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Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Adviser: Benjamin C. Amick, III. Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0974. Includes bibliographical references.

Introduction: Neurological complications and stroke in association with cardiac surgery is a serious problem. The stroke event can occur during surgery (early stroke) or in the postoperative period with a symptom free interval (delayed stroke). Particle embolization due to aortic manipulation during surgery has been suspected as a mechanism for early stroke. The present thesis address mechanisms and survival effects of stroke both clinically (I-III) and experimentally (IV-V). Methods: Study I) Within a cohort of 2641 consecutive cases, a group of cardiac surgery patients with stroke and evaluated by computed tomography (CT) were studied (n=77). CT-findings were analyzed in relation to stroke symptoms. Study II) Data from 9122 patients undergoing coronary surgery were analyzed. Records of patients with any signs of neurological complications were reviewed to extract 149 subjects with stroke at extubation (early, 1.6%) versus 99 patients having a free interval (delayed, 1.1%). Early and delayed stroke were evaluated separately. Independent risk factors for stroke were analyzed by logistic regression and survival by Cox regression (9.3 years median follow-up). Study III) Patients with early (n=223) and delayed stroke (n=116) were identified among 10809 patients undergoing cardiac and aortic surgery, both groups exposed to cardiopulmonary bypass. Stroke patients were subdivided by the hemispheric location of lesions. Subgroups were compared and their associated pre- and peroperative variables and survival were analyzed. Study IV) Aortic cross-clamp manipulation was studied in a human cadaveric perfusion model. The pressurized aorta was repeatedly cross-clamped and washout samples were collected before and after clamp maneuvers. Particles in the washout samples were evaluated by microscopy and by digital image analysis. Study V) Pig aortas were pressurized and cannulated. Washout samples were collected before and after cannulation (n = 40). Particles were deposited onto a 10-μm filter to be evaluated by microscopy and digital image analysis. Results: Study I) In the group of patients exposed to routine cardiac surgery (i.e., clamping and cannulation) and with early stroke, right-hemispheric lesions were more frequent than of the contra-lateral side (P=0.005). Patients with aortic dissections had a strong dominance of bilateral findings, which was different from the unilateral pattern in the routine-surgery group (P<0.001). Study II) Early and delayed stroke did not share any risk factors. Both early and delayed stroke explained mortality in the early postoperative period (P<0.001, P<0.001 respectively) but also at long term follow-up (P=0.008, P<0.001 respectively). For patients surviving their first postoperative year, delayed but not early stroke influenced long-term mortality (P=0.001 and P=0.695, respectively). Study III) Stroke lesions in association to cardiac surgery were near exclusively ischemic. Early stroke had a preponderance for right-hemispheric lesions (P=0.009). In contrast, patients with early stroke that had undergone surgery of the aorta with circulatory arrest showed a pattern with more bilateral lesions compared to ‘cardiac-type’ operations (P<0.001). Patients with bilateral lesions had a dramatically impaired survival compared to those with unilateral lesions (P<0.001). Study IV) In the cadaveric perfusion model, cross-clamping produced a significant output of particles, which was seen for size intervals of 1 mm and smaller (P=0.002 to P=0.022). In all size intervals the particle output correlated with the degree of overall aortic calcification (P =0.002 to P=0.025). Study V) At cannulation of the pig aorta, more particles were noted after cannulation compared to before the maneuver (P<0.001). This increase included small (<0.1 mm, P<0.001) and intermediate-size particles (0.1-0.5 mm, P< 0.001). Particles above 0.5 mm were few and were not associated with cannulation. Conclusions: The influence of stroke on mortality was devastating, for both early and delayed stroke. These two stroke groups had obvious differences in both their risk factors and their hemispheric distribution. It is here emphasized that early and delayed stroke should be considered as two separate entities with suggested mechanistic differences. Ischemic lesions accounted for near all stroke events seen in association to cardiac surgery. For early stroke, these were mostly located within the right hemisphere. Results from the experimental studies underscore microembolic risks associated with aortic manipulation.

Tuberculosis (TBC) is an infectious disease with long history, that goes to the beginnings of humanity. Nowadays, TBC is mainly creating socioeconomic issues connected with overpopulation. In 21st century, TBC remains major concern for public health in terms of infectious diseases in European region. Even though the joint efforts of political, economical and health institution are being successful, there is still need for better health care coordination, diagnosis improvement, and help to the endangered groups of people in lower income countries. The aim of this thesis is to assess the epidemiological situation of TBC incidence in the Central Bohemia region in the years from 2008 to 2017 with a special focus on impact of health and socioeconomic risk factor for developing TBC. Research questions concern population structure characteristics of TBC patients, differences between sexes and factors that affect TBC death. Methods of contingence tables, χ2 -test of independence and logistic regression were applied to analyse of the effect of age, comorbidities, and risk behaviour on the development of TBC. It was found that there are differences in age structure of patients with TBC between men and women. The most affected by TBC are men in middle and older age, while women are affected in the oldest age...

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20241号 / 医博第4200号 / 新制||医||1020(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 川上 浩司, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20288号 / 社医博第77号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 一山 智, 教授 伊達 洋至 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DGAM

The prevalence of cancer in the world continues to grow, faster in economically developed countries. According to current scientific knowledge, at least one third of cases could be prevented by adopting a healthy lifestyle. The present thesis therefore sought to analyze the prevalence of cancer in connection with the lifestyle of the European population, of 63,772 respondents of the SHARE study (The Survey of Health, Aging and Retirement in Europe) in fact. The work contains the theoretical description of the problem and the analytical part. The differences in the prevalence of the diseases of the respondents from 16 European countries were monitored in the empirical part. The relation between the incidence of cancer and the groups of diseases defined by alcohol consumption, smoking, obesity and the lifestyle of the respondents was analyzed by the method of binary logistic regression. The survey was expanded by the summarizing indicator of Healthy Lifestyle Index, compiled from smoking, alcohol consumption, physical activity, body weight, and consumption of fruit and vegetables. The analysis, among other things, showed that with the decline in the healthy lifestyle index, the risk of malignancy in both men and women increased and is more pronounced in males. Keywords: cancer, prevalence, healthy...

En Europe, les prairies occupent 25% de la surface du territoire soit près de 40% de la surface agricole utile. De nombreux services écosystémiques dépendent de cet écosystème comme par exemple la production fourragère, un réservoir de diversité végétale et animale et une capacité de stockage de carbone dans les sols. Dans un contexte de changement climatique (augmentation de la température moyenne de l’air et de la concentration atmosphérique en CO2) et de déprise agricole (extensification des prairies de moyenne montagne), les recherches actuelles s’intéressent au maintien des services écosystémiques tels que la capacité de stockage de carbone dans le sol pour limiter l’augmentation de la concentration atmosphérique en CO2, la production fourragère et la conservation de la richesse spécifique. Cette thèse a pour objectif d’observer in situ les effets des principaux déterminants du changement climatique (température de l’air, précipitations, concentration atmosphérique enCO2) sur le fonctionnement du système racinaire et des déterminants du stockage de carbone sur une prairie permanente de moyenne montagne gérée de manière extensive. Cette étude porte sur l’influence d’un scénario de changement climatique prévu à l’horizon 2080 pour le centre de la France. Ce scénario (ACCACIA A2) prévoit une augmentation de la température de l’air de 3.5°C (T) et de la concentration atmosphérique en CO2 de 200 Nmol mol-1 (CO2) et une réduction des précipitations estivales de 20 % (D). La démographie (croissance, mortalité, durée de vie et risque de mortalité) de cohortes racinaires a été suivie durant 3 à 4 ans à l’aide du Minirhizotron. La croissance potentielle des racines dans un ingrowth core a été suivie pendant une année après 4 ans de changement climatique avec en même temps des mesures de décomposition de litière racinaire et de respiration du sol. Après 3 ans d’expérimentation, un effet positif du réchauffement (T) et du changement climatique (TDCO2) a été observé sur la production racinaire, ainsi qu’une baisse de la durée de vie sous réchauffement. Une stimulation de l’allongement des racines (ratio longueur/volume), sous climat réchauffé (T, TD, TDCO2), a certainement permis de favoriser l’absorption en eau et en nutriments. Cependant, après 5 ans d’application des traitements, le réchauffement (T) a diminué la production racinaire et accéléré la décomposition d’une litière standard. L’augmentation du CO2 a permis de compenser l’effet négatif du réchauffement sur la production racinaire. Le changement climatique (TDCO2) a accéléré les entrées mais aussi les sorties (décomposition et respiration accélérées) de carbone du sol. De part, l’effet négatif du réchauffement sur la production aérienne et souterraine sur le moyen terme et sur la demande en nutriment, les matières organiques se sont accumulées dans le sol, contrairement à l’augmentation du CO2 qui a diminué cette quantité. Dans un contexte de changement climatique, la production racinaire semble en partie maintenue ainsi que les stocks de matière organique dans les sols. Les processus souterrains (croissance, mortalité, décomposition) et la respiration du sol se sont accrus. A l’avenir, le bilan de CO2 et des différents gaz à effet de serre pourrait être négatif et accentuer le changement climatique. / In Europe, grasslands occupy 25% of the land area and nearly 40% of the agricultural area. Many ecosystem services depend on this ecosystem such as forage production, reservoir of plant and animal diversity and ability of carbone storage in soils. In a context of climate change and agricultural abandonment (extensification of grassland in upland), current research interest to estimate the storage capacity of carbon in the soil with the maintenance of ecosystem services. This thesis aims to observe in situ the effects of major determinants of climate change(air temperature, precipitation, atmospheric CO2 concentration) on the functioning of the root system and determinants of carbon storage on extensive permanent grasslands. This study examines the influence of projected climate change scenario by 2080 for the center of France. This scenario (Accacia A2) provides an increase in air temperature of 3.5°C (T) and atmospheric CO2 concentration of 200 Nmol mol-1 (CO2) and a reduction in summerprecipitation by 20% (D). A follow-up of root cohorts for 3 to 4 years with the Minirhizotron is performed to monitor the demography (growth, mortality, life span and risk of mortality). The potential growth in ingrowth core is followed over a year after 4 years of climate change along with measures of root litter decomposition and soil respiration. After 3 years of experiment, we observed a positive effect of air warming (T) and climate change (TDCO2) on root production and climate change and a decreasing of root life span under air warming. An increasing of root fineness under warmed conditions (T, TD,TDCO2) should facilitate nutrients and water uptake. After 5 years of experiment, air warming (T) decreases the root production, root life span and accelerates decomposition of root litter. The increase in CO2 offset the negative effect of air warming on production. Climate change (TDCO2) accelerates the inputs but also outputs (decomposition and respiration were accelerated) in soil carbon. With the negative effect of air warming on above and belowground production in the medium term and nutrient demand, organic matter accumulated in the soil, whereas the increase of atmospheric CO2 concentration has reduced this amount. In a context of climate change, root production and the stock of organic matter in soils seems to be partly retained. However, with the acceleration of belowground process (growth, mortality, decomposition), soil respiration was increased. The CO2 and the others greenhouse gas emissions balance could be negative and accentuate climate change in the future.

In this thesis we focus on modeling stochastic mortality and parameter risk in assessing mortality. We explore two mortality stochastic models for modeling the number of deaths in portfolio which consist of one or more than one cohort. We define the term mixture of distributions and introduce Beta-Binomial and Poisson-Gamma model. We address immediate life annuities and we apply Bayesian Poisson- Gamma model to quantify longevity risk on data. The obvious increasing trend of average lifetime leads insurance companies to greater protection against longevity risk. We show how to deal with solvency rules by internal models designed consistently with the requirement in the standard formula of Solvency II. Powered by TCPDF (www.tcpdf.org)

La capacité des particules HDL à exercer des effets anti-athérogènes passe notamment par leur capacité à assurer le transport inverse du cholestérol (RCT). L'objectif principal de mon programme de recherche est l'étude de l'étape initiale du transport inverse du cholestérol que représente l'efflux de cholestérol du macrophage, dans le contexte des maladies métaboliques et du risque cardiovasculaire et de mortalité. J'ai étudié la relation entre l'efflux, et les conséquences sur le développement de l'athérosclérose dans un contexte métabolique particulier ; le syndrome métabolique (SM). J'ai démontré que les critères individuels du SM sont intimement liés à l'efflux et que ces deux notions sont associées de façon indépendante aux paramètres cliniques de l'athérosclérose. J'ai aussi évalué la pertinence de l'efflux de cholestérol comme biomarqueur de la mortalité. Cette étude identifie l'efflux comme prédicteur de la mortalité toutes causes confondues, indépendamment des taux de HDL-cholestérol et des facteurs de risques cardiovasculaires traditionnels, dans une population de patients traités par angioplastie coronaire primaire, suite à un infarctus du myocarde avec élévation du segment ST. Enfin, je me suis intéressée à à une situation métabolique particulière ; l'état postprandial. Mes travaux montrent que la réponse postprandiale hypertriglycéridémique physiologique observée chez des individus sans désordre métabolique ne s'accompagne pas d'altération majeure de l'efficacité du RCT ou de l'inflammation systémique. Mes travaux confirment le rôle déterminant de l'efflux dans la prévention du développement de l'athérosclérose et de la mortalité cardiovasculaire. / The contribution of high-density lipoprotein to cardiovascular benefit is closely linked to its anti-atherogenic role in the cellular cholesterol efflux. The main purpose of my project was to evaluate the efficiency of the first step of reverse cholesterol transport (RCT), which is the efflux capacity, on metabolic disorder context, on cardiovascular risk and on mortality. My research has focused on three independent and complementary parts. I have first evaluated the relationship between efflux and its consequences on atherosclerosis development in a metabolic syndrome (MetS) population. I have shown that individual criteria of MetS are closely related synergistically to cholesterol efflux capacity. In addition, established metabolic syndrome and cholesterol efflux capacity were independently associated with clinical features of atherosclerosis. In a second study I identified cholesterol efflux capacity as a predictor of all-cause mortality in consecutive ST-segment elevation myocardial infarction patients treated by primary angioplasty, independent of HDL-C, traditional cardiovascular risks or cardiac risk factors. Finally I have evaluated the consequences of postprandial hypertriglyceridemia on the functionality of key steps of RCT and associated anti-inflammatory components. My work has shown that the physiological postprandial hypertriglyceridemia response is not accompanied by a major alteration in the efficiency of RCT or systemic inflammation, on individual without metabolic syndrome. In conclusion, I have confirmed the crucial role of the first step of reverse cholesterol transport in preventing the development of atherosclerosis and cardiovascular mortality.