/Kg plus fluonazole 400 mg, every 12h during 12 weeks. Therapeutic monitoring of amphotericin B and fluconazole in plasma and in CSF showed ratios that indicate the penetration of antifungal drugs into CNS. Mean (CI95%) data were for amphotericin B 2.30 (0.02-5.08 ) &#181;g/mL in plasma and 0.30 (0.19-0.36) &#181;g/mL in CSF. Fluconazole showed 31.7 (20.1-43.3) &#181;g/mL in plasma and 19.4 (11.1-27.7) &#181;g/mL in CSF. Based on data obtained we conclude that the penetration of amphotericin B was poor (10-27%) while fluconazole was adequate 67% (47-87%), mean (CI95%).

A hidrocefalia é uma doença ocasionada pelo distúrbio na formação, circulação ou absorção do líquido cefalorraquidiano (líquor) que acarreta na elevação da pressão intracraniana. O tratamento mais usual para a disfunção é a derivação ventrículo-peritoneal (DVP) responsável pela drenagem do líquor do ventrículo até o abdômen do paciente, através do implante de um cateter ventricular, uma válvula neurológica e um cateter peritoneal. Desse modo, o presente estudo apresenta o conceito de uma nova válvula neurológica com um mecanismo inovador para alteração da pressão de funcionamento, com um menor custo produtivo e de possível aceitação pelo Sistema Único de Saúde (SUS). A norma ISO 7197 forneceu as diretrizes atendidas no desenvolvimento da válvula neurológica ajustável e as informações para a construção das bancadas de testes, utilizadas para a realização dos ensaios hidrodinâmicos no protótipo do dispositivo valvular. Foram pesquisados os biomateriais empregados na fabricação de válvulas neurológicas comerciais, para a proposição dos materiais necessários para a construção da válvula ajustável por acionamento mecânico proposta. O aparato utilizado nos testes hidrodinâmicos apresentou incertezas experimentais, que não comprometem os resultados e a avaliação do desempenho in vitro do dispositivo testado. O protótipo da válvula resistiu aos testes de vazamento e de refluxo de fluido. As pressões de abertura e de fechamento apresentaram-se adequadas para o início e a interrupção do escoamento na DVP. Também foi obtido o comportamento do diferencial de pressão, em função da vazão, para as quatro classes de funcionamento disponíveis no protótipo testado. A avaliação hidrodinâmica do protótipo da válvula ajustável por acionamento mecânico apresenta resultados satisfatórios no controle da drenagem de líquor, frente a todos os ensaios hidrodinâmicos realizados. / Hydrocephalus is a disease caused by disturbance in formation, circulation or absorption of cerebrospinal fluid (CSF) which causes high intracranial pressure. The most common treatment for the dysfunction is the ventricle-peritoneal shunt responsible for drainage of cerebrospinal fluid from the patient\'s ventricle to the abdomen, through the implant of a ventricular catheter, a neurological valve and a peritoneal catheter. Thus, the present study introduces the concept of a new valve with an innovative mechanism to change the working pressure, with a lower cost of production and possible acceptance by the Brazilian Health System. ISO 7197 provided the guidelines met in the development of adjustable neurological valve and the information for the construction of testing rigs, used for hydrodynamic testing on the valve device prototype. Biomaterials used in manufacturing commercial neurological valves have been researched for proposition of materials needed for the proposed adjustable neurological valve by mechanical drive. The apparatus used in hydrodynamic tests presented experimental uncertainties, which do not compromise the results and evaluation of in vitro performance of the device tested. The prototype of the valve withstood the leak and the fluid backflow testing. The opening and closing pressures were suitable for the beginning and the interruption of the flow in the ventricle-peritoneal shunt. It was also obtained the behavior of the pressure differential, due to the flow, for the four classes of operation available in the prototype tested. Hydrodynamic evaluation of the prototype of the adjustable valve by mechanical drive shows satisfactory results in the control of CSF drain, dealing with all hydrodynamic tests carried out.

L’apparition de la technique CellSearch® a permis d’obtenir la sensibilité et la spécificité suffisantes et de détecter les CTCs en ciblant les marqueurs spécifiques dans le sang périphérique. Elle permet la numération et l’étude morphologique des CTCs qui est largement utilisée et validée. Nous décrivons une adaptation de la méthode CellSearch® pour détecter les cellules tumorale chez les LM (métastases leptoméningées) patients atteints de cancers du sein, du poumon et mélanomes, qui semble atteindre une sensibilité améliorée en comparaison avec la cytologie conventionnelle. Nous présentons également un cas clinique pour la détection de cellules tumorales dans l’ascite et du sang chez un patient avec le cancer de l’oesophage métastatique. De plus, la détection des cellules tumorales dans le redon chez les patients subis une chirurgie de la tête et du cou a été également réalisée. En utilisant cette méthode, les résultats sont non seulement quatitatifs, mais aussi quantitatifs avec des images numériques de chaque cellule, et des résultats séquentiels ont été étudiés chez certains patients atteints de cancer du sein, de cancer du poumon et de mélanome. Les données ont montré des changements dynamiques des nombres de cellules tumorales détectées dans le LCR, mais leurs corrélations avec la réponse au traitement ou la progression de la maladie ont besoin des études supplémentaires plus contrôlées avec une grande cohorte de patients. La mise en évidence de cette application serait importante en clinique pour le diagnostic, le pronostic et le traitement des patients atteints de cancer avec des métastases aux niveaux du SNC, du péritoine / The introduction of CellSearch® technology allows to give sufficient sensitivity and specificity and to detect CTCs targeting specific markers in peripheral blood. The enumeration and morphological study of CTCs are widely used and validated. We described an adaptation of the CellSearch® method to detect tumor cells in LM (leptomeningeal metastases) patients with breast cancer, lung cancer and melanoma, which appeared to achieve an improved sensitivity in comparison with conventional cytology. We also presented a case report for the detection of tumor cells in the ascites and blood of a patient with metastatic oesophageal cancer. Furthermore, the detection of tumor cells in aspirative drains after neck dissectionin from the patients undergoing surgery for head and neck cancer was also performed. Using this method, the results were not only quatitative but also quantitative with digital images of each cell, and sequential results were studied in some patients with breast cancer, lung cancer and melanoma. The data showed dynamic changes of the numbers of tumor cells detected in CSF, but their correlation with the response to treatment or disease progression need additional more controlled studies with a large cohort of patients. The application would be important for the clinical diagnosis, prognosis and treatment of cancer patients with CNS metastases and peritoneal metastases

A meningite bacteriana continua sendo um problema de saúde pública no Brasil, estudá-la em todos seus aspectos faz com que as chances de intervenções possam ser descobertas a fim de diminuir seus altos índices de mortalidade e sequelas dentre as pessoas acometidas. O presente trabalho teve por finalidade caracterizar o perfil etiológico da meningite bacteriana no estado do Tocantins, no período de 2010 a 2017, através de um estudo retrospectivo, transversal, de natureza quantitativa, realizado a partir de dados provenientes do Laboratório Central de Saúde Pública do Estado do Tocantins (LACEN-TO), em relação à realização de culturas de líquido cefalorraquidiano (LCR) para o diagnóstico laboratorial de meningite bacteriana. Este estudo constatou que foram realizadas 2041 culturas de LCR e um baixo crescimento microbiológico dentre elas. O grupo bacteriano com maior crescimento dentre as culturas positivas foram o Staphylococcus coagulase negativos (SCN), principalmente o S. epidermides. Dentre as bactérias de importância a saúde pública, a de maior incidência foi Streptococcus pneumoniae (sorotipo 3 e 19A), acometendo principalmente indivíduos do sexo masculino e as faixas etárias abaixo de 60 anos, não havendo distinção considerável entre crianças, adolescentes e adultos, seguido de Neisseria meningitides (sorogrupo C) e Haemophilus influenzae (sorotipo b); a maioria dos sorotipos de S. pneumoniae apresentaram susceptibilidade aos antimicrobianos, exceto sorotipo 19A, que apresentou multirresistência. Assim, o principal agente etiológico da meningite bacteriana no estado do Tocantins, de importância a saúde pública, no período estudado foi o Streptococcus pneumoniae, porém devido à baixa positividade de culturas e isolamento desses agentes, é necessário que haja melhorias no diagnóstico laboratorial dessa doença desde o ato da punção, para minimizar o crescimento de bactérias da microbiota, à liberação de resultados, inclusive introdução de novas tecnologias, como a reação em cadeia da polimerase (PCR), que poderá diminuir o tempo de resposta do resultado e aumentar o conhecimento da etiologia deste agravo, devido sofrer menos influência em relação a qualidade de amostra e tempo de processamento. / The bacterial meningitis is still a public health problem in Brazil, studying it in all its aspects causes that the chances of interventions can be discovered in order to reduce their high mortality rates and sequelae among people affected. The present study aimed to characterize the etiological profile of bacterial meningitis in the state of Tocantins, from 2010 to 2017, through a retrospective cross-sectional study of a quantitative nature, based on data from the Central Laboratory of Public Health of the State of Tocantins (LACEN-TO), in relation to cerebrospinal fluid cultures (CSF) for the laboratory diagnosis of bacterial meningitis. This study found that 2041 cultures of CSF and low microbiological growth were performed among them. The bacterial group with the highest growth among the positive cultures were coagulase negative Staphylococcus (SCN), mainly S. epidermides. Among the bacteria of public health importance, Streptococcus pneumoniae (serotype 3 and 19A) was the most prevalent, affecting mainly male individuals and the age groups below 60 years, with no significant distinction among children, adolescents and adults, followed Neisseria meningitides (serogroup C) and Haemophilus influenzae (serotype b); the majority of serotypes of S. pneumoniae showed antimicrobial susceptibility, except for serotype 19A, which presented multiresistance. Thus, the main etiological agent of bacterial meningitis in the State of Tocantins, of importance to public health, during the period studied was Streptococcus pneumoniae, but due to the low positivity of cultures and isolation of these agents, it is necessary to have improvements in the laboratory diagnosis of this disease since the puncture act to minimize the growth of bacteria in the microbiota, the release of results, including introduction of new technologies, such as polymerase chain reaction (PCR), which may decrease the response time of the result and increase knowledge of the etiology of this less influence on sample quality and processing time.

Amyloidogenic neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD) are an important health issue. However, the underlying molecular mechanisms of the disease-related protein aggregates, that are present in humans, are only understood partially. I have used and developed biophysical methods to study the structural and biological properties of individual aggregates of Amyloid β peptide and α-Synuclein, proteins whose aggregation is associated with the development of Alzheimer's and Parkinson's disease respectively. I expanded the single aggregate visualisation through enhancement (SAVE) technique, which is a method based on the fluorescent dye Thioflavin T (ThT) that reversibly bind to the aggregates and whose fluorescence increases upon binding. I firstly explored the use of other dyes for these experiments and found that a ThT dimer has higher affinity to α-Synuclein aggregates in vitro. I then applied the SAVE method to the cerebral spinal fluid (CSF) of a cohort of AD patients and control CSF and observed no clear difference in aggregate number. However, these experiments provided insights into how antibodies bind the aggregates in human CSF. I could show, that despite altering the Ca2+ influx into both cells and vesicles, the antibody did not measurably affect the aggregate structure. To study the size specific effects of the Amyloid β 42 (Aβ42) peptide in more detail, I used and optimised gradient ultracentrifugation combined with single aggregate imaging to study the structural properties of the isolated aggregates. This aggregation kinetic independent method allowed me to compare the properties of fluorescently labelled and unlabelled Aβ42 and characterize the size dependent properties of aggregates in a single experiment. Since I could measure the relative concentration of different size aggregates it was also possible to compare the properties of single aggregates of different sizes. I then used biological assays to examine the ability of aggregates to permeabilise membranes resulting in the entry of calcium ions, and their ability to induce TNFα production in microglia cells. Both processes are thought to play key roles in the development of AD. I found that small soluble oligomers are most potent at inducing Ca2+ influx, whereas longer protofilaments are the most potent inducers of TNFα production. My results suggest that the mechanism by which aggregates damage cells changes as aggregation proceeds, as longer aggregates with different structures are formed. Protofilaments with a diameter of 1 nm or less have a structure that could make them particularly potent at causing the signalling of toll-like receptors, providing a molecular basis for their ability to induce TNFα production.