The symptoms in Idiopathic Adult Hydrocephalus Syndrome (IAHS) – gait disturbance, incontinence, and cognitive deficit – correlate anatomically to neuronal dysfunction in periventricular white matter. The pathophysiology is considered to include a cerebrospinal fluid (CSF) hydrodynamic disturbance, including pressure oscillations (“B waves”), in combination with cerebrovascular disease. IAHS and Subcortical Arteriosclerotic Encephalopathy (SAE) show clinical similarities, which constitutes a diagnostic problem. The aim of this thesis was to investigate biochemical markers in CSF, possibly related to the pathophysiology, and their usefulness in diagnosis, to investigate the effect of ICP changes on glucose supply and metabolism in periventricular deep white matter, and to present criteria for objective, computerised methods for evaluating the content of B waves in an intracranial pressure (ICP) registration. CSF samples from 62 IAHS patients, 26 SAE patients, and 23 controls were analysed for sulfatide, total-tau (T-tau) hyperphosphorylated tau (P-tau), neurofilament protein light (NFL), and beta-amyloid-42 (Aß42). In ten IAHS patients, recordings of ICP, brain tissue oxygen tension (PtiO2), and samplings of brain extracellular fluid from periventricular white matter by way of microdialysis were performed, at rest and during a CSF infusion and tap test. Microdialysis samples were analysed for glucose, lactate, pyruvate, glutamate, glycerol, and urea. Patterns before and after spinal tap were analysed and changes from increasing ICP during the infusion test were described. The long term ICP registration was used to evaluate two computerised methods according to optimal amplitude threshold, monitoring time, and correlation to the manual visual method. In CSF, NFL was elevated in both IAHS and SAE patients, reflecting the axonal damage. In a multinominal logistic regression model, the combined pattern of high NFL, low P-tau and low Aß42 in CSF was shown to be highly predictive in distinguishing between IAHS, SAE and controls. Analysis of microdialysis samples for glucose, lactate, and pyruvate showed, in combination with PtiO2, a pattern of low-grade ischemia. After the spinal tap of CSF, the pattern changed, indicating increased glucose metabolic rate. During the infusion test, there were prompt decreases in the microdialysis values of glucose, lactate and pyruvate during ICP increase, but no sign of hypoxia. The values normalised immediately when ICP was lowered, indicating that the infusion test is not causing damage. One of the computerised methods, with an amplitude threshold set to 1 mm Hg, was shown robust in evaluating B wave content in an ICP registration. At least 5 hours registration time was needed. The highly predictive pattern of biochemical markers in CSF indicates a possibility of identifying simple tests in diagnosing and selecting patients for surgical treatment. The results of microdialysis and PtiO2 indicate low-grade ischemia in the periventricular white matter, which is ameliorated from CSF removal, and that glucose supply and metabolism are sensitive to short-term ICP elevations, thus proposing a link between ICP oscillations and symptoms from neuronal disturbance. A computerised method for evaluation of B waves is a prerequisite for evaluating the impact of pressure oscillations in the pathophysiology of IAHS.

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O objetivo deste estudo foi avaliar a eficiência da baixa tensão de oxigênio (5% de CO2; 5% de O2 e 90% de N2) na maturação oocitária in vitro em meio quimicamente definido (0,1% de PVA) ou suplementado com 10 % de PFF. Foram avaliados a migração dos grânulos corticais, a quantificação e distribuição da proteína HSP70, a maturação nuclear, as concentrações intracelulares da glutationa reduzida, a avaliação dos índices de penetração espermática e o desenvolvimento e qualidade de embriões fecundados in vitro em oócitos antes da maturação (0 hora) e após a maturação in vitro nos diferentes tratamentos (atmosfera = 5 ou 20% de O2 e suplementação do meio de maturação = 0,1% de PVA ou 10% de PFF). Para verificar a influência da atmosfera e da suplementação do meio no sistema de maturação foram avaliados o ciclo celular das células do cumulus, o número de células do cumulus por oócitos, as concentrações intracelulares de glutationa reduzida (GSH) das células do cumulus, as concentrações de TBARS no meio de maturação e a resistência das células do cumulus ao estresse oxidativo. Avaliações quanto às concentrações de GSH e HSP70 foram realizadas em oócitos in vivo, visando comparar a eficiência do sistema in vitro. Para a maioria dos parâmetros avaliados não houve interação entre a atmosfera e a suplementação do meio de maturação, indicando que o efeito da atmosfera independe do meio utilizado. Foi observado que em atmosfera com baixa tensão de O2 houve diminuição da concentração de glutationa nas células do cumulus, do índice de clivagem e do número total de blastômeros dos embriões e houve aumento do número de células por oócito após o período de maturação in vitro. A suplementação do meio de maturação com 0,1% de PVA diminuiu os índices de migração dos grânulos corticais, contudo não alterou os índices de penetração espermática. Os oócitos do grupo 0 hora apresentaram índices maiores de HSP70 do que cada um dos demais grupos, indicando provável diminuição dos estoques de HSP70 durante o período de maturação em todos os grupos de maturação in vitro. As células do cumulus provenientes de oócitos maturados em meio suplementado com 0,1% de PVA apresentaram maior número de células na fase S e G2/M do que o grupo 0 hora, entretanto isso não refletiu em aumento no número de células por oócito após a maturação. Este trabalho permite concluir que o uso de baixa tensão de oxigênio não melhora as condições do sistema de maturação oocitária in vitro em suínos, sendo que o efeito do uso desta atmosfera é, na maioria das variáveis avaliadas, independente do tipo de suplementação que se utiliza no meio de maturação in vitro. / The aim of this study was to evaluate the efficiency of low oxygen tension (5% CO2, 5% O2 and 90% N2) on in vitro oocyte maturation using defined media (0.1% PVA) or supplemented with 10% PFF. To achieve this goal, oocytes were evaluated prior to in vitro maturation (0 hour) and after in vitro maturation on different treatments (atmosphere = 5 or 20% O2 and media supplementation = 0.1% PVA or 10% PFF) for cortical granules migration, quantification and distribution of HSP70 protein, nuclear maturation, intracellular concentrations of reduced glutathione, evaluation of sperm penetration and development and quality of in vitro-produced embryos. Furthermore, to evaluate the effects on maturation system, several factors were analyzed, such as: the cell cycle phase of cumulus cells, the number of cumulus cells per oocyte, the intracellular concentrations of reduced glutathione in cumulus cells, the concentrations of TBARS in maturation media and the resistance of cumulus cells to the oxidative stress. Some of these evaluations were performed on in vivo oocytes, aiming to analyze oocyte competence after in vitro maturation. Concerning the majority of the parameters analyzed, there were no interaction between atmosphere and the supplementation of maturation media, indicating that the effect of atmosphere is independent of the media used. It was possible to observe that low tension atmosphere of O2 decreased glutathione concentrations in cumulus cells, cleavage rate and total number of embryo blastomeres and increased the number of cells per oocyte after the period of in vitro maturation. The maturation media supplementation with 0.1% PVA decreased the migration of cortical granules; however this fact did not have effect on in vitro sperm penetration levels. The 0 hour oocytes showed higher levels of HSP70 than each one of the in vitro maturated groups, indicating decrease of this protein stock during the maturation period in all of the in vitro maturated groups. The cumulus cells originated from maturated oocytes in supplemented media with 0.1% PVA showed higher number of cells in S and G2/M phase than 0 hour group; however this fact did not reflect in increased cell numbers per oocyte after maturation. Therefore, the use of low oxygen tension does not improve the conditions of the in vitro porcine oocyte maturation system and their effect in most of the factors analyzed is not dependent on the supplementation of maturation media.

O objetivo deste estudo foi avaliar a eficiência da baixa tensão de oxigênio (5% de CO2; 5% de O2 e 90% de N2) na maturação oocitária in vitro em meio quimicamente definido (0,1% de PVA) ou suplementado com 10 % de PFF. Foram avaliados a migração dos grânulos corticais, a quantificação e distribuição da proteína HSP70, a maturação nuclear, as concentrações intracelulares da glutationa reduzida, a avaliação dos índices de penetração espermática e o desenvolvimento e qualidade de embriões fecundados in vitro em oócitos antes da maturação (0 hora) e após a maturação in vitro nos diferentes tratamentos (atmosfera = 5 ou 20% de O2 e suplementação do meio de maturação = 0,1% de PVA ou 10% de PFF). Para verificar a influência da atmosfera e da suplementação do meio no sistema de maturação foram avaliados o ciclo celular das células do cumulus, o número de células do cumulus por oócitos, as concentrações intracelulares de glutationa reduzida (GSH) das células do cumulus, as concentrações de TBARS no meio de maturação e a resistência das células do cumulus ao estresse oxidativo. Avaliações quanto às concentrações de GSH e HSP70 foram realizadas em oócitos in vivo, visando comparar a eficiência do sistema in vitro. Para a maioria dos parâmetros avaliados não houve interação entre a atmosfera e a suplementação do meio de maturação, indicando que o efeito da atmosfera independe do meio utilizado. Foi observado que em atmosfera com baixa tensão de O2 houve diminuição da concentração de glutationa nas células do cumulus, do índice de clivagem e do número total de blastômeros dos embriões e houve aumento do número de células por oócito após o período de maturação in vitro. A suplementação do meio de maturação com 0,1% de PVA diminuiu os índices de migração dos grânulos corticais, contudo não alterou os índices de penetração espermática. Os oócitos do grupo 0 hora apresentaram índices maiores de HSP70 do que cada um dos demais grupos, indicando provável diminuição dos estoques de HSP70 durante o período de maturação em todos os grupos de maturação in vitro. As células do cumulus provenientes de oócitos maturados em meio suplementado com 0,1% de PVA apresentaram maior número de células na fase S e G2/M do que o grupo 0 hora, entretanto isso não refletiu em aumento no número de células por oócito após a maturação. Este trabalho permite concluir que o uso de baixa tensão de oxigênio não melhora as condições do sistema de maturação oocitária in vitro em suínos, sendo que o efeito do uso desta atmosfera é, na maioria das variáveis avaliadas, independente do tipo de suplementação que se utiliza no meio de maturação in vitro. / The aim of this study was to evaluate the efficiency of low oxygen tension (5% CO2, 5% O2 and 90% N2) on in vitro oocyte maturation using defined media (0.1% PVA) or supplemented with 10% PFF. To achieve this goal, oocytes were evaluated prior to in vitro maturation (0 hour) and after in vitro maturation on different treatments (atmosphere = 5 or 20% O2 and media supplementation = 0.1% PVA or 10% PFF) for cortical granules migration, quantification and distribution of HSP70 protein, nuclear maturation, intracellular concentrations of reduced glutathione, evaluation of sperm penetration and development and quality of in vitro-produced embryos. Furthermore, to evaluate the effects on maturation system, several factors were analyzed, such as: the cell cycle phase of cumulus cells, the number of cumulus cells per oocyte, the intracellular concentrations of reduced glutathione in cumulus cells, the concentrations of TBARS in maturation media and the resistance of cumulus cells to the oxidative stress. Some of these evaluations were performed on in vivo oocytes, aiming to analyze oocyte competence after in vitro maturation. Concerning the majority of the parameters analyzed, there were no interaction between atmosphere and the supplementation of maturation media, indicating that the effect of atmosphere is independent of the media used. It was possible to observe that low tension atmosphere of O2 decreased glutathione concentrations in cumulus cells, cleavage rate and total number of embryo blastomeres and increased the number of cells per oocyte after the period of in vitro maturation. The maturation media supplementation with 0.1% PVA decreased the migration of cortical granules; however this fact did not have effect on in vitro sperm penetration levels. The 0 hour oocytes showed higher levels of HSP70 than each one of the in vitro maturated groups, indicating decrease of this protein stock during the maturation period in all of the in vitro maturated groups. The cumulus cells originated from maturated oocytes in supplemented media with 0.1% PVA showed higher number of cells in S and G2/M phase than 0 hour group; however this fact did not reflect in increased cell numbers per oocyte after maturation. Therefore, the use of low oxygen tension does not improve the conditions of the in vitro porcine oocyte maturation system and their effect in most of the factors analyzed is not dependent on the supplementation of maturation media.

<p>The kidney is the major organ responsible for the regulation of the composition and volume of the body fluids, which is essential for homeostasis. The glycosaminoglycan hyaluronan (HA), with extreme water-binding capacity, is present in the interstitium of the kidney with a heterogenous distribution. The importance of HA in renal water-handling is unknown and was the focus of the present investigation.</p><p>Acute water-loading in rats caused the amount of papillary HA to increase and during water deprivation, the amount was reduced. Gerbils, with extreme urine concentrating capacity, have less HA in the renal papilla in normal conditions and responded diametrically different to water-loading (reduction in HA). Renomedullary interstitial cells (RMICs), which are probably the main producers of HA in the renal medulla, were cultured at different media osmolalities to mimic the milieu of the medulla during variations in the water balance. The amount of HA found in the media was decreased at high osmolalities and increased at low osmolalities, thereby strengthening the <i>in vivo</i> results. CD44, an HA-receptor involved in the uptake and degradation of HA, was expressed on RMICs in an osmolality dependent manner. During high media osmolality, the CD44 expression increased and at lower osmolalities, the opposite occurred, probably due to the need for uptake and degradation of HA.</p><p>Renal ischemia-reperfusion injury causes a cortical accumulation of HA, up-regulation of CD44, and a depression of functional parameters. The time periods of ischemia correlated with the accumulation of HA which, in turn, was inversely correlated to GFR. Hyaluronidase injections in this setting failed to reduce HA levels and significantly improve renal function.</p><p>In conclusion, the results from the present study suggest an important role for HA and RMICs in renal water-handling and that the intrarenal distribution of HA is altered after ischemia-reperfusion injury, which correlates with renal dysfunction.</p>

<p>Diabetes-induced renal complications, i.e. diabetes nephropathy, are a major cause of morbidity and mortality. The exact mechanism mediating the negative influence of hyperglycaemia on renal function is unclear, although several hypotheses have been postulated. Glucose-induced excessive formation of reactive oxygen species (ROS) and increased glucose flux through the polyol pathway are two major mechanisms that have recently gained increasing support. In order to investigate the development of hyperglycaemia-induced renal alterations further, it is of great importance to use an animal model in agreement with the pathological development in diabetic patients.</p><p>The aims of these investigations were to evaluate the streptozotocin (STZ)-diabetic Wistar Furth rat as a model for human diabetic nephropathy and to investigate involvement of ROS and the polyol pathway in development of diabetes-induced renal alterations.</p><p>The used STZ-diabetic animal model displayed several similarities with the progression of human disease, including initial hyperfiltration and albuminuria. However, the observed proteinuria could be partly linked to the STZ treatment <i>per se</i>, making the use of this animal model less suitable for research concerning diabetes-induced urinary protein leakage.</p><p>The diabetic state induced numerous alterations in renal function and metabolism, including increased oxygen consumption, decreased renal oxygen tension (pO₂), and altered lactate/pyruvate ratio. These renal alterations were preventable by daily treatment with either a radical scavenger (α-tocopherol) or an aldose reductase inhibitor (AL-1576).</p><p>In separate experiments the influence of nitric oxide (NO) on renal blood perfusion and pO₂ was investigated. The diabetic animals displayed a larger increase in renal NO activity after injecting the NO substrate L-arginine compared to non-diabetic animals, suggesting substrate limitation of the nitric oxide synthase during chronic hyperglycaemia.</p><p>In conclusion, the results from these investigations show that both ROS and the polyol pathway are involved in the development of diabetes-induced renal alterations in the STZ- diabetic Wistar Furth rat.</p>

The kidney is the major organ responsible for the regulation of the composition and volume of the body fluids, which is essential for homeostasis. The glycosaminoglycan hyaluronan (HA), with extreme water-binding capacity, is present in the interstitium of the kidney with a heterogenous distribution. The importance of HA in renal water-handling is unknown and was the focus of the present investigation. Acute water-loading in rats caused the amount of papillary HA to increase and during water deprivation, the amount was reduced. Gerbils, with extreme urine concentrating capacity, have less HA in the renal papilla in normal conditions and responded diametrically different to water-loading (reduction in HA). Renomedullary interstitial cells (RMICs), which are probably the main producers of HA in the renal medulla, were cultured at different media osmolalities to mimic the milieu of the medulla during variations in the water balance. The amount of HA found in the media was decreased at high osmolalities and increased at low osmolalities, thereby strengthening the in vivo results. CD44, an HA-receptor involved in the uptake and degradation of HA, was expressed on RMICs in an osmolality dependent manner. During high media osmolality, the CD44 expression increased and at lower osmolalities, the opposite occurred, probably due to the need for uptake and degradation of HA. Renal ischemia-reperfusion injury causes a cortical accumulation of HA, up-regulation of CD44, and a depression of functional parameters. The time periods of ischemia correlated with the accumulation of HA which, in turn, was inversely correlated to GFR. Hyaluronidase injections in this setting failed to reduce HA levels and significantly improve renal function. In conclusion, the results from the present study suggest an important role for HA and RMICs in renal water-handling and that the intrarenal distribution of HA is altered after ischemia-reperfusion injury, which correlates with renal dysfunction.

Diabetes-induced renal complications, i.e. diabetes nephropathy, are a major cause of morbidity and mortality. The exact mechanism mediating the negative influence of hyperglycaemia on renal function is unclear, although several hypotheses have been postulated. Glucose-induced excessive formation of reactive oxygen species (ROS) and increased glucose flux through the polyol pathway are two major mechanisms that have recently gained increasing support. In order to investigate the development of hyperglycaemia-induced renal alterations further, it is of great importance to use an animal model in agreement with the pathological development in diabetic patients. The aims of these investigations were to evaluate the streptozotocin (STZ)-diabetic Wistar Furth rat as a model for human diabetic nephropathy and to investigate involvement of ROS and the polyol pathway in development of diabetes-induced renal alterations. The used STZ-diabetic animal model displayed several similarities with the progression of human disease, including initial hyperfiltration and albuminuria. However, the observed proteinuria could be partly linked to the STZ treatment per se, making the use of this animal model less suitable for research concerning diabetes-induced urinary protein leakage. The diabetic state induced numerous alterations in renal function and metabolism, including increased oxygen consumption, decreased renal oxygen tension (pO2), and altered lactate/pyruvate ratio. These renal alterations were preventable by daily treatment with either a radical scavenger (α-tocopherol) or an aldose reductase inhibitor (AL-1576). In separate experiments the influence of nitric oxide (NO) on renal blood perfusion and pO2 was investigated. The diabetic animals displayed a larger increase in renal NO activity after injecting the NO substrate L-arginine compared to non-diabetic animals, suggesting substrate limitation of the nitric oxide synthase during chronic hyperglycaemia. In conclusion, the results from these investigations show that both ROS and the polyol pathway are involved in the development of diabetes-induced renal alterations in the STZ- diabetic Wistar Furth rat.

Background and aims: Unrecognized intestinal mucosal ischemia in severely ill patients may trigger development of multiple organ failure. Such ischemia can be evaluated by intraluminal tonometry reflecting mucosal PCO2 and intramucosal pH (pHi). The aims were to develop an apparatus for continuous saline tonometry (CST), to analyse circulatory control mechanisms during intestinal hypoperfusion and to evaluate the effect of dopexamine on intestinal circulation. Methods: A modified standard tonometry catheter was integrated in a closed system with circulating saline. By measuring saline PCO2 in a measurement unit pHi could be calculated. This novel system was tested in vitro and in vivo. In a porcine study, CST was evaluated against standard saline tonometry, tissue oxygenation (PO2 TISSUE), jejunal mucosal perfusion (laser doppler flowmetry; LDF) and mesenteric net lactate flux during graded reductions of superior mesenteric arterial pressure (PSMA). Local control mechanisms for maintenance of intestinal oxygenation were analysed. Effects of dopexamine on the intestinal vascular bed were explored. Mucosal lactate production was assessed by microdialysis. Results: CST measured accurate PCO2 values and changes in pHi during restricted intestinal circulation and at reperfusion. Local control mechanisms were insufficient at a PSMA of 30 mmHg, pHi was reduced to 7.10 and intestinal net lactate production was demonstrated. Absence of anaerobic intestinal metabolism was verified at PSMA ≥ 50 mmHg, pHi ≥ 7.22 and a PCO2 gap ≤ 15.8 mmHg. Dopexamine induced negative regional metabolic effects at the lowest PSMA, as expressed by decreased PO2 TISSUE and pHi, increased PCO2 gap and intestinal net lactate production. Conclusions: CST reflected changes in pHi, induced by intestinal hypoperfusion and at reperfusion. Levels of PSMA, pHi and PCO2 gap as indicators of aerobic conditions were defined. Dopexamine induced a decrease of PO2 TISSUE and pHi as well as an increase in lactate flux at the lowest PSMA level.

This dissertation presents the development and use of a novel optical imaging system capable of monitoring changes in blood flow, oxygenated hemoglobin, deoxygenated hemoglobin, and absolute pO₂ in the brain. There are several imaging modalities capable of monitoring these parameters separately. Laser speckle contrast imaging (LSCI) and multi-spectral reflectance imaging (MSRI) have been used to monitor relative blood flow and hemoglobin changes respectively. Phosphorescence quenching, while not typically used for imaging, is capable of noninvasive measurements of pO₂. Combining these three techniques has led to the development of an imaging system that could ultimately lead to a better understanding of brain physiology. By combining techniques such as LSCI and MSRI, it becomes possible to estimate the cerebral metabolic rate of oxygen (CMRO₂), an important indicator of neuronal function. It is equally important to understand absolute pO₂ levels so that oxygen metabolism can be examined in context. Integrating phosphorescence quenching and a spatial light modulator into the imaging system allowed absolute pO₂ to be simultaneously measured in distinct regions. This new combined system was used to investigate pathophysiological conditions such as cortical spreading depression (CSD) and ischemia. The observed hemodynamic changes associated with these events were largely dictated by baseline oxygen levels and varied significantly in different regions. This finding highlighted the importance of having a system capable of monitoring hemodynamic changes and absolute pO₂ simultaneously while maintaining enough spatial resolution to distinguish the changes in different regions. It was found that animals with low baseline pO₂ were unable to deliver enough oxygen to the brain during events like CSD because of the high metabolic demand. In order for this technique to become more prevalent among researchers, it is essential to make it cost effective and simple to use. This was accomplished by replacing the expensive excitation sources with cheaper light emitting diodes (LEDs) and redesigning the software interface so that it was easier to control the entire device. The final system shows the potential to become a key tool for researchers studying the role of absolute pO₂ and other hemodynamic parameters during pathophysiological conditions such as CSD and ischemia. / text