by Tong Hung Man Joanna. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 150-172). / Abstract --- p.i / Acknowledgments --- p.iii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter Chapter 2 --- Literature Review --- p.5 / Chapter 1. --- Overview of renal cell carcinoma --- p.6 / Chapter 1.1 --- Epidemiology --- p.6 / Chapter 1.2 --- Etiology --- p.6 / Chapter 1.3 --- Clinical features --- p.7 / Chapter 1.4 --- Pathology --- p.9 / Chapter 2. --- The biological cell cycle --- p.15 / Chapter 2.1 --- Cell Cycle --- p.15 / Chapter 2.2 --- Cell cycle control --- p.18 / Chapter 3. --- Overview of DNA ploidy and the relationship with the biological behavior of renal cell carcinoma --- p.18 / Chapter 3.1 --- Overview of DNA ploidy --- p.18 / Chapter 3.2 --- Intratumoral heterogeneity --- p.20 / Chapter 3.3 --- Controversial prognostic value of DNA ploidy analysis in RCC --- p.21 / Chapter 3.4 --- Assessment of DNA ploidy --- p.23 / Chapter 4. --- Cell proliferation and its assessment by immunohistochemical methods --- p.34 / Chapter 4.1 --- Proliferation activity and tumor growth --- p.34 / Chapter 4.2 --- Basic principles of immunohistochemistry (IHC) --- p.34 / Chapter 4.3 --- "Ki 67, a cell proliferation marker" --- p.39 / Chapter 4.4 --- "p27kipl, a cell cycle arrest marker" --- p.41 / Chapter Chapter 3 --- Aims of the study --- p.44 / Chapter Chapter 4 --- Materials and Methods --- p.46 / Chapter 1. --- Tissue samples --- p.47 / Chapter 1.1 --- Sample retrieval --- p.47 / Chapter 1.2 --- Tissue processing --- p.47 / Chapter 1.3 --- Preparation of tissue sections --- p.47 / Chapter 2. --- Methods for quantitative DNA analysis --- p.49 / Chapter 2.1 --- Instrumentation --- p.49 / Chapter 2.2 --- Procedures for quantitative DNA analysis --- p.50 / Chapter 3. --- Immunohistochemical (IHC) studies of proliferation activity of RCC --- p.59 / Chapter 3.1 --- Antibodies used --- p.59 / Chapter 3.2 --- Other reagents --- p.60 / Chapter 3.3 --- Unmasking of antigens --- p.62 / Chapter 3.4 --- ABC method for monoclonal antibodies with a avidin/biotin blocking --- p.62 / Chapter 3.5 --- Interpretation and scoring of immunostaining --- p.64 / Chapter 4. --- Clinical data retrieval --- p.64 / Chapter 5. --- Statistical analysis --- p.65 / Chapter Chapter 5 --- Results --- p.66 / Chapter 1. --- Clinical information --- p.67 / Chapter 2. --- Pathological features --- p.67 / Chapter 2.1 --- Histological subtypes --- p.67 / Chapter 2.2 --- Nuclear grading --- p.68 / Chapter 2.3 --- Clinical stage --- p.68 / Chapter 3. --- DNA ploidy analysis --- p.76 / Chapter 3.1 --- By flow cytometry --- p.76 / Chapter 3.2 --- By static image cytometry using cytospin preparations --- p.82 / Chapter 3.3 --- By static image cytometry using tissue sections --- p.87 / Chapter 4. --- Immunohistochemistry --- p.92 / Chapter 4.1 --- Ki 67 (MIB-1) --- p.92 / Chapter 4.2 --- p27kipl --- p.96 / Chapter 5. --- Statistical analysis --- p.101 / Chapter 5.1 --- DNA ploidy analysis --- p.101 / Chapter 5.2 --- Ki 67 (MIB-1) --- p.108 / Chapter 5.3 --- p27kipl --- p.110 / Chapter 5.4 --- Nuclear grade and nuclear area --- p.112 / Chapter 5.5 --- Stage --- p.115 / Chapter 5.6 --- Survival analysis --- p.117 / Chapter Chapter 6 --- Discussion --- p.118 / Chapter 1. --- DNA ploidy analysis --- p.119 / Chapter 1.1 --- Flow cytometry --- p.119 / Chapter 1.2 --- Image analysis using cytospin preparations --- p.123 / Chapter 1.3 --- Image analysis using tissue sections --- p.126 / Chapter 1.4 --- Intratumoral heterogeneity --- p.130 / Chapter 1.5 --- Comparison of the results from three methods --- p.131 / Chapter 1.6 --- The potential significance of the DNA ploidy status --- p.137 / Chapter 2. --- Proliferation activity of RCC --- p.139 / Chapter 2.1 --- Ki 67 --- p.139 / Chapter 2.2 --- p27kipl --- p.140 / Chapter 3. --- Nuclear grade --- p.142 / Chapter 4. --- Stage --- p.143 / Chapter Chapter 7 --- Conclusion --- p.144 / Chapter Chapter 8 --- Further studies --- p.147 / References --- p.149

INTRODUÇÃO: A Pitiríase liquenoide (PL) é doença cutânea de etiologia desconhecida. Foi recentemente classificada no grupo das discrasias linfóides de células T. Excetuando-se os estudos sobre as características fenotípicas e moleculares dos linfócitos T na PL, trabalhos relativos aos demais componentes da resposta tecidual cutânea nesta doença são escassos. MÉTODOS: Biopsias de 34 pacientes com diagnóstico clínico e histopatológico de PL foram classificadas de acordo com características histopatológicas nos grupos de pitiríase liquenóide aguda (PLA) (n = 15) e crônica (PLC) (n = 19), e submetidas a técnica imunoistoquímica para demonstração de células de Langerhans, dendrócitos dérmicos fator XIIIIa+, expressão da forma induzida da óxido nítrico sintase (iNOS), fator de necrose tumoral alfa (TNFalfa), interferon gama (IFNy) e interleucinas (IL) 12 e 10. Fez-se a comparação dos resultados obtidos entre os grupos de PLA e PLC. A expressão de iNOS foi também comparada com grupo controle de pele normal (n = 10). RESULTADOS: A população de células de Langerhans epidérmicas foi menor no grupo de PLA. O número de dendrócitos dérmicos fator XIIIa+ não diferiu entre os grupos. Foi observada expressão epidérmica e dérmica de iNOS em ambos os grupos de PL. Três espécimes do grupo controle de pele normal apresentaram fraca expressão de iNOS epidérmica e dérmica. O grupo de lesões de PLA mostrou maior expressão dérmica de TNFalfa e IFNy. A depleção de células de Langerhans epidérmicas foi acompanhada de maior expressão epidérmica de TNFalfa e IL-10. Houve correlação entre a expressão de iNOS e a população de dendrócitos dérmicos fator XIIIa+. CONCLUSÕES: Na PLA a população de células de Langerhans é menor que na PLC e se correlacionou com maior expressão epidérmica de TNFalfa e IL-10. Não houve diferenças na população de dendrócitos dérmicos fator XIIIa+ nos dois grupos de lesão. Demonstrou-se, pela primeira vez, expressão epidérmica e dérmica de iNOS nas lesões de PL. A expressão de iNOS dérmica correlacionou-se com a população dendrocítica Fator XIIIa+. Houve correlação entre a expressão de TNFalfa e de IFNy com as alterações inflamatórias da PLA. Houve correlação negativa entre a expressão dérmica de IL-12 e IL-10 nas lesões da PL. No espectro da resposta tecidual da PL participam as células dendríticas da pele, em ambiente de padrão imunológico Th1 predominante, com conseqüente indução da expressão de iNOS nos sítios de lesão. / BACKGROUND: Pityriasis lichenoides (PL) is a cutaneous disease of unknown etiology which has been regarded as an immunologically mediated reaction. Recently, it was reclassified in the group of Cutaneous Lymphoid T cell Dyscrasia. There are few reports addressing mainly T cell subsets in PL tissue reaction. METHODS: Skin biopsies taken from 34 patients with confirmed diagnosis of PL where classified as pityriasis lichenoides et varioloformis acuta (PLEVA) (n = 15) and pityriasis lichenoides chronica (PLC) (n = 19) according to histopathological features. The skin biopsies where subjected to immunohistochemical technique to demonstrate Langerhans cells, Factor XIIIa+ dermal dendrocytes, inducible nitric oxide synthase (iNOS) expression, tumor necrosis factor alfa (TNFalfa), interferon gama (IFNy) and interleukins (IL) 12 and 10. The ensuing results were compared among the two PL groups. The iNOS results in PL group were also compared to a normal skin control group (n = 10). RESULTS: In PLEVA lesions, there was a decrease in Langerhans cells population when compared to PLC lesions. The factor XIIIa+ dermal dendrocytes number did not differ among PL groups. There was a strong epidermal and dermal iNOS expression in both PL groups. A faint iNOS expression was observed in three specimens of the control group. A higher TNFalfa and INFy expression was observed in PLEVA lesions. The Langerhans cells decrease observed in those lesions was accompanied by higher TNFalfa and IL-10 expression. There was a significant correlation between factor XIIIa+ dermal dendrocytes population and dermal iNOS expression. CONCLUSIONS: PLEVA lesions displayed a decrease in Langerhans cells number, accompanied by higher TNFalfa and IL-10 expression. There was no difference in the amount of factor XIIIa+ dermal dendrocytes in PLEVA and PLC lesions. The study demonstrated, for the first time, the iNOS expression in PL lesions. The factor XIIIa+ dermal dendrocytes population correlated to dermal iNOS expression. TNFalfa and INFy expression correlated to inflammatory alterations observed in PLEVA lesions. There was a negative correlation between IL-12 and IL-10 expression in PL lesions. Dendritic cells participate in the PL spectrum of tissue reaction which is characterized by predominant TH1 cytokines milieu that favors iNOS expression.

Pan, Tak Yin. / Thesis submitted in: November 2007. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references. / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract (English) --- p.ii / Abstract (Chinese) --- p.iv / Content --- p.v / Abbreviations --- p.x / List of Figures --- p.xi / List of Tables --- p.xii / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Alzheimer's Disease --- p.1 / Chapter 1.1.1 --- Cholinergic hypothesis --- p.2 / Chapter 1.1.2 --- p-amyloid hypothesis --- p.2 / Chapter 1.1.3 --- Taupathy hypothesis --- p.3 / Chapter 1.1.4 --- Current therapies --- p.4 / Chapter 1.2 --- Proteins Involved in Alzhemer's Disease --- p.5 / Chapter 1.2.1 --- Acetylcholinesterase (AChE) --- p.5 / Chapter 1.2.2 --- p-amyloid --- p.6 / Chapter 1.2.3 --- Paired helical filaments (PHF) --- p.7 / Chapter 1.2.4 --- Protein kinases --- p.8 / Chapter 1.2.4.1 --- Glycogen synthase kinase-3 (GSK-3) --- p.9 / Chapter 1.2.4.2 --- Cyclin-dependent kinase-5 (CDK-5) --- p.9 / Chapter 1.2.5 --- Protein phosphatase (PP) --- p.10 / Chapter 1.2.5.1 --- Protein phosphatase 1 (PP-1) --- p.11 / Chapter 1.2.5.2 --- Protein phosphatise 2A (PP-2A) --- p.12 / Chapter 1.2.5.3 --- Protein phosphatise 2B (PP-2B) --- p.13 / Chapter 1.2.6 --- Apoptotic and Anti-apoptotic proteins --- p.14 / Chapter 1.2.6.1 --- Caspase-3 --- p.15 / Chapter 1.2.6.2 --- Bcl-2 --- p.15 / Chapter 1.3 --- Flavonoids --- p.16 / Chapter 1.3.1 --- Biosynthesis of flavonoids --- p.17 / Chapter 1.3.2 --- Biological functions of flavonoids in plants --- p.18 / Chapter 1.3.3 --- Beneficial effects of flavonoids on human health --- p.19 / Chapter Chapter 2: --- Materials and Methods --- p.20 / Chapter 2.1 --- Differentiation of SHSY-5Y cells --- p.20 / Chapter 2.1.1 --- SHSY-5Y cell culture --- p.20 / Chapter 2.1.2 --- Counting cells --- p.20 / Chapter 2.1.3 --- Retinoic acid differentiation --- p.21 / Chapter 2.2 --- Western blot analysis --- p.21 / Chapter 2.2.1 --- Extraction of proteins from mammalian cells --- p.21 / Chapter 2.2.2 --- Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.22 / Chapter 2.2.3 --- Semi-dry protein transfer to nitrocellulose membrane --- p.23 / Chapter 2.2.4. --- Membrane blocking and immunostaining --- p.24 / Chapter 2.3 --- MTT assay --- p.25 / Chapter 2.4 --- Hoechst 33342 Nuclei staining --- p.25 / Chapter 2.5 --- Cell cycle analysis --- p.25 / Chapter 2.5.1 --- Ethanol fixation --- p.25 / Chapter 2.5.2 --- Propidium iodide staining --- p.26 / Chapter 2.6 --- Annexin V-FITC & Propidium iodide staining --- p.26 / Chapter 2.7 --- DNA fragmentation analysis --- p.26 / Chapter 2.7.1 --- Phenol/Chloroform extraction of DNA --- p.26 / Chapter 2.7.2 --- Ethanol precipitation of DNA --- p.27 / Chapter 2.7.3 --- Agarose gel electrophoresis of DNA --- p.27 / Chapter 2.8 --- Proteomic analysis --- p.28 / Chapter 2.8.1 --- First dimension: isoelectric focusing --- p.28 / Chapter 2.8.2 --- Second dimension: SDS PAGE --- p.29 / Chapter 2.8.3 --- Gel staining --- p.30 / Chapter 2.8.3.1 --- Silver staining --- p.30 / Chapter 2.8.3.2 --- SYBRO Ruby staining --- p.31 / Chapter 2.8.4 --- Gel scanning and image analysis --- p.31 / Chapter 2.8.5 --- ln-gel digestion --- p.32 / Chapter 2.8.6 --- Zip Tip for desalting the digested sample --- p.33 / Chapter 2.8.7 --- Protein identification with mass spectrometry and database search --- p.33 / Chapter Chapter 3: --- Characterization of Okadaic acid-induced tail hyperphosphorylation in SHSY-5Y cells --- p.35 / Chapter 3.1 --- Introduction --- p.35 / Chapter 3.2 --- Objectives --- p.37 / Chapter 3.3 --- Results --- p.38 / Chapter 3.3.1 --- Differentiation of SH-SY5Y cell --- p.38 / Chapter 3.3.2 --- Changes of protein expression after okadaic acid treatment --- p.40 / Chapter 3.3.3 --- Neurite Retraction Induced by okadaic acid --- p.42 / Chapter 3.3.4 --- Okadaic acid-induced Cell Death measured by MTT assay --- p.44 / Chapter 3.3.5 --- Hoechst 33342 Nuclei Staining --- p.44 / Chapter 3.3.6 --- Cell cycle analysis by propidium iodide staining --- p.47 / Chapter 3.3.7 --- Early Apoptotic cells detection by Annexin V/PI staini --- p.49 / Chapter 3.3.8 --- DNA fragmentation --- p.51 / Chapter 3.4 --- Discussion --- p.53 / Chapter Chapter 4: --- Flavonoids screening for protecting neuronal death by preventing tau hyperphosphorylation --- p.57 / Chapter 4.1 --- Introduction --- p.57 / Chapter 4.2 --- Objectives --- p.58 / Chapter 4.3 --- Tested flavonoids --- p.59 / Chapter 4.4 --- Results --- p.60 / Chapter 4.4.1 --- Toxicity of flavonoids --- p.60 / Chapter 4.4.2 --- Effects of flavonoid pre-treatment on OA-induced neu retractions and cell death --- p.62 / Chapter 4.4.3 --- Western blot analysis --- p.65 / Chapter 4.4.4 --- The effect of different concentrations of hesperidin or OA treatment --- p.70 / Chapter 4.4.5 --- Proteomic analysis --- p.74 / Chapter 4.5 --- Discussion --- p.78 / Chapter Chapter 5: --- General Discussion --- p.82 / References

As porfirias, síndromes associadas a deficiências de atividade enzimática da biossíntese do grupo heme, presente em quase todas células do organismo, com maior atividade no fígado e medula óssea, agrupam-se em formas hereditárias ou primárias e secundárias ou químicas. No caso das primárias ocorre déficit da expressão de enzimas ou inibição da atividade de outras. A variação dos metabólitos acumulados é o que tange o polimorfismo clínico. Dentre as secundárias, destacam-se o saturnismo (intoxicação por chumbo) e a tirosinemia subaguda ou crônica (onde o acúmulo de succinilacetona, intermediário da degradação de tirosina, inibe a ALA desidratase, enzima biossintética do grupo heme). Nestas últimas e na porfiria aguda intermitente (PAI), de herança autossômica dominante do cromossomo 11q, além de outros intermediários menores, ocorre o acúmulo do ácido 5-aminolevulínico (ALA) no sangue e outros tecidos. O ALA é uma α-aminocetona passível de rápida enolização em pH fisiológico. Foi demonstrado que o enol formado sofre oxidação subsequente catalisada por complexos de ferro em pH fisiológico com formação de espécies reativas de oxigênio e ALA enoil radical. Este comportamento causa dano oxidativo em mitocôndria, lipossomos, DNA e proteínas. A formação do ânion superóxido (O2•-) no meio promove liberação de ferro do retículo endoplasmático e de ferritina e in vivo aumenta significantemente a concentração de ferro não-hemínico em fígado de rato. Vários estudos se seguiram para demonstrar que ALA acumulado nos distúrbios porfirínicos sofreria oxidação a partir do enol, tendo como produto final o ácido 4,5-dioxovalérico (DOVA), e este comportamento seria o responsável pelas alterações neurobioquímicas encontradas: aumento da captação de cálcio em sinaptosomas, elevação de ferro total cortical e estriatal seguido por elevação secundária de ferritina, aumento da atividade CuZnSOD (cobre-zinco superóxido dismutase), bem como proteínas oxidadas e produtos de lipoperóxidos nos homogenatos totais de córtex de rato. In vitro, estes efeitos foram todos inibidos por agentes antioxidantes, químicos ou enzimáticos. As evidências neuroquímicas clássicas para as manifestações neuropsiquiátricas supostamente promovidas pelo ALA apoiavam-se na similaridade estrutural ALA/GABA, proposta por Brennan e Cantrill em 1979. Nosso estudo modelo, utilizando membranas sinápticas, evidenciou através de ensaios de radioligação com 3H-muscimol na presença de 10 mM de ALA ou após tratamento crônico com 40 mg/kg em ratos, alteração do Kd (constante de dissociação do complexo receptor-ligante), mas sem mudança no \"pool\" total de receptores. Outro aspecto não esclarecido era se o DOVA afetaria o sistema GABAérgico, não pelo mecanismo oxidativo, mas através de um antagonismo farmacológico (similaridade estrutural com o GABA) ou através de sua reatividade ao formar adutos cíclicos com proteínas similar ao que acontece nos AGEs (\"Advanced Glication End Products\"). Nesta dissertação estudamos o mecanismo de captação de cálcio por sinaptosomas influenciada por ALA e DOVA. São discutidos os resultados dos ensaios de radioligação com 3H-muscimol na verificação do efeito de DOVA nos sítios GABAérgicos também em sinaptosomas corticais de ratos. Os estudos usando cultura de células transformadas de linhagem neuronal WERI (derivadas de retinoblastoma humano com mutação no gene rb) foram conduzidos para avaliar a citotoxicidade ao ALA e DOVA, bem como extender a análise da via GABAérgica, envolvida na fisiopatologia dos efeitos citados. Nossos resultados demonstram o efeito de ALA, metabolito intermediário acumulado nas porfirias, em particular na PAI e saturnismo, como espécie pro-oxidante nociva ao sistema sinaptosomal. Seu efeito é mediado pela quebra na homeostade do cálcio desencadeando colapso energético mitocondrial, cujo efeito tem reversão parcial com o uso de antioxidantes e bloqueadores de canal de cálcio. Já o DOVA tem demonstrado seu efeito principalmente comprometendo a vitalidade celular não relacionada à homeostase do cálcio, mas com envolvimento do sistema GABAérgico de receptores ligados ao canal de cloreto. Tal efeito parece estar relacionado com a alteração do \"pool\" total de receptores celulares e sua citolocalização. / Abstract not available.

Growth factor delivery may be useful to accelerate the rate of tendon healing. We studied Platelet Concentrate, which in effect can be regarded as a cocktail of growth factors relevant for tendon healing. In a rat Achilles tendon transection model, one postoperative injection of Platelet Concentrate resulted in increased strength even 3 weeks later. Mechanical stimulation improves the repair of ruptured tendons. We studied the effects of platelets upon Achilles tendon regenerates in rats 3, 5 and 14 days after transection, either unloaded or mechanically stimulated. At 14 days, physical activity and platelets increased repair independently. Unloading decreased the mechanical properties of the repair tissue to less than half of normal. Moreover, the platelets had no effect without loading. Thrombin, which we used for platelet activation, improved healing of the rat Achilles tendon by itself. Conversely, continuous inhibition of thrombin by low molecular weight heparin (LMWH) inhibited tendon repair. However, intermittent inhibition, similar to clinical thromboprophylaxis, had no effect on tendon healing. Cartilage Derived Morphogenetic Protein-2 (CDMP-2) can improve tendon healing in loaded defect models. We now studied unloaded repair in a rabbit patellar tendon model. Two hours postoperative, the rabbits received CDMP-2 injected into the haematoma. The healing tendon became 65 % stronger than controls. We then studied Achilles tendon healing with CDMP-2 injections in sheep, to get a bigger animal model. There was an unexpectedly high variation of repair in these animals, and the study turned out to be underpowered. Spontaneous ruptures in humans have a more variable geometry than in our sheep model, so humans can also be expected to vary a lot in mechanical characteristics of Achilles tendon repair. This accentuates the importance of individualized rehabilitation programs. In conclusion, both platelet concentrate and CDMP-2 injections might be of interest for clinical use as a complement to surgical or conservative treatment of tendon ruptures. Platelet treatment for tendon ruptures should probably be combined with early physiotherapy.

Rheumatoid arthritis (RA) is a major cause of progressive joint damage and disability, and is associated with decline in quality of life, reduced ability to work and increased health care utilisation. The economic consequences of the disease are substantial for the individuals and their families and for the society as a whole. This thesis describes a 5-year follow up of 320 patients with early RA, enrolled between January 1996 and April 1998 in the Swedish multi-centre inception cohort TIRA (early interventions in rheumatoid arthritis). Health status, function and costs were investigated. Predictors of high costs were calculated, and an algorithm was constructed to predict future need for TNFinhibitor treatment in patients not responding to traditional disease-modifying antirheumatic drugs (DMARDs). Clinical and laboratory data, measures of functional capacity and self-reported assessments were collected regularly. In addition, patients completed biannual/annual questionnaires concerning all health care utilisation and days lost from work due to the disease. Within 3 months, improvements were seen regarding all variables assessing disease activity and functional ability, but 15% of the patients had sustained high or moderate disease activity throughout the study period. The scores of ‘health assessment questionnaire’ (HAQ) were similar for men and women at baseline, but had a less favourable course in women, who also had DMARDs more frequently prescribed. Ambulatory care accounted for 76% of the direct costs during the first year. Women had more ambulatory care visits and higher usage of complementary medicine compared to men. Men ≥65 years had low costs compared to younger men and compared to women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM-class rheumatoid factor (RF), and poor hand function increased the odds of incurring high direct costs. Poor hand function and pain increased the odds of incurring high indirect costs. Indirect costs exceeded direct costs all three years. The average direct costs were €3,704 (US$ 3,297) year 1 and €2,652 (US$ 2,360) year 3. All costs decreased over the years, except those for medication and surgery. The indirect costs were €8,871 (US$ 7,895) year 1 and remained essentially unchanged, similarly for both sexes. More than 50% were on sick leave or early retirement at inclusion. Sick leave decreased but was offset by increase in early retirement. 14 patients (5%) were prescribed TNF-inhibitors at the 3- year follow up, thus increasing drug costs substantially. However, they incurred higher costs even before prescription of anti-TNF therapy. At the 5-year follow-up (2001-2003), 31 patients (12%) were prescribed TNFinhibitors. Baseline values of erythrocyte sedimentation rate, C-reactive protein, anti-CCP antibodies and morning stiffness were significantly higher in this group. These patients were also to a larger extent RF-positive and carriers of the ‘shared epitope’ (SE). Anti-TNF treated patients were significantly younger and more often women. For men, a predictive model was constructed using baseline data including SE+ and IgA-RF >100 U/L and anti-CCP >240 U/L yielding a specificity of 98% and a sensitivity of 71%. For women, disease activity score (DAS28) at the 3-month follow-up proved to be a better predictor, and the final model comprised SE+ and 3-month DAS28>5.2, giving a specificity of 95% and a sensitivity of 59%.

The involvement of corticotropin-releasing hormone (CRH) and neuropeptide Y (NPY) in the pathophysiology of anxiety and anxiety-related disorders is well established. The objective of this study is to explore the genetic variations in the CRH and NPY genes in a well-documented behavioral animal model, the vervet monkey (Chlorocebus aethiops sabaeus), in order to uncover a possible association between these polymorphisms and behavioral traits quantitatively extracted following analysis of social behavior and responses to novelty challenges. / The vervet CRH and NPY genes were amplified and sequenced; the priority was given to the regions expanding from -1kb upstream of the transcription initiation site (where most of the regulatory elements are found in both genes) through the second exon. / Polymorphism discovery analysis revealed the presence of 9 vervet CRH SNPs and 9 vervet NPY SNPs; the SNPs are relatively evenly distributed across the regions covered. An association between one intronic NPY SNP and "defensive aggression" was detected. / These results are coherent with other reports implicating NPY in defensive aggressive behavior, and support the notion that fear responses are fundamental behavioral traits for the dissection of anxiety.

Postnatal handling of rat litters during the first week of life greatly decreases behavioural fearfulness to novelty in the adult offspring. Our first question was to what extent the Benzodiazepine/GABAA receptor complex, a system critical for the expression of fear, might be involved in mediating the observed reduced fearfulness in handled animals (H). Benzodiazepine receptor (BZ) binding was reduced in the amygdala and locus coeruleus (LC), regions important for the expression of fear in non-handled (NH) and maternally separated animals (MS). Moreover, levels of the mRNA for the gamma2 sub-unit of the GABAA receptor complex, which confers high affinity BZ binding, were higher in the amygdaloid nuclei as well as in the LC of handled compared with both NH and MS animals. / Studies with the handling paradigm have lead to the idea that variations mother-pup interactions may actually be the cause of the handling effects. As adults, the offspring of mothers which exhibited high levels of licking/grooming and arched-back nursing (LG-ABN) showed substantially reduced behavioral fearfulness in response to novelty compared to the offspring of low LG-ABN mothers. In addition, the adult offspring of the high and low LGABN mothers showed the same receptor and molecular profiles as H and NH adult offspring. Corticotropin releasing factor (CRF) and alpha2 norepinephrine receptor levels, additional receptor systems thought to be important in the expression of fearfulness, differed in these animals too. Adoption studies give further support to the maternal hypothesis in the finding that the expression mRNA for the gamma2 sub-unit of the GABAA receptor complex can be differentially expressed as a result of different offspring to mother combinations. / Taken together, these findings suggest that early life events (ie: naturally occurring differences in maternal care) during the first few days of life have long-term effects on the development of central neurotransmitter systems, which mediate the expression of fearfulness to novelty.

This dissertation presents three experiments designed to demonstrate the effects of cognitive, emotional and psychosocial factors on pain perception in humans and to identify potential neuroanatomical substrates of attentional and emotional pain modulation. / The first two chapters provide an introduction, including the statement of the rationale and objectives of this Ph.D. project (Chapter 1) and an overview of the relevant background literature (Chapter 2). / Chapter 3 presents a voxel-based morphometry study on the neural correlates of attentional and emotional pain modulation. In agreement with the observation that manipulations of emotion and attention differentially affect pain perception, the results of this experiment suggest that separate neuroanatomical substrates may underlie these pain modulations: the right lateral orbitofrontal, left medial prefrontal, and bilateral entorhinal cortices appear to be implicated in emotional pain modulation, while the right putamen appears to be involved in attentional pain modulation. / The study described in Chapter 4 shows that the experimental manipulation of mood using emotionally-laden visual stimuli preferentially alters pain unpleasantness, leaving pain intensity unaffected. This study replicates the psychophysical observations presented in the study of Chapter 3 (and in previous reports), which used odors to manipulate emotional state, therefore suggesting the independence of this phenomenon from the mood induction technique employed. / The study in Chapter 5 shows that empathy has an effect on pain perception as well, which cannot be explained by mood effects. Participants for whom a state of high empathy was evoked rated painful stimuli applied to themselves as more intense and unpleasant than did those in a state of low empathy; furthermore, the state empathy ratings correlated with the pain ratings. / By showing that emotional state, attention and empathy can influence pain perception, the work in this thesis provides evidence demonstrating that the pain experience can be significantly molded by top-down factors, and is therefore far from being solely determined by the physical properties of the noxious stimulation. These observations might partially explain why the pain response in certain situations appears disproportionately large, or surprisingly small, in relation to the noxious stimulation, and support the utility of psychological methods in the management of pain symptoms.

Introduction: Stroke is associated with a high prevalence of dysphagia in the elderly population. Hence, dysphagia evaluation and management are key issues in stroke rehabilitation. The McGill Ingestive Skills Assessment (MISA) is a recently developed mealtime observational tool aimed at evaluating the functional aspects of the oral phase of ingestion. Objective: To determine the discriminative validity of the MISA by assessing known/extreme groups of elderly individuals presenting with stroke, who have been admitted to an acute-care-hospital or a rehabilitation center. Participants were allocated to one of two groups: 1) individuals with stroke and no dysphagia, who are on a regular diet and 2) individuals with stroke and dysphagia, who are permitted only purees. Methods: Participants were evaluated with the MISA and a comprehensive chart review was conducted. Analysis: Groups were compared on socio-demographic and clinical characteristics. Univariate tests were performed to test the significance of between-group differences. Conclusion and significance: The results of the study are satisfactory, and enhance the clinical usefulness of the tool for dysphagia management. These results also support future studies addressing the responsiveness of the MISA.