Le but de ce travail est d’étudier le lien suspecté entre l’inflammation buccale et la survenue des AVC ischémiques. Dans les pays occidentaux, l’incidence des infarctus cérébraux est en augmentation malgré les campagnes de prévention visant à limiter l’exposition aux facteurs de risque classiques des pathologies ischémiques. Près de 9% des accidents vasculaires cérébraux sont sans étiologie connue. Le facteur déclenchant de l’AVC ischémique ou le « key trigger » reste inconnu. Des études récentes montrent qu’un AVC ischémique est plus susceptible de se déclencher dans la semaine qui suit un événement infectieux. De ce fait, l’inflammation buccale entraînant une élévation de différents biomarqueurs inflammatoires est susceptible de favoriser la survenue des AVC. Dans un premier temps, une méta-analyse a été effectuée afin de faire la synthèse des données étudiant la relation entre l’inflammation buccale et la survenue des AVC. Elle a montré que le risque d’avoir un AVC ischémique fatal augmente de 38% chez les sujets atteints de parodontite sévère. Dans un deuxième temps, deux études cliniques observationnelles ont été mises en place afin de renforcer la validité des liens épidémiologiques supposés et d’apporter de nouveaux éléments dans la compréhension des mécanismes physiopathologiques liant l’inflammation buccale et la survenue des AVCI. Les résultats montrent une relation entre le degré d’inflammation buccale et les marqueurs biologiques athéromateux et inflammatoires. En effet, nos résultats montrent une augmentation des taux de CRP, de VLDL, de triglycérides et une diminution des taux de HDL lors d’une atteinte parodontale sévère. C’est la perte osseuse parmi les marqueurs cliniques de l’inflammation buccale aisément évaluable sur un panoramique dentaire, qui est la plus significativement liée au risque de la survenue des AVC ischémiques. Les résultats de cette thèse suggèrent que la présence d’un contexte buccal inflammatoire favoriserait la survenue le développement d’un AVCI. En outre, nos résultats confirment la nécessité d’une coopération entre l’odontologue et le neurologue afin d’améliorer la prise en charge du risque vasculaire chez un patient ayant un AVCI avec une inflammation buccale. / The aim of this work is to investigate the suspected link between oral inflammation and the occurrence of ischemic stroke. In Western countries, the incidence of ischemic stroke is rising despite prevention campaigns aiming at limiting the exposure to common risk factors for ischemic diseases. Nearly 9% of strokes are of unknown etiology. The triggering factor for ischemic stroke or "trigger key" remains unknown. Recent studies have shown that ischemic stroke is more likely to occur in the week following an infectious event. Therefore, oral inflammation, that causes a rise in various inflammatory biomarkers is studied as potentially increasing the risk of stroke. Firstly, a meta-analysis was performed to synthesize data about the relationship between oral inflammation and the occurrence of stroke. It has shown that the risk of fatal ischemic stroke increases by 38% in patients with severe periodontitis. Secondly, two observational clinical studies have been implemented to strengthen the validity of the supposed epidemiological links and bring new elements in our understanding about the pathophysiological mechanisms linking oral inflammation and the occurrence of ischemic stroke. The results show a proportional relationship between the degree of oral-inflammation and biological assessments that demonstrate pro-atherosclerotic and pro-inflammatory state. Indeed, we observe an increase in CRP levels, VLDL triglycerides and a decrease in HDL in patients with severe periodontal disease. Bone loss, that is easily measurable on a dental panoramic radiograph, appears to be the main risk factor of the occurrence of ischemic stroke.The results of this thesis show that the presence of an inflammatory oral environment is an additional marker for the discovery of a cardiovascular risk in patients combining other conventional risk factors of ischemic stroke. In addition, our results suggest the need for cooperation between the neurologists and odontologists to improve the management of cardiovascular risk in patients with ischemic stroke and oral inflammation.

No description available.

1 Cardiovascular risks in chronic airway disease in childhood The aim of this thesis was to evaluate cardiovascular risk by using a combined diagnostic approach by measuring RHI and specific biochemical markers in patients with chronic respiratory disease, where we could assume a possible risk of CVD. A total of 119 probands were examined, including 22 patients with cystic fibrosis (CF) and 52 asthma patients. We evaluated RHI using a new plethysmographic method that has a number of advantages over the ultrasonographic methods used in other studies, including non-invasiveness, high sensitivity, low biological variability and objectivity due to automatic processing. Of the biochemical parameters, we measured 4 biomarkers in relation to endothelial dysfunction (ED): hsCRP, ADMA, E-selectin, and VCAM-1. We compared RHI and biomarkers in CF and asthma patients with healthy controls and sought mutual correlations. We did not prove a statistically significant difference in RHI between the test groups with CF children but we confirmed the decreasing trend of RHI since adolescence and significantly lower RHI values in CF adults, confirming the progressive development of atherogenesis and worsening of ED with age. Biochemical parameters showed significantly higher levels of hsCRP, sVCAM-1 and E-selectin in CF...

O linfoma é uma doença neoplásica comum em cães, requerendo quimioterapia para aumentar a sobrevida dos pacientes. Durante o tratamento, são freqüentes as recidivas, que motivam alteração do protocolo medicamentoso. Proteína C-reativa e amilóide A sérica são mediadores de fase aguda produzidos no fígado que apresentam elevações de concentrações séricas em condições inflamatórias, infecciosas e neoplásicas de maneira geral. O objetivo do trabalho foi avaliar o papel dessas proteínas na monitorização da remissão e recidiva do linfoma em cães, utilizando 2 protocolos de tratamento. O protocolo COP (ciclofosfamida, vincristina e prednisona) caracterizou-se por fase de indução de 1 mês e ciclos de manutenção a cada 21 dias e o protocolo VCM (vincristina, ciclofosfamida, metotrexato e L- asparaginase) foi empregado em um regime semanal contínuo. Constituíram-se 5 grupos de estudo: Normal (20 cães hígidos), Controle COP (4 cães hígidos submetidos a quimioterapia com o protocolo COP), Controle VCM (4 cães hígidos submetidos a quimioterapia com o protocolo VCM), Linfoma COP (10 cães com linfoma multicêntrico tratados com o protocolo COP) e Linfoma VCM (10 cães com linfoma multicêntrico tratados com o protocolo VCM). Proteína C-reativa e amilóide A sérica foram determinadas pela técnica de Elisa e a eletroforese foi feita em tiras de acetato de celulose. Nos cães do grupo Normal, o estabelecimento das concentrações de proteína C-reativa, amilóide A sérica e as rações eletroforéticas ocorreu uma única vez; nos cães dos grupos Controle COP e Controle VCM na 1ª, 2ª, 3ª, 4ª, 7ª, 10ª, 13ª e 16ª semanas de quimioterapia e, nos cães dos grupos Linfoma COP e Linfoma VCM, na 1ª, 2ª, 3ª e 4ª semanas, bem como na recidiva e num momento de estabilidade da doença imediatamente antes da recidiva. Os resultados foram interpretados por análise de variância com medidas repetidas, tendo como fatores de controle os grupos e as semanas de observação, seguida de comparações múltiplas de Tukey, ao nível de significância de 5 %. Concluiu-se que: o linfoma induz a resposta de fase aguda em cães, sendo a intensidade da resposta amenizada durante o tratamento bem-sucedido dos pacientes; incrementos de proteína C-reativa e amilóide A sérica não estão relacionados à recidiva do linfoma; a quimioterapia do linfoma com os protocolos COP e VCM não altera a resposta de fase aguda, avaliada por meio dessas proteínas, nem existe diferença na resposta de fase aguda entre tais protocolos; existe relação direta entre os níveis de proteína C-reativa e amilóide A sérica no curso do linfoma e da quimioterapia; aumentos das concentrações séricas de proteína C-reativa são acompanhados de elevações da fração de β2-globulinas e aumentos de amilóide A sérica são acompanhados de elevações de β1-globulinas. / Lymphoma is a common neoplasm in dogs and chemotherapy is indicated to achieve long-term survivals. During the treatment, frequent relapses require drug regimen modifications. C-reactive protein (CRP) and serum amyloid A (SAA) are hepatic acute-phase mediators and usually are increased in inflammatory, infectious and neoplastic conditions. The aim of this study was to evaluate the role of these proteins in remission and relapse monitoring of dogs with lymphoma, under 2 chemotherapy protocols. COP protocol (cyclophosphamide, vincristine and prednisone) included an one-month induction period and maintenance cycles each 21 days and VCM protocol (vincristine, cyclophosphamide, methotrexate and L-asparaginase) was administered in a continuous weekly schedule. Five groups were composed: Normal (20 healthy dogs), COP Control (4 healthy dogs submitted to chemotherapy with COP protocol), VCM Control (4 healthy dogs submitted to chemotherapy with VCM protocol), COP Lymphoma (10 dogs with multicentric lymphoma treated with COP protocol) and VCM Lymphoma (10 dogs with multicentric lymphoma treated with VCM protocol). CRP and SAA were determined by Elisa tests and the electrophoresis was performed in cellulose acetate strips. In Normal dogs, CRP and SAA levels, as well the electrophoretic fractions, were measured only one time; in COP Control and VCM Control groups of dogs at the chemotherapy weeks 1, 2, 3, 4, 7, 10, 13 and 16; in dogs from groups COP Lymphoma and VCM Lymphoma, at the weeks 1, 2, 3 and 4, beside the relapse and a called stability moment immediately before the relapse. Results were compared by means of repeated measures variancy analyses, considering the groups and the observation weeks as the control factors, followed by Tukey´s multiple comparisons, at 5 % of significance level. It was concluded that: lymphoma induces an acute phase response in dogs and the intensity of response declines along the disease remission; increases of CRP and SAA are not related to lymphoma relapse; neither COP nor VCM chemotherapy changes the acute-phase response, when CRP and SAA are taken in account, and there is not difference on acute-phase response between both regimens; there is a positive correlation between CRP and SAA levels during lymphoma assessment and chemotherapy; increases of CRP levels are followed by β2-globulin elevations and increases of SAA levels are related to β1-globulin elevations.

Introdução: A readmissão de pacientes nas unidades de terapia intensiva (UTIs) está associada a piores desfechos durante a internação hospitalar. Através da análise de preditores existe a possibilidade de identificar os pacientes sob risco de readmissão e planejar possíveis intervenções visando melhorar a segurança destes pacientes. Objetivos: Avaliar o desempenho da saturação venosa central (SvcO2), do lactato, do déficit de bases (DB), dos níveis de proteína C reativa (PCR), do Sequential Organ Failure Assessment (SOFA), do Stability and Workload Index for Transfer (SWIFT) escore do dia da alta da UTI como preditores e fatores de risco para readmissão de pacientes na unidade de terapia intensiva (UTI), além de verificar a frequência de readmissões na UTI. Métodos: O estudo avaliou pacientes criticamente enfermos internados consecutivamente na unidade de terapia intensiva do Hospital Nossa Senhora da Conceição que receberem alta da UTI, no período entre Agosto/2011 e Agosto/2012. Resultados principais: Utilizando análise multivariada o SOFA e o SWIFT da alta foram identificados como fatores de risco independentemente associados à readmissão na UTI. Entretanto, com uma área sob a curva receiver operating characteristic (ROC) de 0,63 e 0,66 respectivamente, estes escores podem não ter grande aplicabilidade clínica em nossa população. A PCR, a SvcO2, o DB e o lactato não estão associados a readmissão de pacientes críticos. Conclusões: Apesar do grande impacto clínico e econômico associado à readmissão de pacientes na UTI, nossa capacidade para discriminar os pacientes sob risco de readmissão e objetivar os critérios de alta dos pacientes críticos segue inadequada. / Background: Readmission of patients in intensive care units (ICUs) is associated with worse outcomes during hospitalization. Possibly, identifying patients at risk for readmission through the analysis of predictors, some intervention may be planned for the security of these patients. Objectives: To evaluate the performance of central venous oxygen saturation (ScvO2), lactate, base deficit (BD), C-reactive protein (CRP), the Sequential Organ Failure Assessment (SOFA) score and the Stability and Workload Index for Transfer (SWIFT) score at the day of discharge from the intensive care unit (ICU) as predictors and risk factors for readmission or unexpected death among critically ill patients and to identify the frequency of readmissions in the ICU. Design: Prospective observational study. Location: academic tertiary hospital in Brazil. Patients: A total of 1,360 patients admitted to a 59 beds medical-surgical ICU from August 2011 to August 2012. Methods: We compared the characteristics and laboratory data of readmitted patients and not readmitted patients discharged from the ICU. Through multivariate analysis we identified potential risk factors independently associated with readmission. Main results: SOFA and SWIFT were identified as significant risk factors for ICU readmission. However, with an area under the ROC curve of 0.63 and 0.66, these scores would appear to have limited clinical applicability in our population. CRP, ScvO2, BD and lactate were not associated with readmission of critically ill patients. Conclusions: Perfusion and inflammatory markers are not good predictors of ICU readmission. Despite the clinical and economic impact associated with readmission in ICU, our ability to predict which patients will be readmitted is still inadequate.

Bisphenol A (BPA), a widely used chemical in plastic, has drawn wide attention due to its presence in many consumer products and the environment. The purpose of this study was to examine the association between urinary BPA and the reporting of cardiovascular diseases (CVD), and then to examine the effect of C-reactive protein (CRP) as a moderating variable. The data used in this research were extracted from the National Health and Nutrition Examination Survey collected in 2009-2010. Guided by the advanced epidemiological triangle, analysis involved 2 stepwise binary logistic regressions. The first step suggested that the controls were significant in predicting CVD (Ï?2 (5) = 83.72, p < .001, R2 = .15). The Nagelkerke R2 coefficient of determination indicated that the controls explained approximately 15% of the variance in instances of CVD. The second step of the binary logistic regression included the controls and BPA level in the model together. The regression analysis suggested that the Nagelkerke coefficient of determination (Ï?2 (6) = 83.76, p < .001, R2 = .15) did not increase from the 15% explained by the controls, and BPA level was found to be a nonsignificant predictor of CVD (p = .853). Due to lack of association between BPA and CVD, the analysis was shifted to examine the association between urinary BPA and serum CRP. The association between urinary BPA and serum CRP was also statistically nonsignificant (Spearman correlation coefficient, rs= .06, p = .015). The results may have positive social change by contributing to the body of knowledge on BPA and by increasing scientific scrutiny for substances used in people's daily lives.

Maîtriser la biocontamination surfacique et les risques susceptibles d'y être associés demeure un challenge majeur. Cette maîtrise passe par la préparation de nouveaux matériaux polymères possédant des propriétés de surface adaptées. Dans cette optique le LCOM développe depuis quelques années une thématique consistant à mettre au point des méthodes de modifications de surfaces de matériaux polymères par greffage de biomolecules. [ ] [ ] [ ] Dans ce contexte, l'objectif de cette étude est de fonctionnaliser des films polymères de type poly (téréphtalate d'éthylène) (PET) avec des dérivés sucrés et/ou polysaccharides dans le but d'étudier le caractère bactériostatique, biocide et pro ou anti-adhésion. [ ] La préparation des matériaux se fait en plusieurs étapes :Etape 1 : Fonctionnalisation de surfaces polymères (films) par traitement plasma N2/H2 et NH3 pour introduire à la surface des fonctions amines. Cette technique modifie la surface sans changer les propriétés intrinsèques des matériaux.Etape 2 : Greffage d'un amorceur de polymérisation radicalaire par transfert d'atome (ATRP)Etape 3 : Polymérisation en surface d'un monomère sucré par ATRP (contrôle de la longueur des chaînes greffées). La mise au point des paramètres de polymérisation ATRP de ces monomères est d'abord menée en solution avant d'étudier la polymérisation en surface.Etape 4 : Etudes microbiologiques des surfaces modifiées.Après chaque étape de modification de surface, les matériaux sont caractérisés par différentes méthodes d'analyses telles que : la spectroscopie de photoélectrons X (XPS), la microscopie à force atomique, la chromatographie d'exclusion stérique. Des glycopolymères protégés et déprotégés issus du galactose et de la glucosamine ont été synthétisés. Ceux issus de la glucosamine ont été synthétisés afin de mimer les propriétés antibactériennes du chitosane. Le glycomonomère issu du galactose est polymérisé par ATRP par voie " grafting from " sur des surfaces de PET. Ces surfaces modifiées présentent des propriétés anti-adhésives intéressantes contre les bactéries du type Bacillus subtilis. En effet, après greffage du glycomonomère déprotégé, il n' ya plus d'adhésion de bactéries. Des polymères contenant des fonctions ammonium quaternaire et fluor ont aussi été greffés avec succès sur les films de PET par la même méthode.

<p>Type 1 diabetes is caused by immuno-mediated β-cell destruction leading to insulin deficiency and hyperglycaemia. The decline in β-cell function and the clinical course after diagnosis vary. Whether the process of destruction of the β-cells is associated with markers of a non-specific inflammatory response is unknown. The aims of these studies were to identify factors of importance for clinical remission (low insulin need and normoglycaemia) and long-term β-cell function and estimate the degree of non-inflammatory response in type 1 diabetes in young adults. Clinical remission and β-cell function eight years after diagnosis were assessed and related to clinical, biochemical and immunological variables at diagnosis, including islet autoantibodies [ICA, GADA, IA-2A]. Markers of low-grade inflammation in plasma [CRP and IL-6] were estimated and the concentrations were related β-cell function [plasma C-peptide], glycaemic control and autoimmunity at diagnosis and the first year thereafter. The results showed that clinical remission occurred in about half of the patients with newly diagnosed type 1 diabetes. Preserved β-cell function eight years after diagnosis was observed in 16% of the patients classified at diagnosis as having autoimmune type 1 diabetes. Duration of remission was dependent on BMI, degree of metabolic derangement and presence of GADA at diagnosis. BMI at diagnosis was also of importance for preserved β-cell function after eight years of the disease, as were the amount of islet antibodies and presence of ICA. Elevated CRP levels were noted in the majority of cases at diagnosis and both CRP and IL-6 concentrations were stable the first year after clinical diagnosis. High concentrations of CRP and IL-6 did not relate to β-cell destruction or the degree of autoimmunity. CRP concentrations were higher in islet antibody negative than in positive patients. CRP also correlated positively to BMI, C-peptide at 12 months and to increasing HbA1c between six and 12 months. In general, females had shorter remissions, lower concentrations of serum bicarbonate and higher levels and prevalence of GADA at diagnosis, compared to males. Females also had higher HbA1c and CRP values the first year after diagnosis. In summary, BMI at diagnosis is a strong predictor of duration of remission and preservation of β-cell function. Elevated CRP concentrations are correlated to factors linked rather to insulin resistance than to β-cell destruction. Females appear to have a more acute onset and a more severe course of the disease than males.</p>

Type 1 diabetes is caused by immuno-mediated β-cell destruction leading to insulin deficiency and hyperglycaemia. The decline in β-cell function and the clinical course after diagnosis vary. Whether the process of destruction of the β-cells is associated with markers of a non-specific inflammatory response is unknown. The aims of these studies were to identify factors of importance for clinical remission (low insulin need and normoglycaemia) and long-term β-cell function and estimate the degree of non-inflammatory response in type 1 diabetes in young adults. Clinical remission and β-cell function eight years after diagnosis were assessed and related to clinical, biochemical and immunological variables at diagnosis, including islet autoantibodies [ICA, GADA, IA-2A]. Markers of low-grade inflammation in plasma [CRP and IL-6] were estimated and the concentrations were related β-cell function [plasma C-peptide], glycaemic control and autoimmunity at diagnosis and the first year thereafter. The results showed that clinical remission occurred in about half of the patients with newly diagnosed type 1 diabetes. Preserved β-cell function eight years after diagnosis was observed in 16% of the patients classified at diagnosis as having autoimmune type 1 diabetes. Duration of remission was dependent on BMI, degree of metabolic derangement and presence of GADA at diagnosis. BMI at diagnosis was also of importance for preserved β-cell function after eight years of the disease, as were the amount of islet antibodies and presence of ICA. Elevated CRP levels were noted in the majority of cases at diagnosis and both CRP and IL-6 concentrations were stable the first year after clinical diagnosis. High concentrations of CRP and IL-6 did not relate to β-cell destruction or the degree of autoimmunity. CRP concentrations were higher in islet antibody negative than in positive patients. CRP also correlated positively to BMI, C-peptide at 12 months and to increasing HbA1c between six and 12 months. In general, females had shorter remissions, lower concentrations of serum bicarbonate and higher levels and prevalence of GADA at diagnosis, compared to males. Females also had higher HbA1c and CRP values the first year after diagnosis. In summary, BMI at diagnosis is a strong predictor of duration of remission and preservation of β-cell function. Elevated CRP concentrations are correlated to factors linked rather to insulin resistance than to β-cell destruction. Females appear to have a more acute onset and a more severe course of the disease than males.

Bisphenol A (BPA), a widely used chemical in plastic, has drawn wide attention due to its presence in many consumer products and the environment. The purpose of this study was to examine the association between urinary BPA and the reporting of cardiovascular diseases (CVD), and then to examine the effect of C-reactive protein (CRP) as a moderating variable. The data used in this research were extracted from the National Health and Nutrition Examination Survey collected in 2009-2010. Guided by the advanced epidemiological triangle, analysis involved 2 stepwise binary logistic regressions. The first step suggested that the controls were significant in predicting CVD (Ï?2 (5) = 83.72, p < .001, R2 = .15). The Nagelkerke R2 coefficient of determination indicated that the controls explained approximately 15% of the variance in instances of CVD. The second step of the binary logistic regression included the controls and BPA level in the model together. The regression analysis suggested that the Nagelkerke coefficient of determination (Ï?2 (6) = 83.76, p < .001, R2 = .15) did not increase from the 15% explained by the controls, and BPA level was found to be a nonsignificant predictor of CVD (p = .853). Due to lack of association between BPA and CVD, the analysis was shifted to examine the association between urinary BPA and serum CRP. The association between urinary BPA and serum CRP was also statistically nonsignificant (Spearman correlation coefficient, rs= .06, p = .015). The results may have positive social change by contributing to the body of knowledge on BPA and by increasing scientific scrutiny for substances used in people's daily lives.