Orientador: João Pessoa Araujo Junior / Resumo: A suinocultura é uma das principais atividades do agronegócio brasileiro. Por isso, perdas devem ser evitadas a fim de satisfazer a indústria e o bem-estar dos animais. O aparecimento de úlceras gastroesofágicas em suínos causa prejuízos para o produtor e pode levar os animais à morte. O objetivo do trabalho foi verificar a participação de Fusobacterium necrophorum e Helicobacter suis como agentes etiológicos das úlceras nos suínos. Para isso foi realizada avaliação macroscópica e microscópica das lesões, padronização e aplicação de qPCR para diagnóstico bacteriano e visualização de micro-organismos em lâminas de histopatologia coradas por prata, a partir de estômagos de suínos com e sem úlceras. Foram avaliados 126 estômagos, 63 sadios e 63 com úlcera. O DNA extraído de fragmento de tecido da região do pars oesophagea foi utilizado para a análise por qPCR. Foi detectado DNA de F. necrophorum em seis (4,8%) estômagos e H. suis em 16 (12,7%). Os resultados demonstraram que houve diferença quanto a classificação macroscópica e microscópica das lesões. A classificação macroscópica das lesões dos estômagos serve como uma forma de triagem a fim de demonstrar as condições de saúde do animal abatido. A histopatologia pode demonstrar o processo inflamatório desde o seu início, quando a lesão ainda não é visível macroscopicamente favorecendo o rastreamento das possíveis causas das lesões. Os resultados demonstraram associação entre a detecção de H. suis e a presença de úlceras. Para a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Swine production is one of the main activities of the Brazilian agribusiness and because of that losses must be avoided in order to satisfy the industry and animal welfare. The appearance of gastroesophageal ulcers in swine causes loss to the producer and can lead to animal’s death. The aim of the present study was to verify the participation of Fusobacterium necrophorum and Helicobacter suis as etiological agents of ulcers in swine. Macroscopic and microscopic evaluation of the lesions was performed, qPCR for bacterial diagnose and microorganism visualization in histology slides stained with silver from swine with and without ulcers was also performed. In total, 126 stomachs were evaluated, 63 healthy and 63 with ulcer. The DNA extracted from the tissue fragment of the region pars oesophagea was used for qPCR. DNA of F. necrophorum was detected in six (4.8%) stomachs and H. suis in 16 (12.7%). Results demonstrated that there was statistical difference as to the macroscopic and microscopic lesions classification. Data pointed to an association between H. suis detection and ulcer presence. An association between gravity of the lesions and the presence of bacteria was observed to both microorganisms. The macroscopic classification of the stomachs lesions serves as a form of screening in order to demonstrate the health conditions of the slaughtered animals. Histopathology can demonstrate the inflammatory process from its onset, when the lesion is not yet visible macroscopically ... (Complete abstract click electronic access below) / Doutor

Chez les hamsters, les jours longs activent la reproduction. Cette activation photopériodique (AP) impliquerait la mélatonine, l’hormone thyroïdienne (HT) et les RFamides hypothalamiques. Si les jours courts inhibiteurs sont maintenus au-delà de 20 semaines, une réactivation photoréfractaire (RP) de l’axe hypothalamo pituitaire gonadotrope (HPG) est déclenchée. Les mécanismes de cette RP sont inconnus. Notre analyse de la cinétique des changements moléculaires induits par l’AP et la RP montre dans les deux cas une inhibition précoce de l’expression de la Désiodinase 3 (Dio3), l’enzyme catabolisant les HT, dans les tanycytes. Associée à une inhibition tardive du transporteur MCT8 des HT, la diminution de Dio3 pourrait créer un pic d’HT dans l’hypothalamus. Dans les 2 activations, Kisspeptine et RFRP3 augmentent plusieurs semaines après l’inhibition de Dio3 et l’activation de l’HPG. Aussi, une inhibition d’RFRP3 lors de l’AP n’affecte pas l’HPG, mettant en cause le rôle du RFRP3. Nous avons donc découvert une inhibition précoce de Dio3 pouvant induire l’activation saisonnière de l’HPG. Le régulateur saisonnier précoce de Dio3 reste à découvrir. / In hamsters, reproduction is activated by long days. This photoactivation (PA) supposedly involves melatonin, hypothalamic thyroid hormones (TH) and RFamide peptides. Maintaining inhibitory short days for over 20 weeks triggers a photorefractory reactivation of the hypothalamo pituito gonadotropic axis (HPG) The mechanisms of this PR are so far unknown. Our cinetic analysis of the dynamic molecular changes in PA and PR revealed a conserved early inhibition of tanycytic deiodinase 3 (Dio3), which catabolizes TH, in both activation mechanisms. Associated with a late decrease of the TH transporter MCT8, the inhibition of Dio3 could generate an early peak of hypothalamic TH. In both activations, RFamide upregulation occurs several weeks after the initial Dio3 inhibition. Also, pharmacological inhibition of RFRP3 during PA does not influence the HPG activity, questioning the role of RFRP3 in HPG activation. We have thus uncovered a so far unreported early Dio3 inhibition that could be sufficient to seasonally reactivate the gonadotropic axis. The seasonal regulator of Dio3 remains to be discovered.

La régulation endogène de la physiologie saisonnière, comme les rythmes circannuels et l’histoire photopériodique vécue pendant la gestation, permet aux individus d’anticiper à l’arrivée des saisons. L’objectif de cette thèse a été l’étude de l’effet de ces deux phénomènes à long terme sur les voies neuroendocrines contrôlant la physiologie saisonnière. Ces études montrent que les rythmes circannuels sont initiés au niveau de l’expression de la thyréostimuline dans la pars tuberalis et celle-ci est transmisse à l’hypothalamus où elle contrôle les niveaux d’hormone thyroïdienne et de neuropeptides. De façon similaire, la photopériode vécue pendant la gestation semble programmer l’expression des déiodinases dans l’hypothalamus des rongeurs adultes. Dans l’ensemble, ces résultats montrent la conservation du rôle de la pars tuberalis en tant que site central pour l’intégration des signaux impliqués dans le contrôle de la physiologie saisonnière. / Internal long-term timing strategies, like circannual rhythms and photoperiodic history, allow changes in physiology in anticipation to the seasons. In this project I investigated the effects of both types of history dependent timing on the neuro endocrine pathways for regulation of seasonal physiology. My work revealed that internal circannual timing is initiated through the control of thyroid stimulating hormone at the pars tuberalis and is integrated into the regulation of hypothalamic thyroid hormone levels and neuropeptides.Similarly, history-dependent expression in hypothalamic deiodinases was observed in adult rodents based on their gestational photoperiodic experience. Overall, my results highlight the pars tuberalis as a conserved central site in mammals for the integration of multiple seasonal cues, which via differential control of thyroid hormone levels in the hypothalamus dictates the timing in seasonal physiology.

Univerzita Karlova 1. lékařská fakulta Studijní program: Zobrazovací metody v lékařství (P5150) Studijní obor: Zobrazovací metody v lékařství (5103V000) MUDr. Adam Kopecký Změny na předním segmentu po 25G+ PPV Changes in the Anterior Segment after 25G+ PPV Abstract Vedoucí závěrečné práce/Školitel: doc. MUDr. Jiří Pašta, CSc., FEBO Praha, 2019 Abstract: Pars plana vitrectomy is a dominant surgical method in posterior segment surgery of the eye. The principle of this method is the surgical approach via the pars plana anatomical region. With this approach, surgeon performs the posterior segment surgery without directly affecting the anterior segment of the eye. Short-term effect of pars plana vitrectomy on the anterior segment of the eye has been repeatedly proven. That might be an important factor both in assessing the complications of this method and planning the surgery in complicated patients. Generally, it is presumed that we do not observe long-term effects on anterior segment after pars plana vitrectomy. The aim of our work is to evaluate the long-term changes in the anterior segment after the uncomplicated 25G + PPV with gas tamponde. The group of 20 patients was selected according to strict indication criteria. Using a series of examinations, we examined specific parameters such as: intraocular...

UA Open Access Publishing Fund / Background: Atlantoaxial surgical fixation is widely employed treatment strategy for a myriad of pathologies affecting the stability of the atlantoaxial joint. The most common technique used in adults, and in certain cases in children, involves a posterior construct with C1 lateral mass screws, and C2 pars or pedicle screws. This technical note aims to provide a step‑by‑step guide to this procedure using cadaveric and fluoroscopic images. Methods: An embalmed, human, cadaveric, specimen was used for this study. The subject did not have obvious occipital‑cervical pathology. Dissections and techniques were performed to mimic actual surgical technique. Photographs were taken during each step, and the critical aspects of each step were highlighted. Fluoroscopic images from a real patient undergoing C1/C2 fixation were also utilized to further highlight the anatomic‑radiographic relationships. This study was performed without external or industry funding. Results: Photographic and radiographic pictures and drawings are presented to illustrate the pertinent anatomy and technical aspects of this technique. The nuances of each step, including complication avoidance strategies are also highlighted. Conclusions: Given the widespread utilization of this technique, described step‑by‑step guide is timely for surgeons and trainees alike.

Studies described in this thesis were performed to investigate associations among season, diet, pituitary pars intermedia dysfunction (PPID) and blood concentrations of adrenocorticotropic hormone (ACTH), insulin, glucose, and leptin in horses. In the first study, higher ACTH concentrations were detected in horses affected with PPID. A seasonal increase in plasma ACTH concentration was detected in the late summer and early fall, but PPID did not affect the timing or duration of this increase. Pasture grazing raised glucose and insulin concentrations with a peak in September, at the same time that horses had higher ACTH concentrations, and this convergence of risk factors may raise the risk of laminitis. All of the horses included in this study were from the same farm. The second study was performed to determine whether horses from different locations within the same region exhibited the same seasonal increase in ACTH concentrations. Results of this study indicate that the seasonal increase in plasma ACTH concentrations occurs in horses from different farms with varying management practices. The third study investigated the effects of season on plasma leptin concentrations in the horses from the first study. We hypothesized that higher leptin concentrations would be detected in advance of the seasonal increase in plasma ACTH concentrations. Results did not support our hypothesis because leptin concentrations increased after ACTH concentrations peaked in September. Our findings suggest that the seasonal increase in ACTH concentrations induced leptin resistance, which might facilitate weight gain in the autumn. Alternatively, leptin concentrations increased as a result of weight gain or change in body fat composition. In summary, season appears to signal upregulation of the hypothalamic-pituitary-adrenal axis in horses, in an effort to prepare for winter. This upregulation is retained in horses with PPID, a disorder associated with loss of dopaminergic inhibition to the pars intermedia of the pituitary. The seasonal rise in plasma ACTH concentrations is followed by an increase in leptin concentrations, which suggests the development of leptin resistance or an increase in adiposity.

The purpose of this project is to study the risk of cataract development in patients who had undergone pars plana vitrectomy, scleral buckle, or both. A retrospective study was performed of phakic patients who underwent pars plana vitrectomy, scleral buckle, or both at Yale University Eye Center from 1998 to 2005. Mild postoperative cataract, defined as a change in severity of 1+, developed in 32 of 53 (60%) eyes following vitrectomy, 2 of 19 (11%) post scleral buckle, and 14 of 16 (88%) after both. Moderate postoperative cataract, defined as a change in severity of 2+, developed in 14 of 53 (26%) eyes post vitrectomy, 1 of 19 (5%) post scleral buckle, and 11 of 16 (69%) after both procedures. In eyes that underwent vitrectomy, a lens change of at least 2+ occurred in 8% at 3 months, 15% at 6 months, 21% at 12 months, and 26% at 36 months. In eyes status post scleral buckle surgery, one eye (5%) experienced a 2+ change at 36 months. In eyes that underwent both vitrectomy and scleral buckle, a lens change of at least 2+ occurred in 44% at 3 months, 50% at 6 months, 63% at 12 months, and 69% at 36 months. Cataract extraction surgery was performed in 15% of eyes post vitrectomy, 0% post scleral buckling, and 50% after both. The most common type of cataract to develop was nuclear sclerotic, which accounted for 61% of cataracts after vitrectomy, 50% after scleral buckling, and 50% after combined vitrectomy and scleral buckling. Scleral buckling surgery is associated with a low risk of cataract formation. Pars plana vitrectomy and combined vitrectomy and buckle have a higher risk of cataract development.

In der Humanmedizin wird zur Beurteilung der Magenschleimhautproben das aktualisierte Sydney-System nach STOLTE (1997) angewendet. Das Ziel war es herauszufinden, ob das histologische Grading System auch in der Veterinärmedizin, für die Beurteilung von Pferdemagenschleimhautpräparaten, genutzt werden kann und ob daraus neue Erkenntnisse erwachsen. Von 60 Pferden wurden direkt post mortem Schleimhautproben aus der Pars glandularis (Drüsenschleimhaut), im Bereich der großen Kurvatur und dem Pylorus, entnommen. Die Patienten wurden in 4 Gruppen, 10 operierte (Kolik)pferde, 36 Pferde mit Kolik und infauster Prognose, 6 Pferde mit hochgradigen Magenulzera und 8 Pferde, die nicht auf Grund einer Kolik euthanasiert wurden, eingeteilt. Die makroskopische Beurteilung der 60 Pferdemägen erfolgte nach MURRAY et al. (1989) und MACALLISTER et al. (1995). Die histopathologische Beurteilung erfolgt in der Humanmedizin anhand der Helicobacter-like-Organismen Dichte, dem Grad der chronischen Entzündung, der Aktivität der Gastritis, der Atrophie und der intestinalen Metaplasie. Nach diesen Beurteilungsvariablen wurden die 120 Proben aus den 60 Pferdemägen beurteilt. Die ätiologischen Diagnosen sind in der Humanmedizin das Ergebnis jahrzehntelanger Forschung. Beim Pferd liegen dagegen zur Ätiologie der Gastritis noch keine gesicherten Erkenntnisse vor. Beim Pferd gibt es bestimmte Gastritisformen, die denen des Menschen ähnlich sind. Doch können die morphologischen Befunde in der Veterinärmedizin, nach den jetzigen Erkenntnissen, keinen Ätiologien zugeordnet werden. Die ätiologischen Diagnosen in dieser veterinärmedizinischen Studie beruhen auf der Diagnostik am Menschen und wurden noch nicht auf ihre Richtigkeit beim Pferd überprüft. Von den 60 untersuchten Pferdemägen wiesen 31 makroskopisch Läsionen in der Magenschleimhaut auf. 20 Pferde mit Veränderungen hatten diese in der Pars glandularis. Bei 44 der Pferde bestätigt der histologische Befund, nach dem aktualisierten Sydney- System, das makroskopische Grading. 13 der Pferde hatten nach dem aktualisierten Sydney-System histologisch einen pathologischen Befund, obwohl makroskopisch die Schleimhaut keine Auffälligkeiten aufwies. Bei nur 3 von den 60 Pferden konnte der histologische den makroskopischen Befund nicht bestätigen. Ätiologisch wurde, nach humanmedizinischen Beurteilungskriterien, bei 18 Pferden im Bereich der großen Kurvatur der Pars glandularis und, oder im Bereich des Pylorus eine C-Gastritis (chemische Gastritis), bei 11 Pferden eine like B-Gastritis (bakterielle Gastritis ohne den Nachweis von Helicobacter-like-Organismen), 3 Pferden eine B-Gastritis (bakterielle Gastritis mit dem Nachweis von Helicobacter-like-Organismen) und bei 9 Pferden eine Sonderform der Gastritis diagnostiziert. 6 Pferde bekamen die Diagnose: zur Zeit nicht klassifizierbar und 7 Pferde die deskriptive Diagnose erosive oder ulzerative Gastritis gestellt. 24 Pferde hatten keinen pathologischen Befund in einem der oben genannten Bereiche der Schleimhaut. Die histopathologischen Befunde der Pferde mit einer like-B-Gastritis oder einer B-Gastritis entsprachen nach humanmedizinischen Gesichtspunkten dem Bild einer Helicobacter-pylori-Gastritis beim Menschen. Bandartige Anordnung der Lymphozyten in der Lamina propria mucosae und neutrophile Granulozyten in Verbindung mit einer Atrophie des Drüsenkörpers, intestinaler Metaplasie und Erosionen. Bei drei Pferden konnte in der Warthin–Starry-Färbung und in der IHC-Reaktion Helicobacter-like-Organismen nachgewiesen werden. Die Pylorusschleimhaut war doppelt so häufig, im Vergleich zur Drüsenschleimhaut der großen Kurvatur, von einer like-B-Gastritis oder B-Gastritis betroffen. Die histologische Auswertung von Magenschleimhautbioptaten, in dieser Studie nach dem aktualisierten Sydney-System aus der Humanmedizin, komplettiert die makroskopische (endoskopische) Diagnostik. Nach den Ergebnissen der vorliegenden Studie gehört in der Pferdemedizin zu jeder Gastroskopie die Bioptatentnahme. Das aktualisierte Sydney-System kann in Zukunft in der Veterinärmedizin als Arbeitsgrundlage für die weitere wissenschaftliche Forschung genutzt werden. / Stolte’s updated Sydney system is used in the field of human medicine for grading the gastric mucosa (STOLTE 1997). The goal of this study was to determine whether this system could also be applied for histological parameter grading in veterinary medicine, in order to gain new insights into medications for treating equine gastric mucosa. Post mortem biopsies of mucosa were taken from 60 equines along the greater curve and pylorus of the pars glandularis. The test animals were divided into four groups: 10 post-colic surgery equines, 36 with colic and an infaust prognosis, six with chronic EGUS (equine gastric ulcer syndrome), and eight equines not euthanized for reasons other than colic. Macroscopic grading of the 60 equine stomachs was performed in accordance with MURRAY et al. (1989) and MACALLISTER et al. (1995). In human medicine, histological scoring is based on the following five parameters: density of Helicobacter-like organisms, grade of the chronic inflammation, level of gastric activity, atrophy, and intestinal metaplasia. A total of 120 biopsies taken from the 60 equines were graded according to these parameters. Etiologic diagnoses for humans are the outcome of decades of research, but the etiology of equine gastritis lacks an equivalent foundation. Equines exhibit forms of gastritis similar to those in humans, but their morphology cannot be classified into any specific etiology. In this study, the etiological diagnoses were based on human diagnostics, but their validity for equines has yet to be substantiated. Of the 60 equine stomachs examined, 31 showed lesions in the gastric mucosa, while 20 of those with changes had lesions in the pars glandularis. Histological findings of 44 equines confirmed the macroscopic grading according to the updated Sydney system. Thirteen equines exhibited pathological findings based on the updated Sydney system histology, although no abnormalities were discovered in the macroscopic examination. The histological diagnosis did not confirm the macroscopic grading for only three of the 60 subjects. The following etiological findings were reached in terms of human medicine: 18 equines with type C gastritis (chemical gastritis) along the greater curve of the pars glandularis and/or pylorus, 11 equines with type B-like gastritis (bacterial gastritis without evidence of H-like organisms), three equines with type B gastritis (bacterial gastritis with evidence of H-like organisms), and nine with a special form of gastritis. Six of the equines could not be classified, while seven showed erosive gastritis or ulceration. A total of 24 equines exhibited no pathological findings along any of the above-mentioned mucosae. The histopathological findings of the equines with either type B-like gastritis or type B gastritis corresponded with H pylori gastritis seen in humans, as ligamental lymphocytes in the lamina propria mucosae and neutrophilic granulocytes associated with atrophy of the glandular corpus, intestinal metaplasia, and erosion. Warthin-Starry staining and the IHC reaction confirmed H-like organisms in three of the equines. The frequency of type B-like gastritis or type B gastritis was observed to be twice as high in the pylorus mucosa as along the glandular mucosa of the greater curve. This study has demonstrated that histological analysis of gastric mucosa biopsies graded according to the updated Sydney system for human medicine significantly complements veterinary gastroscopy, which should therefore always include a biopsy. The updated Sydney system can thus serve as a platform for future scientific research in the field of veterinary medicine.

Idiopathic Epiretinal membrane is a proliferation of contractile cells on the surface of the retina that typically occurs after posterior vitreous detachment. Though many questions have been raised on the causes of this condition, a greater debate has been on the treatment of this pathology. The literature suggest the potential benefit in peeling ILM, due to its inherent proliferative characteristics, along with the ERM, during the surgery, however sufficient data has yet to been found. Due to the lack of consensus in treatment of iERM, this study set forth to provide some insight on the surgical outcomes of patients that undergo combined peeling as well attempting to contribute to a potential surgical protocol in treating iERM. This was a retrospective case series study looking at 140 eyes from 126 iERM patients that underwent ERM surgical treatment at Beth Israel Deaconess Medical Center between 1998 and 2015. Pre- and post- operative visual acuities, lens status (phakic, aphakic, pseudophakic), type (kenalog with or without ICG) and duration (0.5min, 1 min, 1.5 min) of the stains used in the procedure, and any prior or successive surgeries were recorded and analyzed. Overall, ERM surgeries demonstrated a significant (p<0.0001) improvement in visual acuity. Furthermore, the combined peel patients demonstrated a significantly (p<0.0467) greater mean change in logMAR score when compared to ERM-only peel procedures. In addition, the combined peel group showed a smaller rate of recurrence. Lastly, simultaneous cataract surgery and the use of ILM stains did not have an impact on the outcome of ERM surgery. The study found that combined (ERM and ILM) peeling along with simultaneous cataract surgery, if a cataract was present, along with the utilization of ILM stains is cost-effective, safe, and effective approach in treating iERM and decreasing its recurrence.

PURPOSE: This study examined the surgical outcomes after pars plana vitrectomy in patients with proliferative diabetic retinopathy at various stages of posterior vitreous detachment. The investigation assessed the changes in visual acuity and the frequency of complications associated with each stage of detachment. METHODS: This retrospective, single-site, single-surgeon study reviewed 328 medical records of patients at Beth Israel Deaconess Medical Center (Boston, MA) requiring pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy between 2000 and 2017. The 328 patients were separated into 4 groups based on their vitreous status (Stages 0 and 1, Stage 2, Stage 3, and Stage 4). Preoperative characteristics were collected, including best-corrected visual acuity (BCVA) and diabetes duration. Complications, visual acuity, and reoperation data were collected postoperatively. RESULTS: Sixty-one percent of the patients in the combined group (Stages 0 and 1), 56% in Stage 2, 67% in Stage 3, and 77% in Stage 4 did not require a revision PPV. Thirteen percent of the patients in the combined group, 13% in Stage 2, 5% in Stage 3, and 0% in Stage 4 required a revision PPV for retinal detachment. This represented a statistically significant difference between the groups (p = 0.0254). The combined group had a postoperative change in BCVA of 0.31 compared with 0.29 for Stage 2, 0.67 for Stage 3, and 0.90 for Stage 4. These BCVA changes represented a statistically significant difference (p = 0.0001) between the groups. CONCLUSIONS: This study shows that having a preoperative posterior vitreous detachment leads to improved visual acuity postoperatively and decreased chance of developing a postoperative retinal detachment. The study also indicates that increased vitreoretinal traction results in less change in visual acuity and an increase in complications. Further research is needed to validate these findings.