A interleucina-2 (IL-2) atua na modulação da atividade dopaminérgica, que influencia o comportamento maternal. Neste estudo observou-se que o estado lactacional reduziu a atividade geral em campo aberto, porém não alterou os níveis de dopamina e seus metabólitos. A administração de IL-2, tanto sistêmica com diretamente no N.Ac não alterou a atividade geral em campo aberto, indicando a ausência de efeito motor da mesma. Além disso, a administração de IL-2 sistêmica e no N.Ac reduziu as porcentagens de ratas que agrupam os filhotes e de filhotes agrupados por rata. A injeção de IL-2 no N.Ac aumentou as latências de busca do primeiro e segundo filhotes e o comportamento agressivo. A administração sistêmica de IL-2 em ratas virgens reduziu somente do valor absoluto de DOPAC (metabólito de dopamina) após 100 e 120. Este achado corrobora a idéia de que o IL-2 altera a atividade dopaminérgica. Os resultados sugerem que a administração sistêmica da dose de IL-2 estudada não influencia de forma significativa os níveis de dopamina e de seus metabólitos no N.Ac. / Interleukin-2 (IL-2) modulates the dopaminergic neurotransmission, that into the nucleus accumbens (N.Ac) plays a role in maternal behavior. The IL-2 dose used in this study does not have motor effects. Both peripheral and central N.Ac injections decreased the percent of mothers grouping pups together and the number of grouped pups. IL-2 injections into the N.Ac resulted in longer latencies to retrieve first and second pups and increased aggressive behavior. In order to test if these behavioral effects would be related to the IL-2 reduced the DOPAC (dopamine metabolite) concentrations in the N.Ac of virgin rats treated with IL-2. This suggests suggest that the IL-2 dose used in this study does not alter so much the dopaminergic transmission by influencing extracellular levels of this neurotransmitter.

Der Schlaganfall steht hinter den Herz- und Tumor-Erkrankungen an dritter Stelle aller Todesursachen. Der wichtigste Faktor für die Vermeidung dauerhafter Invalidität und die Wiederherstellung maximaler Lebensqualität ist die Verhinderung von sekundären Komplikationen. Dabei stellt die Infarktprogression eine der schwerwiegendsten Komplikationen dar. Im Rahmen dieser Arbeit konnte bei insgesamt 45 Patienten mit einem malignen Schlaganfall mittels serieller MRT-Aufnahmen bestimmt werden, ob eine Infarktprogression vorlag. Ein Schwerpunkt der Arbeit war es, die hämodynamische Antwort und die zeitliche und räumliche Ausbreitung von Spreading Depolarizationen (CSD) im Periinfarktgewebe von Patienten mit malignem Schlaganfall zu untersuchen. In dieser Studie konnte zum ersten Mal die zeitliche und räumliche Ausbreitung von CSDs und deren hämodynamische Kopplung am humanen Kortex gezeigt werden. In einer zweiten Substudie wurden mit Hilfe der zerebralen Mikrodialyse die Konzentrationen von Glutamat, Glukose, Laktat und Pyruvat im Periinfarktgewebe bestimmt. Damit sollte im Besonderen geklärt werden, ob es Unterschiede in den Konzentrationen bei Patienten mit Infarktprogression zu Patienten ohne Infarktprogression gibt. Zusammenfassend war ein bemerkenswerter Anteil von verzögerter Infarktprogression nach Dekompression bei Patienten mit malignem Schlaganfall assoziiert mit veränderten biochemischen Markern innerhalb der Periinfarktregion. Des Weiteren wurde untersucht, inwiefern CSDs mit einer veränderten Konzentration von Glutamat, Glukose, Laktat und Pyruvat einhergeht. Hierzu wurde eine Korrelation zwischen CSDs und den Mikrodialysekonzentrationen von Glutamat, Glukose, Laktat und Pyruvat erstellt. / Stroke is the third leading cause of death. The most important factor in preventing permanent disability and recovering quality of life is the prevention of secondary complications. Infarct progression is one of the most serious complications after stroke. In the present study we determined by volumetric analysis from serial magnetic resonance imaging in 45 patients with malignant hemispheric stroke whether an infarct progression was present or not. The next aim was to investigate the hemodynamic response pattern and spatiotemporal propagation of cortical spreading depolarization (CSD) in the peri-infarct region of malignant hemispheric stroke. For the first time, intraoperatively the spatiotemporal propagation of CSDs and their hemodynamic coupling in the human cerebral cortex was visualized. In a second study, the levels of glutamate, glucose, lactate and pyruvate in the peri-infarct region using cerebral microdialysis in patients with malignant stroke were investigated. In particular, it was necessary to clarify whether there are differences in the metabolic changes are associated with delayed infarct progression. In summary, we observed a notable proportion of delayed infarct progression after decompressive surgery in patients with malignant hemispheric stroke associated with a disarrangement of biochemical markers within the peri-infarct region. Furthermore I investigated how CSDs are associated with metabolic changes. For this, a correlation between CSD and the concentrations of glutamate, glucose, lactate and pyruvate was prepared.

Introdução. A estimulação do córtex motor (ECM) tem sido utilizada para o tratamento de pacientes com síndromes neuropáticas dolorosas crônicas e resistentes a tratamentos farmacológicos convencionais. O córtex motor primário pode ser a estrutura mais rostral do neuroeixo relacionada ao sistema de modulação da dor, e a ECM provoca ativação neuronal na substância cinzenta periaquedutal (PAG). A PAG é um dos principais centros do sistema descendente supressor de dor e recebe aferências de diferentes regiões do encéfalo. Esse estudo investiga o efeito da estimulação do córtex motor sobre a liberação de neurotransmissores na PAG em modelo de dor neuropática, com o objetivo de investigar os mecanismos neuroquímicos responsáveis pelo feito terapêutico. Métodos. No primeiro experimento, ratos Wistar machos foram aleatoriamente divididos em três grupos. No primeiro grupo, os animais foram submetidos à indução de dor neuropática através da constrição crônica do nervo ciático, no segundo grupo, os animais foram submetidos apenas à exposição do nervo ciático e no terceiro grupo, nenhuma intervenção para indução de dor neuropática foi realizada. Todos os animais foram submetidos a implante unilateral epidural de eletródios de estimulação sobre a área do córtex motor correspondente a pata posterior e implante de cânula guia direcionada à PAG utilizando coordenadas estereotáxicas. Os animais foram avaliados no teste de hiperalgesia mecânica e uma sonda de microdiálise foi introduzida em direção a PAG. As amotras de microdiálise foram coletadas e a análise dos neurotransmissores foi feita em um sistema de cromatografia líquida de alta eficiência (HPLC). No segundo experimento, ratos Wistar machos com dor neuropática induzida na pata posterior foram submetidos a implante estereotáxico de cânula guia direcionada à PAG, e foi realizada micro-injeção de antagonista de glicina e/ou GABA na PAG, previamente a ECM, para avaliar a influência desses antagonistas no efeito analgésico induzido pela estimulação cortical. Resultados. Animais submetidos à indução de dor neuropática apresentaram reversão da hiperalgesia mecânica após ECM. A estimulação cortical induziu um aumento significativo nos níveis de glicina durante (aumento de 153%) e após MCS (134%). A concentração de GABA aumentou 145% durante a estimulação epidural. Os níveis de glutamato não mostraram alteração no microdialisado da PAG após ECM. Houve uma correlação estatisticamente significativa entre o posicionamento da sonda de microdiálise nas colunas lateral e dorsolateral da PAG e o aumento na liberação do neurotransmissor glicina nos animais do grupo CCI. A administração de antagonista de glicina na PAG reverteu o efeito antinociceptivo da estimulação cortical. A micro-injeção de antagonista de GABA na PAG reverteu parcialmente o efeito da ECM. Conclusões. Nossos resultados sugerem que os neutransmissores glicina e GABA, liberados na PAG durante ECM, contribuem para o efeito antinociceptivo da via analgésica descendente. Os resultados desse projeto poderão contribuir para a elucidação dos mecanismos do efeito antinociceptivo da ECM / Introduction. Motor cortex stimulation (MCS) has been used for the treatment of patients with chronic neuropathic pain syndromes that are resistant to conventional pharmacological treatment. The motor cortex may be the most rostral structure in the neuroaxis responsible for pain modulation, and MCS increase the neuronal activation of periaqueductal gray (PAG). The PAG is one of the main subcortical centers of the descending pain suppressor system, and receives inputs from several brain areas. This study investigates the effects of MCS on the release of neurotransmitters in the PAG in neuropathic pain model, in order to investigate the possible neurochemical mechanisms responsible for this effect. Methods. In the first experiment, Wistar male rats were randomly subdivided into three surgical groups. In the first group, induction of neuropathic pain was performed through chronic constriction injury of the right sciatic nerve, in the second group, the animals were submitted just to exposure of the sciatic nerve and in the third group, no intervention for induction of neuropathic pain was performed. All the rats underwent implantation of unilateral epidural electrodes on the motor area corresponding to the right hind paw. The animals were evaluated for mechanical hyperalgesia test and a microdialysis guide cannula was stereotaxically implanted into the PAG. The microdialysate samples were collected and the neurotransmitters analysis was performed by a high- performance (HPLC). In the second experiment, animals with induced neuropathic pain in the hind paw were submitted to a stereotaxic implantation of a guidewire directed to PAG, and a microinjection of glycine and/or GABA antagonist in the PAG before the ECM was performed, to evaluate the influence of these antagonists on the analgesic effect induced by the cortical stimulation. Results. Animals subjected to induction of neuropathic pain showed reversal of mechanical hyperalgesia after motor cortex stimulation. Cortical stimulation induced a significant increase in glycine levels during (153 % increase) and after MCS (134%). The GABA concentration increases 145 % during transdural stimulation. Glutamate levels showed no change in PAG microdialysate after MCS. There was a statistically significant correlation between the positioning of the microdialysis probe in the lateral and dorsolateral columns of the PAG and the increase in the release of the neurotransmitter glycine in the animals of the CCI group. Administration of glycine antagonist in PAG reversed the antinociceptive effect of cortical stimulation. Microinjection of GABA antagonist in PAG partially reversed the effect of MCS. Conclusions. Our results suggest that the neurotransmitters glycine and GABA, released in PAG during MCS, contribute to descending antinociceptive actions. The results of this project will contribute for the elucidation of the mechanisms of the antinociceptive effect of MCS, a phenomenon that has not been fully understood currently

Biofilmes são comunidades bacterianas complexas encapsuladas em matrizes poliméricas autoproduzidas e podem se desenvolver em superfícies inertes ou tecidos vivos. A formação do biofilme é um importante fator de virulência, pois permite à bactéria resistir às respostas do hospedeiro e à terapia antimicrobiana. Devido a essa elevada resistência aos antimicrobianos, é difícil estabelecer uma estratégia eficaz para o tratamento de infecções com formação de biofilmes, levando a falhas na erradicação das mesmas. Nesse contexto, o objetivo do presente estudo é desenvolver um modelo farmacocinético/farmacodinâmico (PK/PD) para descrever o efeito do ciprofloxacino (CIP) na presença de biofilmes de Pseudomonas aeruginosa (ATCC 27853), visto que a modelagem PK/PD de antimicrobianos é uma ferramenta útil na escolha de regimes posológicos que atinjam o efeito bactericida máximo, minimizando o desenvolvimento de resistência. Para atingir esse objetivo, inicialmente um método analítico por CLAE/fluorescência foi desenvolvido para quantificar o CIP em amostras de plasma e microdialisado. O método desenvolvido foi simples, rápido e com sensibilidade adequada para corretamente caracterizar a farmacocinética plasmática e pulmonar do CIP. Posteriormente, um modelo animal de infecção pulmonar crônica foi adaptado da literatura e padronizado, permitindo a investigação da distribuição pulmonar do CIP em ratos Wistar sadios e infectados. Para tal, bactérias foram imobilizadas em beads de alginato a fim de manter a infecção por até 14 dias com cargas bacterianas superiores à 108 UFC/pulmão. Estudo de microdiálise foi então conduzido para avaliar as concentrações livres de CIP após administração intravenosa de 20 mg/kg. A análise não-compartimental (NCA) e a modelagem farmacocinética populacional (PopPK) dos dados foram realizadas nos softwares Phoenix® e NONMEM®, respectivamente. Diferenças significativas foram observadas no clearance plasmático (1,59 ± 0,41 L/h/kg e 0,89 ± 0,44 L/h/kg) e na constante de eliminação (0,23 ± 0,04 h-1 e 0,14 ± 0,08 h-1) para ratos sadios e infectados, resultando em uma exposição plasmática maior nos animais infectados (ASC0-∞ = 27,3 ± 12,1 μg·h/mL) quando comparados com os animais sadios (ASC0-∞ = 13,3 ± 3,5 μg·h/mL) ( = 0,05). Apesar da maior exposição plasmática, quando comparados com os animais saudáveis (fT = 1,69), animais infectados apresentaram uma penetração pulmonar quatro vezes menor (fT = 0,44). Diferenças na constante de eliminação pulmonar não foram observadas. Dados plasmáticos e pulmonares foram simultaneamente descritos por modelo PopPK constituído de compartimentos venoso e arterial, dois compartimentos representativos de duas regiões pulmonares distintas e dois compartimentos periféricos, representando outros tecidos que não os pulmões. Um clearance pulmonar foi adicionado ao modelo apenas para os dados de microdiálise dos animais infectados (CLlung = 0,643 L/h/kg) afim de explicar a exposição tecidual diminuída. O modelo desenvolvido descreveu, com sucesso, os dados plasmáticos e teciduais de animais sadios e infectados, permitindo a correta caracterização das alterações observadas na disposição plasmática e pulmonar do CIP decorrentes da infecção com biofilme. Para os estudos de farmacodinâmica, o efeito bactericida do CIP frente a biofilmes e células planctônicas de P. aeruginosa foi simultaneamente avaliado através do uso de curvas de morte bacteriana. Para a construção destas curvas, biofilmes de P. aeruginosa foram formados na superfície de blocos de acrílico e sua formação foi confirmada pelo ensaio cristal violeta e por microscopia eletrônica de varredura. Os blocos foram expostos a concentrações constantes de CIP (de 0,0625 a 10 μg/mL) e, em tempos pré-determinados, células planctônicas e de biofilmes eram amostradas para quantificação. Um modelo semi-mecanístico que incorpora um modelo Emax sigmoidal foi utilizado para descrever o efeito do CIP frente a ambos estilos de vida bacteriano. Uma subpopulação pré-existente com menor suscetibilidade ao CIP foi incluída no modelo e o efeito do CIP nesta subpopulação também foi descrito pelo modelo Emax sigmoidal. A comparação dos parâmetros estimados pelo modelo demonstrou que o efeito in vitro do CIP é maior para as células planctônicas (EC50 = 0,259 mg/L e 0,123 mg/L e Emax = 2,25 h-1 e 5,59 h-1 para biofilmes e planctônicas, respectivamente). A potência estimada do CIP para a subpopulação resistente foi muito menor para ambos estilos de vida bacteriano (EC50 = 2,71 mg/L e 1,15 mg/L para biofilmes e planctônicas, respectivamente). Os modelos desenvolvidos podem ser utilizados para a simulação de cenários não testados e servir como uma ferramenta para guiar a escolha dos regimes posológicos adequados, contribuindo para o sucesso terapêutico no tratamento de infecções associadas à biofilmes. / Biofilms are complex bacterial communities enclosed in self-produced polymeric matrices that can develop in inert surfaces or living tissues. Biofilm formation is an important virulence factor that allows bacteria to resist host responses and antibacterial agents. Due to this high resistance to antibiotics, it is difficult to establish an efficacious strategy for treatment of infections with biofilm formation leading to failure in infection eradication. In this context, the goal of this study was to develop a pharmacokinetic/pharmacodynamic (PK/PD) model to describe the antimicrobial effect of ciprofloxacin (CIP) in the presence of biofilms of Pseudomonas aeruginosa (ATCC 27853), since PK/PD modeling for antibacterial agents can be a useful tool to choose dosing regimens and to achieve the maximum bactericidal effect, minimizing the development of resistance. To reach this goal, firstly an analytical method based on HPLC/fluorescence was developed in order to quantify CIP in plasma and lung microdialysate. The developed method was simple, fast and with enough sensibility to proper characterize CIP plasma and lung pharmacokinetics. Secondly, an animal model of chronic lung infection was adapted from literature and standardized, allowing the analysis of CIP lung distribution in infected and healthy Wistar rats. Bacteria were immobilized in alginate beads prior to inoculation to Wistar rats in order to sustain the pneumonia for 14 days, maintaining a bacterial load superior to 108 CFU/lung. A microdialysis study was then conducted to evaluate free CIP concentrations after an intravenous administration of 20 mg/kg. Non-compartimental analysis (NCA) and populational PK modeling (PopPK) of the data were performed in Phoenix® and NONMEM®, respectively. Statistical differences were observed in the plasma clearance (1.59 ± 0.41 L/h/kg and 0.89 ± 0.44 L/h/kg) and elimination rate constant (0.23 ± 0.04 h-1and 0.14 ± 0.08 h-1) for healthy and infected rats, respectively, resulting in a significantly higher CIP plasma exposure in infected rats (AUC0-∞ = 27.3 ± 12.1 μg·h/mL) compare to healthy animals (AUC0-∞ = 13.3 ± 3.5 μg·h/mL) ( = 0.05). Besides the plasma exposure, a four times lower pulmonary penetration was observed in infected rat’s lungs (fT = 0.44) in comparison to healthy animals (fT = 1.69), with no significant differences in the lung elimination rate constant. Plasma and lung data were simultaneously fitted using a PopPK model consisting of an arterial and a venous compartment, two compartments representing different regions of the lungs and two peripheral distribution compartments, representing tissues other than lungs. A lung clearance was added to the model for infected animals (CLlung = 0.643 L/h/kg) to explain the lower tissue exposure. The model successfully described the plasma and microdialysis data from both, healthy and infected rats and allowed to correctly describe the changes in CIP plasma and lung disposition in biofilm infections. For the pharmacodynamic studies, CIP bactericidal effect against Pseudomonas aeruginosa biofilms and planktonic shedding cells were simultaneously evaluated using the time-kill curves approach. For the time-kill curves construction, P. aeruginosa biofilms were formed in acrylic blocks, which was confirmed by the crystal violet assay and scanning electron microscopy. The blocks were placed in flasks containing Mueller-Hinton growth medium and exposed to constant CIP concentrations (ranging from 0.0625 to 10 μg/mL). At pre-determined time points, biofilm and planktonic cells were sampled for bacterial counting. A mechanism-based model which incorporates a sigmoidal Emax model was used to describe the CIP effect against P.aeruginosa in both llifestyles, biofilm and planktonic. The presence of a pre-existing resistant subpopulation was included in the model and also modeled with a sigmoidal Emax model to describe CIP effect in this subpopulation. Comparison of the parameter estimates showed that the in vitro effect of CIP is higher for planktonic cells (EC50 = 0.259 mg/L and 0.123 mg/L and Emax = 2.25 h-1 and 5.59 h-1 for biofilm and planktonic cells, respectively). CIP potency was much lower for the resistant subpopulation, for both bacteria lifestyles (EC50 = 2.71 mg/L and 1.15 mg/L for biofilm and planktonic, respectively). The developed models can be used to simulate untested scenarios and serve as a tool to guide dosing regimen selection, contributing for the therapeutic success of treatments of biofilm-associated infections.

Les inhibiteurs sélectifs de recapture de la sérotonine (5-HT) (ISRS) bloquent directement le transporteur de la 5-HT (SERT) et stimulent indirectement de multiples auto- et hétérorécepteurs5-HT par l’augmentation de la concentration extracellulaire de 5-HT dans la fente synaptique. Cependant, le rôle des différents récepteurs ainsi que leur interaction dans les effets thérapeutiques des ISRS restent mal connus. Nous avons tenté de les identifier à l'aide de tests neurochimiques (microdialyse intracérébrale in vivo) et électrophysiologiques en utilisant une approche pharmacologique (utilisation de escitalopram, de ligands des récepteurs 5-HT1A/2A) et génétique (utilisation de souris knock-out [KO] SERT, 5-HT1A ou 5-HT2A). Les études neurochimiques et électrophysiologiques révèlent que les auto-(1A) et hétéro-(2A) récepteursagissent de concert pour maintenir une influence inhibitrice sur le système sérotoninergique, en particulier, en réponse au escitalopram : l'absence d'un récepteur est compensée par une régulation de l'autre. Enfin, les souris KO SERT constituent un nouveau modèle pour tester le mécanisme du escitalopram dans l’augmentation des concentrations de noradrénaline (NA). / Selective serotonin (5-HT) reuptake inhibitors (SSRIs) directly block the 5-HT transporter(SERT) and indirectly stimulate multiple 5-HT (auto- and hetero-) receptors by enhancing itsextracellular levels in the synaptic cleft, although the role of particular receptors as well asinteraction(s) among different receptors in the therapeutic effects of SSRIs is not fullyunderstood. We tried to highlight it using neurochemical (in vivo intracerebral microdialysis) andelectrophysiological tests with a pharmacological (using escitalopram, 5-HT1A/2A receptorsagonists and antagonists) and genetic (using SERT, 5-HT1A ou 5-HT2A receptor knock-out [KO]mice) approaches. Neurochemical and electrophysiological experiments indicated that 5-HT1Aauto- and 5-HT2A hetero-receptors act in concert to maintain an inhibitory influence on theserotonergic system, particularly in response of escitalopram to increased levels of endogenous 5-HT: the absence of one receptor being compensated by an up-regulation of the other. Finally,SERT knockout mice might be a new model to test the mechanism of escitalopram for anincrease of norephedrine (NE) level.

A pineal participa da sincronização do organismo pela síntese de melatonina. Diabetes é um distúrbio metabólico caracterizado por hiperglicemia. Diante da controvérsia sobre a síntese de melatonina em animais diabéticos, esse trabalho objetivou avaliar as alterações da glândula pineal mediante o diabetes induzido por STZ (60mg/kg, i.p.). Ratos wistar (250-280g, 12h/12h claro/escuro) foram utilizados em todos os procedimentos que envolveram técnicas de FACS, microdiálise, HPLC, radiometria da atividade enzimática e qPCR. Os resultados mostraram que o diabetes causa diminuição (50%) e perda do perfil mono/bifásico da síntese pineal de melatonina, que não é causada por necrose ou apoptose dos pinealócitos e reflete um desarranjo no metabolismo pineal, evidenciado pela diminuição na atividade da AANAT (55%). Observou-se também um desbalanço rítmico de fatores determinantes como a expressão do receptor ß1 e a atividade e expressão das enzimas TPH1 e HIOMT. A menor concentração de melatonina circulante pode ser um fator contribuinte para o desenvolvimento da doença. / The gland is involved in the organism synchronization via its hormone melatonin. Diabetes involves hyperglicemia and insulin synthesis/signaling impairment. The aim of this work was to evaluate the pineal melatonin synthesis in STZ-diabetic rats (60mg/kg, i.p.). Male wistar rats (250-280g, 12h/12h light/dark) were used as the animal model and FACS, microdialysis, HPLC, enzyme activity assay and qPCR were the techniques used to evaluate the pineal phisiology. The results show a decrease in pineal melatonin (50%) and a circadian profile impairment that were not due to necrosis or apoptosis. This finding reflects an important impairment in the pineal metabolism that was related to a decrease in AANAT activity (55%). An alteration in the rhthmicity of important factors, such as the ß1-adrenergic receptor expression and the TPH1 and HIOMT activity and expression, was also observed. This decrease in circulating melatonin may be of fundamental importance to the establishment and maintenance of diabetes.

The understanding of the mesorectal spread in rectal cancer has lead to wide acceptance of total mesorectal excision (TME) as the surgical technique of choice for carcinoma in the lower and mid rectum. While oncological results and survival have improved with TME-surgery, morbidity and mortality remain important issues. The most feared complication is symptomatic anastomotic leakage. The aim of this thesis was to focus on the role of the defunctioning stoma, risk factors, and postoperative monitoring in regard to anastomotic leakage in sphincter saving resection of the rectum. Intraoperative adverse events were analysed in a retrospective population based case-control study in which all patients who underwent elective anterior resection in Sweden between 1987 and 1995, and who died within 30 days or during the initial hospital stay (n=140), were compared with patients chosen at random (n=423) who underwent the same operation during the same period, but survived the operation. Intraoperative adverse events were more frequent in those who died, and reconstruction of an anastomosis judged unsatisfactory by the surgeon improved the outcome. In a population based retrospective case-control study, risk factors for symptomatic anastomotic leakage were investigated in randomly chosen sample of patients who underwent anterior resection in Sweden between 1987 and 1995 (n=432). Twelve per cent of the patients developed symptomatic leakage, and 25% of the patients with leakage ended up with a permanent stoma. In multivariate regression analysis, low anastomosis, preoperative radiotherapy, male gender and intraoperative adverse events were independent riskfactors for anastomotic leakage. In a randomised multicentre trial patients operated with sphincter saving TME¨surgery for rectal cancer were randomised to a defunctioning stoma (n=116) or not (n=118). The overall rate symptomatic leakage was 19%. Patienst without a defunctioning stoma leaked in 28% and patients with a defunctioing stoma in 10%, a statistically significant difference (p<0.001) not previously demonstrated in any randomised trial of adequate size. Postoperative monitoring with computed tomography scan (CT-scan) on postoperative day 2 and 7, and C-reactive protein (CRP) daily in 33 patients operated on with anterior resection of the rectum, demonstrated larger pelvic fluid collections in patients with leakage before the leakage was clinically diagnosed. CRP was increased from postoperative day 2 and onwards in patients in whom clinical leakage was diagnosed on median postoperative day 8. In 23 patients who underwent anterior resection of the rectum, intraperitoneal metabolism was investigated using microdialysis technique measuring the carbohydrate metabolites lactate, pyruvate and glucose. Intraperitoneal cytokines IL-6, IL-10 and TNF-α were collected through a pelvic drain and analysed. In patients who developed leakage, the latate/pyruvate ratio was increased near the anastomosis on postoperative day 5 and 6, as well as IL-6 and IL-10 which were increased postoperatively day 1 and 2, while TNF-α was higher on day 1.

Performing quantitative analysis of targeted bioactive compounds in biological samples, such as blood plasma, cerebrospinal fluid or extracts from pig liver, put high demands on the ruggedness of the method acquiring the results. In addition to the complexity of the sample matrix, the bioactive compounds targeted for analysis usually have low levels of natural abundance, further increasing the demand on the analytical method sensitivity. Furthermore, quantitation of analytes at trace levels in the presence of large amounts of interfering species in biofluids must aim for repeatable precision, high accuracy ensuring the closeness to the true values, a linear response spanning over several orders of magnitude and low limits of quantitation to be valid for monitoring disease states in clinical analysis. An analytical method most commonly follow a certain order of events, called the analytical chain, which includes; experimental planning, sampling, sample pre-treatment, separation of species, detection, evaluation, interpretation and validation, all equally important for the outcome of the results. In this thesis, the scope has been to create novel methods, or to refine already existing methods, in order to achieve even better performances of the different events in the analytical chain. One of the aspects has been to sample and enrich analytes in vivo by the use of solid supported microdialysis, giving the advantage of almost real-time monitoring of analyte levels within a living host with targeted selectivity due to the analyte affinity for solid particles. Another aspect to selectively clean and enrich analytes in a complex matrix has been developed and automated on-line by the use of a column-switching technique before the analytical separation. By using several steps of extraction and separation coupled on-line to selected detection by the use of a triple quadrupole mass spectrometer facilitates great selectivity of species. The mass spectrometer also gives the ability to distinguish between isotopically labelled analogues coeluting with the analytes yielding the necessary accuracy for quantitative evaluation. Both development of analytical methods and clinical applications has been performed, as well as improvements of existing techniques, all to improve the quantitation of trace levels of targeted analytes in biofluids.

La dépression est une pathologie grave qui, malgré de multiples stratégies thérapeutiques, demeure résistante chez un tiers des patients. Les techniques de stimulation cérébrale sont devenues une alternative intéressante pour les patients résistants à diverses pharmacothérapies. La stimulation du nerf vague (SNV) a ainsi fait preuve de son efficacité en clinique et a récemment été approuvée comme traitement additif pour la dépression résistante. Cependant, les mécanismes d’action de la SNV en rapport avec la dépression n’ont été que peu étudiés. Cette thèse a donc eu comme premier objectif de caractériser l’impact de la SNV sur les différents systèmes monoaminergiques impliqués dans la pathophysiologie de la dépression, à savoir la sérotonine (5-HT), la noradrénaline (NA) et la dopamine (DA), grâce à l’utilisation de techniques électrophysiologiques et de la microdialyse in vivo chez le rat. Des études précliniques avaient déjà révélé qu’une heure de SNV augmente le taux de décharge des neurones NA du locus coeruleus, et que 14 jours de stimulation sont nécessaires pour observer un effet comparable sur les neurones 5-HT. Notre travail a démontré que la SNV modifie aussi le mode de décharge des neurones NA qui présente davantage de bouffées, influençant ainsi la libération terminale de NA, qui est significativement augmentée dans le cortex préfrontal et l’hippocampe après 14 jours. L’augmentation de la neurotransmission NA s’est également manifestée par une élévation de l’activation tonique des récepteurs postsynaptiques α2-adrénergiques de l’hippocampe. Après lésion des neurones NA, nous avons montré que l’effet de la SNV sur les neurones 5-HT était indirect, et médié par le système NA, via l’activation des récepteurs α1-adrénergiques présents sur les neurones du raphé. Aussi, tel que les antidépresseurs classiques, la SNV augmente l’activation tonique des hétérorécepteurs pyramidaux 5-HT1A, dont on connait le rôle clé dans la réponse thérapeutique aux antidépresseurs. Par ailleurs, nous avons constaté que malgré une diminution de l’activité électrique des neurones DA de l’aire tegmentale ventrale, la SNV induit une augmentation de la DA extracellulaire dans le cortex préfrontal et particulièrement dans le noyau accumbens, lequel joue un rôle important dans les comportements de récompense et l’hédonie. Un deuxième objectif a été de caractériser les paramètres optimaux de SNV agissant sur la dépression, en utilisant comme indicateur le taux de décharge des neurones 5-HT. Des modalités de stimulation moins intenses se sont avérées aussi efficaces que les stimulations standards pour augmenter l’activité électrique des neurones 5-HT. Ces nouveaux paramètres de stimulation pourraient s’avérer bénéfiques en clinique, chez des patients ayant déjà répondu à la SNV. Ils pourraient minimiser les effets secondaires reliés aux périodes de stimulation et améliorer ainsi la qualité de vie des patients. Ainsi, ces travaux de thèse ont caractérisé l’influence de la SNV sur les trois systèmes monoaminergiques, laquelle s’avère en partie distincte de celle des antidépresseurs classiques tout en contribuant à son efficacité en clinique. D’autre part, les modalités de stimulation que nous avons définies seraient intéressantes à tester chez des patients recevant la SNV, car elles devraient contribuer à l’amélioration des bénéfices cliniques de cette thérapie. / Depression is a severe psychiatric disorder, in which a third of patients do not achieve remission, despite the wide variety of therapeutic strategies that are currently available. Brain stimulation has emerged as a promising alternative therapy in cases of treatment resistance. Vagus nerve stimulation (VNS) has shown promise in treating resistant-depressed patients, and it has been approved as an adjunctive treatment for resistant depression. However, the mechanism of action by which VNS exerts its antidepressant effects has remained elusive. The first goal of this thesis was therefore to characterize the impact of VNS on monoaminergic systems known to be implicated in the pathophysiology of depression such as serotonin (5-HT), norepinephrine (NE) and dopamine (DA), by means of electrophysiologic techniques and microdialysis in the rat brain. Previous research has indicated that one hour of VNS increased the basal firing activity of locus coeruleus NE neurons and, secondarily, that of 5-HT neurons, but only after 14 days of stimulation. Our work demonstrated that VNS also modified the firing pattern of NE neurons towards a bursting mode of discharge. This mode of firing was shown to lead to enhanced NE release in the prefrontal cortex and hippocampus after 14 days. Increased NE neurotransmission was also evidenced by enhanced tonic activation of postsynaptic α2-adrenoceptors in the hippocampus. Selective lesioning of NE neurons was then used to demonstrate that the effects of VNS on the 5-HT system were indirect, and mediated by the activation of α1-adrenoceptors located on the dorsal raphe 5-HT neurons. Similar to classical antidepressants, VNS also enhanced the tonic activation of pyramidal 5-HT1A heteroreceptors, which are known to play a key role in the antidepressant response. We also found that in spite of a diminished firing activity of ventral tegmental area DA neurons after VNS, extracellular DA levels were significantly elevated in the prefrontal cortex, and particularly in the nucleus accumbens which plays an important role in reward behavior and hedonia. A second objective was to characterize the optimal VNS parameters to treat depression using the firing activity of 5-HT neurons as an indicator. It was found that less stimulation was as effective as the standard levels to increase 5-HT neurons firing rate. These novel parameters could be helpful for clinical application in VNS responsive patients, to potentially minimize and/or even prevent stimulation-related side effects, thus improving their quality of life. In brief, these studies reveal an influence of VNS on all three central monoamine systems, which differs in part from that of classical antidepressants while contributing to the clinical efficacy of this approach. It will also be interesting to determine whether the proposed lower stimulation parameters are as effective in providing antidepressant response in patients receiving VNS, which should contribute to improve the clinical benefits of that therapy.

Outcome after traumatic brain injury (TBI) depends on the extent of primary cell death and on the development of secondary brain injury. The general aim of this thesis was to find strategies and quality systems to minimize the extent of secondary insults in neurointensive care (NIC). An established standardized management protocol system, multimodality monitoring and computerized data collection, and analysis systems were used. The Uppsala TBI register was established for regular monitoring of NIC quality indexes. For 2008-2010 the proportion of patients improving during NIC was 60-80%, whereas 10% deteriorated. The percentage of ‘talk and die’ cases was < 1%. The occurrences of secondary insults were less than 5% of good monitoring time (GMT) for intracranial pressure (ICP) > 25 mmHg, cerebral perfusion pressure (CPP) < 50 mmHg and systolic blood pressure < 100 mmHg. Favorable outcome was achieved by 64% of adults. Nurse checklists of secondary insult occurrence were introduced. Evaluation of the use of nursing checklists showed that the nurses documented their assessments in 84-85% of the shifts and duration of monitoring time at insult level was significantly longer when secondary insults were reported regarding ICP, CPP and temperature. The use of nurse checklist was found to be feasible and accurate.  A clinical tool to avoid secondary insults related to nursing interventions was developed. Secondary brain insults occurred in about 10% of nursing interventions. There were substantial variations between patients. The risk ratios of developing an ICP insult were 4.7 when baseline ICP ≥ 15 mmHg, 2.9 when ICP amplitude ≥ 6 mmHg and 1.7 when pressure autoregulation ≥ 0.3. Hyperthermia, which is a known frequent secondary insult, was studied. Hyperthermia was most common on Day 7 after admission and 90% of the TBI patients had hyperthermia during the first 10 days at the NIC unit. The effects of hyperthermia on intracranial dynamics (ICP, brain energy metabolism and BtipO2) were small but individual differences were observed. Hyperthermia increased ICP slightly more when temperature increased in the groups with low compliance and impaired pressure autoregulation. Ischemic pattern was never observed in the microdialysis samples. The treatment of hyperthermia may be individualized and guided by multimodality monitoring.