Orientador: Carmen Silvia Passos Lima / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T16:24:35Z (GMT). No. of bitstreams: 1 RinckJunior_JoseAugusto_D.pdf: 4925898 bytes, checksum: cf6e78a6e4ad84c7bbe48d34d75fdae6 (MD5) Previous issue date: 2015 / Resumo: As glutationa S-transferases (GSTs) são enzimas detoxificantes. Os genes GSTM1 e GSTT1 são polimórficos e quando deletados perdem a expressão enzimática. As proteínas codificadas pelos genes XPD são responsáveis pelo reparo de lesões do DNA causadas pela luz solar. Polimorfismos nestes genes também podem codificar proteínas com funções comprometidas, em especial o Lys751Gln e o Asp312Asn do gene XPD. Ainda não é claro o papel dos polimorfismos destes genes no risco de melanoma cutâneo (MC) ou se estão associados com os aspectos clínicopatológicos. Foram incluídos 489 indivíduos (231 pacientes, 258 controles). A genotipagem foi realizada por reação em cadeia da polimerase e digestão enzimática. O risco de MC esteve aumentado em 2,00 (IC 95%: 1,05-3,81, P= 0,03) vezes em portadores do genótipo GSTT1 nulo + Asp/Asn + Asn/Asn do XPD Asp312Asn. O GSTT1 nulo elevou o risco de MC metastático em 3,75 (IC 95%: 1,48-9,44, P= 0,006) vezes e se combinado ao GSTM1 nulo em 7,33 (IC 95%: 2,09-25,68, P= 0,003) vezes. O alelo 312Asn elevou o risco de MC no tronco ou membros em 1,80 (IC 95%: 1,19-2,73, P= 0,005) vezes e do subtipo extensivo superficial ou nodular em 1,80 (IC 95%: 1,14-2,84, P= 0,01) vezes. Os genótipos Asn/Asn + Gln/Gln elevou o risco de MC de níveis I, II ou III de Clark em 2,46 (IC 95%: 1,12-5,37, P= 0,02) vezes. Os genótipos GSTM1 nulo + GSTT1 nulo (HR: 3,18; IC95%: 1,21-8,36, P= 0,01) e o genótipo GSTT1nulo + Gln/Gln (HR: 5,93; IC95%: 1,53-22,91, P= 0,01) estiveram associados a maior risco de morte. Concluímos que os referidos polimorfismos em combinações específicas podem aumentar a susceptibilidade ao MC e influenciar suas características clínicopatológicas e sobrevida / Abstract: The glutathione S-transferases (GST) are detoxifying enzymes; the GSTM1 and GSTT1 genes are polymorphic and when deleted lose enzyme expression. The XPD proteins are responsible for DNA damage repair caused by sunlight. Polymorphisms (SNPs) in XPD genes may also result proteins with impaired function, in particular Lys751Gln and Asp312Asn. However It¿s not entirely clear whether the SNPs of these genes influence the risk of cutaneous melanoma (CM) or are associated with clinic pathological aspects of this disease. In the present study 489 individuals were included (231 patients and 258 controls). Genotyping was performed by polymerase chain reaction and enzyme digestion. The risk of MC was increased 2.00-fold (95% CI: 1.05-3.81, P= 0.03) in carriers of the GSTT1 null combined with Asp/Asn + Asn/Asn genotype of XPD Asp312Asn. The GSTT1 null genotype and GSTT1 null + GSTM1 null genotype increased the risk of metastatic MC by 3.75-fold (95% CI: 1.48-9.44, P= 0.006) and 7.33-fold (95% CI: 2.09-25.68, P= 0.003), respectively. The allele 312Asn increased the risk of MC in the trunk or limbs in 1.80-fold (95% CI: 1.19-2.73, P= 0.005) and superficial spreading or nodular subtype in 1.80-fold (95%: 1.14-2.84, P= 0.01). The combined Asn/Asn + Gln/Gln genotype raised the risk of MC in Clark¿s level I, II or III in 2.46-fold (95% CI: 1.12-5.37, P= 0.02). The genotype GSTM1null + GSTT1 null (HR: 3.18; 95% CI: 1.21-8.36, P= 0.01) and GSTT1 null + Gln/Gln (HR: 5.93; 95% CI: 1.53-22.91, P= 0.01) were predictive of lower overall survival. In conclusion, polymorphisms in specific genes combinations may increase susceptibility to MC and influence their clinic pathological features and survival / Doutorado / Clinica Medica / Doutor em Clínica Médica

Orientador: Edgard Graner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-28T00:41:43Z (GMT). No. of bitstreams: 1 Melo_EstevaoAzevedo_M.pdf: 1050744 bytes, checksum: b28d2d7f1bf1683ed75a9b3e47166ad2 (MD5) Previous issue date: 2015 / Resumo: A ácido graxo sintase (FASN) é a enzima responsável pela biossíntese endógena de ácidos graxos e apontada como uma oncoproteína metabólica, por favorecer a proliferação e sobrevivência das células tumorais nas quais sua expressão é elevada. Vários são os compostos capazes de inibir a atividade de FASN, dentre eles o orlistat (Xenical®), que possui efeitos antiproliferativos previamente mostrados em células de câncer de mama, próstata, boca e melanoma. O sistema imunológico apresenta um importante papel na prevenção e defesa do organismo contra neoplasias malignas. As células do sistema imune que se infiltram nos melanomas são produtoras de uma vasta gama de citocinas, dentre elas interleucina 12 (IL-12) e interferon gama (IFN-?) que favorecem uma resposta imune bem sucedida contra os tumores, porém, as células dos melanomas possuem capacidade de produzir interleucina 10 (IL-10) e fator de crescimento transformante beta (TGF-?), capazes de inibir as células imunocompetentes, favorecendo a progressão tumoral e disseminação metastática. O objetivo deste estudo foi avaliar a secreção das citocinas IL-10, IL-12, IFN-? e TGF-? pelas células de melanoma murino B16-F10 após tratamento com orlistat. Para isto, inicialmente determinou-se a dosagem de orlistat capaz de inibir a proliferação celular em 50% (IC50). Em seguida, as células foram tratadas por 24 e 48 horas, quando realizou-se a quantificação da secreção das citocinas por ELISA. Após 24 horas de tratamento, observou-se aumento da secreção de IL-10 e IL-12, no entanto, após 48 horas de tratamento não foi detectada diferenças estatisticamente significantes na secreção de ambas as citocinas, quando comparadas aos seus controles. IFN-? e TGF-? não foram detectáveis. Assim, os resultados desta pesquisa mostram que o tratamento com orlistat alterou a produção das citocinas IL-10 e IL-12, sugerindo que o tratamento promove um equilíbrio entre estas citocinas pró e anti-inflamatórias nas células estudadas / Abstract: Fatty acid synthase (FASN) is the enzyme responsible for the endogenous biosynthesis of fatty acids suggested as a metabolic oncoprotein by promoting proliferation and survival of cancer cells. Several compounds are known to inhibit FASN activity, including orlistat (Xenical®), which has antiproliferative effects in breast, prostate, and oral cancer as well as melanoma cells. Melanoma is an aggressive malignant tumor of melanocytes with high propensity for metastatic spread and resistant to chemotherapy. The immune system plays an important role in the prevention and defense against malignant neoplams. In fact, immune cells that infiltrate melanomas produce a wide range of cytokines, such as interleukin 12 (IL-12) and interferon gamma (IFN-?), which favor a successful immune response against the tumor. However, melanomas cells are able to produce interleukin 10 (IL-10) and transforming growth factor beta (TGF-?) and in turn inhibit immunocompetent cells, favoring tumor progression and metastatic spread. The aim of this research was to evaluate the effect of the FASN inhibitor orlistat on the secretion of the cytokines IL-10, IL-12, IFN-? and TGF-? by B16-F10 mouse melanoma cells. For this purpose, we first searched for the IC50 Of orlistat in B16-F10 cells. Then, cells were treated for 24 and 48 hours with the drug and the secretion of cytokines quantified by ELISA. After 24 hours of treatment the secretion of IL-10 and IL-12 was increased, however, after 48 hours there were no statistically significant changes in the secretion of both cytokines, compared to their controls. IFN-? and TGF-? were not detectable. Thus, the results of this study show that the treatment with orlistat change the production of IL-10 and IL-12, suggesting a balance between the secretion of pro- and anti-inflammatory cytokines / Mestrado / Estomatopatologia / Mestre em Estomatopatologia

A crotoxina é a toxina mais abundante e ativa do veneno da cascavel brasileira Crotalus durissus terrificus. É composta por duas sub-unidades ligadas não covalentemente. A sub-unidade ácida é enzimaticamente inativa e não possui toxicidade, é também conhecida como crotapotina e potencializa a ação da fosfolipase A2 (sub-unidade básica). Alguns autores atribuem à crotoxina um efeito citotóxico e sugerem seu uso como um agente terapêutico contra tumores. Neste trabalho, foi investigada a citotoxidade da crotoxina e suas subunidades em células de melanoma murino e fibroblastos. Os ensaios de indicam que a crotoxina é tóxica para as células de melanoma promovendo a morte até em concentrações mais baixas enquanto os fibroblastos foram afetados somente em concentrações mais altas. Ensaios com as subunidades mostraram que a fosfolipase A2 foi mais tóxica para as células de melanoma que para os fibroblastos. / Crotoxin is the most abundant and active toxin from the venom of the Brazilian rattlesnake Crotalus durissus terrificus. It is composed of two subunits non covalently linked. One acidic with no enzymatic or toxic activity, known as crotapotin, which enhances the phospholipase A2 (basic subunit) action. Some authors have also attributed to this toxin a direct cytotoxic effect, and have suggested its use as a therapeutical agent against tumoral cells. In the present work, we investigated the cytotoxic effect of crotoxin and its subunitis on murine melanoma cells and fibroblasts. Our results indicate that crotoxin is highly toxic to the melanoma cells inducing cell death even at the lowest concentration while the fibroblast were only affected with the higher concentrations. The subunits assays showed that the phospholipase A2 had a higher toxicity on melanoma cells than on fibroblasts.

Les mélanomes oculaires sont des tumeurs rares représentant environ 5% des mélanomes. Les mélanomes oculaires peuvent provenir de deux tissus : l’uvée (~500 cas/an en France) et la conjonctive (~30 cas/an). Les mélanomes uvéaux présentent un très faible taux de mutations somatiques. Ces tumeurs sont également porteuses d’altérations du nombre de copies caractéristiques (gains du 8q, 1q, 6p, pertes du 3, du 1p, du 6q ou du 8p). L’évolution du génome de ces tumeurs durant la progression métastatique est à ce jour mal décrit. Afin d’explorer l’évolution métastatique du mélanome uvéal, nous avons séquencé les exomes de 14 tumeurs primaires et 79 métastases provenant de 24 patients. Il existait une grande proximité génétique entre tumeurs primaires et métastases avec une médiane de 11,5 mutations dans les tumeurs primaires, et 14 dans les métastases. Bien que les mutations SF3B1 et EIF1AX soient des facteurs pronostiques majeurs dans les mélanomes uvéaux, leurs fréquences dans les métastases étaient similaires à celle observée dans les séries historiques de tumeurs primaires. Les métastases présentaient quelques altérations de nombre de copies supplémentaires par rapport aux tumeurs primaires correspondantes. Parmi les altérations du nombre de copies les plus souvent acquises lors du processus métastatique, les gains du 8q étaient présents dans 92% des métastases. Lors de ce travail, nous avons découvert un mélanome uvéal présentant un phénotype hypermuté CpG>TpG chez une patiente ayant présenté une réponse exceptionnelle à une immunothérapie anti-PD1. Ce phénotype hypermutateur a été expliqué par une mutation germinale délétère de MBD4 (Methyl-CpG Binding Domain 4) avec une inactivation bi-allélique dans la tumeur. Deux autres tumeurs hypermutées CpG>TpG porteuses d’une mutation de MBD4 germinale, un mélanome uvéal et un glioblastome, ont été identifiées dans les bases de données publiques. La biologie des mélanomes conjonctivaux et leurs profils génomiques sont mal connus. Nous avons séquencé les génomes de 6 tumeurs, puis procédé à un séquençage ciblé de 47 autres tumeurs. Nous avons montré que ces tumeurs présentent un profil hypermuté C>T induit par l’exposition aux ultra-violets. Ces tumeurs présentaient un profil de mutations proche des mélanomes cutanés avec une fréquence moindre de mutations BRAF (33%), et des mutations plus spécifiques des mélanomes muqueux telles que des mutations activatrices de KIT et SF3B1 dans les mélanomes conjonctivaux non exposés au soleil. Nous avons également identifié des mutations de CTNNB1 dans les tumeurs développées sur des nevi conjonctivaux. L’ensemble de ces travaux illustrent comment la description moléculaire des tumeurs rares permet d’envisager de nouvelles stratégies de médecine de précision. / Ocular melanomas are rare tumors representing about 5% of all melanomas. Ocular melanomas may arise from two tissues: the uvea (~ 500 cases / year in France) and the conjunctiva (~ 30 cases / year). Uveal melanomas have a very low rate of somatic mutations. These tumors also carry specific distinctive copy number alterations (gains of 8q, 1q, 6p, losses of 3, 1p, 6q or 8p). The evolution of the genome of these tumors during metastatic progression has been poorly described.To explore the metastatic evolution of uveal melanoma, we whole-exome sequenced 14 primary tumors and 79 metastases from 24 patients. Primary tumors and metastases presented close genetic profiles with a median of 11.5 mutations in primary tumors, and 14 in metastases. Although SF3B1 and EIF1AX mutations are major prognostic factors in uveal melanomas, their frequencies in metastases were similar to those observed in historical primary tumors. The metastases showed some additional copy number alterations compared to the corresponding primary tumors. Among the alterations acquired during the metastatic process, 8q gains were present in 92% of metastases.Thanks to this work, we found a uveal melanoma with a CpG> TpG hypermutated phenotype in a patient who had an exceptional response to anti-PD1 immunotherapy. This hypermutated phenotype was explained by a deleterious germline mutation of MBD4 (Methyl-CpG Binding Domain 4) with bi-allelic inactivation in the tumor. Two other hypermuted CpG> TpG tumors with germline MBD4 mutation, a uveal melanoma and a glioblastoma, were identified in public databases.The biology of conjunctival melanomas and their genomic profiles have been scarcely described. We sequenced the genomes of 6 tumors and then target-sequenced 47 other tumors. We showed that these tumors had a C> T hypermuted profile induced by ultraviolet exposure. These tumors presented a pattern of mutations close to cutaneous melanomas with a lower frequency of BRAF mutations (33%), and mutations that were more specific of mucosal melanomas such as activating mutations of KIT and SF3B1 in conjunctival melanomas not exposed to the sun. We also identified CTNNB1 mutations in tumors developed on conjunctival nevi.All of these works illustrate how the molecular description of rare tumors opens new avenues for precision medicine.

No description available.

Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin that is highly aggressive and often metastasizes early. MCC is diagnosed based on histopathological findings and is most commonly treated with surgical resection, which may be accompanied by chemotherapy and/or radiation. This report describes a 55-year-old male with history of recurrent malignant melanoma of the right pinna and subsequent excision. Three years following the excision of melanoma, he presents with a lesion to the right forehead as well as a right-sided neck mass that were found to be metastatic Merkel cell carcinoma. Although there have been reports describing the development of second cancers following the treatment of MCC, the development of MCC after the treatment of other malignancies has not been well-described. Merkel cell carcinoma remains a highly aggressive and frequently metastatic malignancy that should not be overlooked, especially when developed after the diagnosis and treatment of other primary cutaneous malignancies such as melanoma.

No description available.

No description available.

Made available in DSpace on 2015-07-22T20:50:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-25 / O melanoma é a forma mais agressiva de câncer de pele em virtude do elevado grau de proliferação, invasão e metástase das células tumorais. Menos de 10% dos pacientes com melanoma metastático sobrevivem por 5 anos. Quimioterapias com um único composto são bem toleradas, mas associadas a baixas taxas de resposta terapêutica. Associações de quimioterápicos já aprovados para uso humano também foram relacionadas a baixas taxas de resposta, sem redução da toxicidade. Logo, a identificação de novos agentes antitumorais é crítica para o tratamento do melanoma, e este trabalho buscou avaliar a atividade antitumoral de novos quimioterápicos derivados de paládio e rutênio no modelo pré-clínico de melanoma murino B16F10-Nex2. Um composto ciclopaladado, [Pd2(S(-)C2, N-dmpa)2 (μ-dppe)Cl2], denominado C7A, avaliado anteriormente pelo nosso grupo, demonstrou elevada atividade antitumoral e baixa toxicidade in vivo, porém, seu mecanismo de ação ainda não estava determinado. Neste trabalho demonstramos que este composto interage com grupos tiol presentes em proteínas da membrana mitocondrial, induzindo uma abrupta redução na acidificação extracelular, colapso do potencial de membrana mitocondrial e translocação da proteína Bax para o interior dessa organela. Evidenciamos também um aumento nas concentrações intracelulares de cálcio, proveniente de organelas celulares e do meio extracelular. Estes efeitos iniciais causaram ativação de caspases efetoras, condensação nuclear, degradação do DNA e dramáticas alterações morfológicas nessas células. Esses dados sugerem que C7A provoca uma morte celular por apoptose induzindo a via intrínseca em células de melanoma murino B16F10-Nex2. Observou-se que células tumorais humanas são sensíveis ao C7A, e o mecanismo de ação do composto nessas células parece ser idêntico ao observado em células murinas. O ciclopaladado 7A reduziu significativamente o número de nódulos pulmonares sem toxicidade aparente, indicando sua eficiência também contra tumores metastáticos. A atividade antitumoral de diversos compostos nitrosil-tetraamina-rutênio (trans-[RuII(NH3)4(L)NO+], onde L corresponde a diferentes ligantes de estabilização, e que são doadores de óxido nítrico (NO) em meios biológicos foi avaliada. Todos os compostos testados foram citotóxicos in vitro para células tumorais murinas e humanas. Alguns compostos foram selecionados e avaliados in vivo, mostrando uma elevada toxicidade em paralelo a uma atividade antitumoral. No entanto, observou-se que os compostos onde o NO havia sido substituído por um radical sulfato, utilizados como controles dos compostos doadores de NO, apresentaram elevada atividade antitumoral e baixa toxicidade in vivo, retardando o desenvolvimento do tumor subcutâneo e prolongando a sobrevida dos animais tratados. Os compostos sulfatados também apresentaram baixa toxicidade ao reduzir o número de nódulos metastáticos dos animais tratados. Esses compostos também foram citotóxicos in vitro para células tumorais humanas, e as alterações morfológicas, externalização de fosfatidilserina, condensação nuclear e degradação de DNA observados sugerem que os compostos tetraamina rutênio sulfatados levam a célula tumoral à morte por apoptose. Ambos os quimioterápicos testados abrem novas possibilidades para o tratamento do melanoma maligno. / Melanoma is the most aggressive form of skin cancer mainly because of the high degree of tumor cell proliferation, invasion and metastasis. Less than 10% of metastatic melanoma patients show 5 years survival. Single drug chemotherapy is well tolerated but associated with low response rates. Associations of chemotherapeutic agents approved for human use are related to low response rates, without improvement on side effects. Therefore, the identification of new antitumor agents is critical to melanoma treatment, and this study aimed to evaluate the antitumor effect of novel palladium and rutheniun derived chemotherapeutic drugs in the preclinical model of murine melanoma B16F10-Nex2. A cyclopalladated compound, [Pd2(S(-)C2, N-dmpa)2 (μ-dppe)Cl2], named C7A was previously evaluated by our group. The complex showed high antitumor and low toxicity in vivo, however, the targets for this compound in tumor cells were not determined yet. In this work we demonstrated that C7A interacts with thiol proteins present in the mitochondrial membrane, leading to an abrupt reduction of extracellular acidification, collapse of mitochondrial membrane potential and Bax translocation to the interior of this organelle. It was also observed an increase in intracellular calcium concentrations, originated from cellular organelles as well as from extracellular medium. These initial effects caused activation of effector caspases, nuclear condensation, DNA degradation and dramatic morphological changes in these cells. All these data suggests that the cyclopalladated 7A induces the intrinsic pathway apoptotic cell death on B16F10-Nex2 murine melanoma cells. Human tumor cells are sensitive to this compound and mitochondria also seem to be the target for C7A on these cells. Cyclopalladated 7A significantly reduced the number of pulmonary nodules with no apparent toxicity, indicating that this compound is also active against metastatic melanoma lesions. Antitumor activity of several nitrosyl tetraammine ruthenium compounds with general formula (trans-[RuII(NH3)4(L)NO+], where L corresponds to different stabilization ligands, were evaluated. These compounds are nitric oxide (NO) donors in biological media. All tested compounds were cytotoxic in vitro to human and murine tumor cells. Some compounds were selected and evaluated in vivo, showing numerous side effects in association with the antitumor effect. However, it was found that the compounds where the NO was replaced by a sulfate group, used regularly as a negative control for NO-donor ruthenium complexes, showed a pronounced antitumor activity and low toxicity in vivo, delaying subcutaneous tumor development and extending survival of treated animals. Sulfate compounds also reduced the number of metastatic lung nodules with no apparent toxicity. These compounds were also cytotoxic for human tumor cells in vitro, and the morphological alterations, phosphatidylserine externalization, nuclear condensation and DNA degradation observed after cell treatment suggested that sulfate tetraamine compounds induced an apoptotic cell death. Both evaluated chemotherapeutic drugs open new possibilities for malignant melanoma treatment. / TEDE / BV UNIFESP: Teses e dissertações

La galectine-3 (Gal-3), protéine de type lectine, de 29-35 kDa, étudiée comme marqueur d’aggressivité dans les gliomes, présente des caractéristiques biologiques importantes justifiant son étude dans le domaine du mélanome. En effet, la Gal-3 est une protéine qui peut se lier à la laminine, tout comme l’intégrine α6/β1 dont l’expression est réduite dans le mélanome. L’expression de cette intégrine peut d’ailleurs être modulée par la Gal-3 comme récemment montré dans des lignées cellulaires de cancer du sein (BT-549) et de glioblastome (U373).<p>Le mélanome, véritable problème de santé publique qui est susceptible d’atteindre 1 individu sur 75 dans nos contrées, reste un tumeur mal comprise avec des évolutions parfois incertaines, et des traitements dont l’efficacité est limitée. Le diagnostic histologique du mélanome lui-même peut parfois représenter une difficulté pour le clinicien et l’expert pathologiste ou dermatopathologiste. La couleur (hyperpigmentation d’un lésion pigmentée), dont l’évaluation d’ailleurs reste subjective à défaut de standardisation, ne peut à elle seule signer la malignité d’une lésion pigmentée. Globalement l’évolution d’un patient est prédite par l’indice de Breslow qui traduit en mm l’épaisseur de la tumeur. Si cet indice dépasse 1mm, le risque métastatique augmente, justifiant la réalisation de bilans extensifs de suivi. Ceci dit, certains mélanomes épais peuvent ne pas présenter de caractéristiques d’aggressivité, alors que des mélanomes fins sont parfois mortels. L’identification de marqueurs moléculaires est donc impérative, tant pour développer des stratégies thérapeutiques ciblées, que pour affiner le diagnostic et le pronostic d’un patient. <p>Après avoir mis en évidence par immunohistochimie une expression de Gal-3 par les mélanocytes, nous avons démontré une surexpression de cette protéine par les mélanocytes tumoraux. Nous avons démontré également sur des lésions primitives qu’à l’aggressivité mesurée selon l’indice de Breslow correspondait une diminution de cette surexpression. Cette observation a pu être confirmée par un modèle de greffe orthotopique chez la souris nude.<p>Nous nous somme intéressés par la suite à la détection de la protéine dans le sérum, et nous avons constaté, un taux élevé de Gal-3 dans le sérum de patients en stade métastatique avancé, ce taux élevé pouvant s’expliquer tant par la charge tumorale que par la présence d’une inflammation, d’ailleurs bien connue chez le patient cancéreux en stade avancé. Le rôle antiapoptotique de la Gal-3 nous a alors amené à préciser la valeur prédictive et pronostique de cette protéine. L’hypothèse d’une potentielle action bénéfique sur la réponse immunitaire des patients atteints de mélanome qui ont été vaccinés a été rejetée. La Gal-3 sérique s’est révélée comme facteur de mauvais pronostic chez les patients métastatiques, et une analyse multivariée avec la définition d’une valeur « cut-off » de 10 ng/ml a permis de montrer une valeur pronostique indépendante, supérieure à la S100B et à la CRP. <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished